Good health and care systems are shaped by the people who work in them, use them, and support them. Integrated Care Systems present a real opportunity to lay down the gauntlet to divest power to local people and communities so they are truly empowered to address their own priorities, using all the assets they have at their disposal.
Integrated Care Boards around England will be asked to approve ‘Working with people and communities strategies’ as Integrated Care Systems become legal entities in July. If all ICS partners are tasked to pull together to achieve this, local residents will have the means to hold local leaders to account and challenge if this is not happening.
Coproducing these strategies is the ideal opportunity to pause and think hard with local people, community organisations, staff and statutory partners about how to bring about this change. At Traverse, we’ve been working with ICSs as a critical friend, asking challenging questions to support meaningful and game changing engagement.
Two key success factors
We know what we are asking isn’t easy, otherwise every health and social care system around the country would be working hand in hand with people and communities by now. But with effort and true commitment, the results and rewards will be worth it - we can already see it in areas where they have been on this journey for longer.
We’ve identified two key success factors for this process.
1. Building trusted relationships
Building strong, trusted relationships takes time and work, and the process can be messy. The range of people, communities and statutory, community, voluntary and faith organisations involved in supporting people’s health and care is enormous.
Each system partners’ priorities, structures, cultures, language they use, level of resourcing etc will be equally as varied, as will the different levels of power they hold, especially if an organisation is reliant on another for funding.
Rarely are these differences acknowledged ‘out loud’ as we often don’t want to draw attention to them, but they will be playing out in the dynamics between people, communities and organisations.
Taking time to understand everyone’s perspectives is key to building trusted relationships. It also makes good practical sense to build relationships and better coordinate work for system partners as people and community engagement is usually under-resourced.
For local residents, especially those who experience health inequalities, it should mean that their involvement and insight is gathered less frequently and is used more effectively to improve services that meet their needs. Retelling stories of poor health outcomes and/or experiences can be retraumatising and exhausting and may do little for those individuals.
We are not saying every part of the health and social care system should cosy up to each other but trying to understand each other’s perspectives will create safe spaces where challenges can be raised when the going gets tough.
2. Co-creating a clear, well-defined vision for working with people and communities
It sounds obvious, right? Well, our observation is that there is often a rush into delivery without spending sufficient time co-creating with people and communities a clear vision of the impact being sought. This vision can be both at a system or local level.
For the work we have been doing with systems, we have helped them co-develop their vision to inform their strategies for working with people and communities.
Identifying opportunities to build on existing good practice, where to focus improvements, test assumptions and tensions, and define the resources that will be needed to deliver these ambitions – all in conversation with local people, communities and partners.
Having a vision in place has also helped us to co-create system-wide evaluation frameworks to enable them to regularly review progress against what they set out to achieve around working with people and communities.
Here are some starter questions to answer with people and communities in co-creating a vision together:
- What is the ultimate outcome we are aiming for? What would good working with people and communities deliver?
- What we are seeking to achieve (in 1, 3, 5 years)?
- How well are we working with people and communities now? Who else do we need to involve?
- What difference is it making to people’s health outcomes? How are we going to address local inequalities?
- What are the challenges and tensions we are going to need to resolve?
- What assets do we have to do this in a meaningful way?
- How will we know when we have got there? What do people and communities want to see measured? Remembering what gets measured, gets done so it is important that clarifying this is a collaborative action.
What are the challenges you are currently facing? Are these issues you would like support with, if so please do contact me for a conversation at firstname.lastname@example.org.