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What good looks like: Example of cross-sector working in Pennine

In Lancashire and South Cumbria, Pennine Lancashire is often cited as an example of good practice in cross-sector working in the design and delivery of health and care services. It is a health and care improvement programme led by health, public sector and voluntary, community, faith and social enterprise sector (VCFSE) colleagues to improve the health and care system in Pennine Lancashire. Here we reflect on what we have learnt from our experiences of collaborating on this programme, in particular around the social prescribing agenda. We recognise that we haven’t got everything right yet, and much work is still to be done, but we hope that by sharing our experience it will contribute to wider discussions about what it means to develop meaningful cross-sector collaboration.

Over time, VCFSE and health sector colleagues in East Lancashire have developed a way of working that shows how being well positioned in the community and having good relationships enables a strong foundation. This has been highlighted in our social prescribing approach that supports people to make changes that improve their own health. The key enablers have been:

1. History of shared working

Our relationships have been solid for a long time and are well embedded. In order to be effective, local structures – e.g. Neighbourhood Teams – and programmes of work – e.g. The Better Care Fund and Community Safety Partnerships – required good partnership working. In such collaborations the voluntary sector feels like an equal partner and, while there is variation from region to region, overall, the sector feels they are sitting at the right tables. This has created a movement of cross-sector partnerships to support the health and social care agenda. We see the VCFSE sector as strong, thriving, flexible, open and passionate about local people and supporting them.

2. Motivation to form relationships

It comes down to our sheer determination not to be left behind. For us in the VCFSE sector, it has always been about the determination to deliver. ‘If we say we’ll do it, no matter the blood, sweat and tears, we’ll make sure it is done so that nobody can come back and say you didn’t do what you said you’d do’.

3. Strong local infrastructure

Structures like Primary Care Neighbourhoods (PCNs) and Integrated Neighbourhood Teams (INTs) have been key. They support integration and provide a space for the VCFSE to demonstrate what they can deliver, as well as reversing the challenge of primary care not knowing or understanding what the sector delivers. The PCNs and INTs were also key to making sure the voices of both large and small organisations were heard. There was a conscious decision to use the word ‘neighbourhoods’ as it conveys a ‘network plus’ approach, meaning it goes beyond just a network to involve communities and neighbourhoods in health and care conversations. Operationally, VCFSE partners are embedded in those structures, enabling the sector to have a strategic voice.

4. Having a common goal

We have tried to move toward being a whole system rather than individual organisations with separate goals. We also recognise that it is important to allow space for different roles within the common goal, and for each person to see how they fit together in the mosaic of things. For example, the VCFSE sector is better placed to engage with communities and understand their priorities, while the PCNs provide structures for better communication. However, everyone must also have sight of the bigger picture and understand how these different roles fit together.

5. Open and flexible commissioning

We have seen what happens when commissioning is open and flexible. Our ambition is to grow this approach, allowing the sector to do what it does best, without being heavy-handed and prescriptive. Two factors that have enabled this way of commissioning are:

  • Involving the VCFSE at a strategic level: Political leadership has supported decisions to involve the VCFSE sector in strategic decision-making.

  • Honest communication: Being transparent and sharing challenges; for example, the potential impact of cuts to public funding. 

6. Getting the relationship right with Primary Care Neighbourhoods (PCNs): 

While the above enablers have helped, when we started working with PCNs, VCFSE colleagues didn’t always feel their voice was represented. However, we were able to build on existing relationships with the Clinical Commissioning Group (CCG) and local authority, and the appointment of Social Prescribing Link Workers has enabled better links into services that can provide support. As the PCNs and partnership working has grown, Clinicians and PCN Clinical Directors are also visibly more involved than they were at the start, and this provides a focus to our relationships and a central contact point in a PCN (that avoids us trying to contact many busy GPs). These relationships feed into the Primary Care Neighbourhood structures, making the connections easier and communication more efficient.

Next steps

The picture is positive, but there is always room for improvement and more that still needs to be done to enable our partnerships to do more. Having made progress, we now need to ensure that the following areas of progress are maintained and strengthened:

  • Continuing to involve VCFSE colleagues at an earlier stage: We’d like to continue to see VCFSE colleagues brought in right at the beginning of the local programme or issue that we’re seeking to respond to, rather than partway through.

  • Increased understanding of breadth and quality of activities delivered by the VCFSE: There remains a risk that the VCFSE sector is seen only as delivering ‘lower level’ activities when there are many high-end services they deliver for vulnerable people and those with complex needs.

  • Increased representation for smaller organisations: With different models in place across the area and small organisations delivering high-end services for vulnerable communities, social prescribing is central to joining up health priorities with the voluntary sector. Social prescribing makes sure that smaller organisations are brought into discussions and there is equity at the table. It is important to ensure better resources are included for them in strategic level discussions. Having a good structure in place will help with engagement, making sure the voices of small organisations are heard.   

  • Continuing to make the best use of the VCFSE role at PCN meetings: It is important, more now than ever, to think about a way of partnership working that sees collaboration between the health and VCFSE sector within prevailing structures in the system is more involved. This way can demonstrate what the VCFSE sector can deliver so that those acting as sector representatives are supported more proactively, and can use these places and forums well to maximise the opportunity.

  • Maintaining a shared vision: With the PCNs taking a role in decision making around priorities, action planning and partnership development, it is important to have a shared vision of what success looks like in communities.

What good looks like

What good looks like 1.
What good looks like 2.



Bringing together VCFSEs and PCNs 

In Lancashire and South Cumbria, statutory and voluntary sector professionals have been working together to design, test and deliver improved health outcomes for local people. IVAR, as a Learning Partner, have supported the Lancashire and South Cumbria Integrated Care System to create and sustain meaningful connections in hyper-local, cross-sector partnerships within the Integrated Care System (ICS), as a part of the Test, Learn & Review initiative. Read more about the work and access resources, here. [add link – http://www.ivar.org.uk/vcfse-pcn-together-for-local-health/  when Live] 



Authors

This blog was authored by the following individuals in the Healthier Pennine Lancashire partnership. Please contact them for more information about their work.  

  • Vicky Shepherd, Chief Executive, Age UK Blackburn with Darwen – Vicky.Shepherd@ageukbwd.org.uk

  • Angela Allen, CEO, Spring North – angela.allen@springnorth.org.uk 

  • Elaine Barker, Chief Officer, Hyndburn & Ribble Valley Council for Voluntary Service – Elaine.Barker@hrv-cvs.org.uk

  • Christine Blythe, NASP north West lead coordinator, Burnley, Pendle and Rossendale Council for Voluntary Service (BPRCVS)

  • Andrea Dixon, Integration & Neighbourhood Lead, Blackburn with Darwen Borough Council – Andrea.Dixon@BLACKBURN.GOV.UK

  • Tim Birch, Community Support Unit Manager, Prevention, Neighbourhoods and Learning Service, Adult Services and Prevention Department, Blackburn with Darwen Borough Council

How we set up a social prescribing service during lockdown

As in many areas, the Social Prescribing Link Worker role is new in Lytham St Anne’s Primary Care Network. Two link workers were employed in March 2020, and in the midst of us learning the role, the country almost immediately went into lockdown due to the COVID-19 pandemic.

Working from home with restrictions on face-to-face meetings had an impact on the way we were able to reach patients, and the closure of local groups made it increasingly difficult to carry out the usual objectives of this kind of role.

Like many areas, Lytham St Anne’s saw an incredible response from local volunteers who were keen to help their neighbours, particularly the elderly, vulnerable and those advised to shield by the government.

We had access to the list of shielding patients and worked alongside primary care colleagues to contact each of these patients by telephone for a supportive chat, finding out what additional needs they may have during lockdown. For those that needed help with shopping, collecting medications or dog walking, we were able to signpost or refer to local mutual aid volunteer groups, as well as to NHS volunteers.

For patients who were found to be especially isolated or lonely, or struggling with their mental health, we provided regular check-up calls, in addition to signposting to telephone befriending services.

We found that patients were appreciative of the calls, even if they had no additional needs; they were grateful that they hadn’t been forgotten. Others chose to receive a weekly wellbeing call from us and reported that this helped them to get through the difficult months of lockdown.

Inevitably, a major challenge of this period has been the lack of active community groups and services to prescribe to patients. While some groups have gone online to hold virtual meetings, the large elderly population in Lytham St Anne’s faced barriers to accessing these groups. Age UK Lancashire provided tablets on loan to people who were without the relevant technology and there were volunteers available to teach people how to access apps such as Facetime or Zoom. Despite this, many patients proved to be reluctant to make the move online, and others do not have access to the internet at all. Furthermore, we found that many local groups did not create an online presence, and have simply been waiting to be allowed to meet again in person.

One prominent local group, Just Good Friends, usually provides regular meetings including dancing, quizzes, musical entertainment and exercise sessions. During lockdown, the group leaders kept in touch with their members via telephone and once guidelines lifted to allow people to meet outdoors in small groups, members began to meet in a local park in socially distanced “pods” of up to six. They have recently started some chair-based exercise sessions in the same pods. We have been able to refer new members to this group.

Although groups and services have been restricted during the pandemic, we have been able to build relationships with local group leaders, establishing a good network of contacts which will be invaluable as the community comes to terms with the “new normal”. We have also started seeing some patients for face-to-face appointments and hope to see more and more groups opening up following lockdown, depending on further restrictions that may arise. Drawing from our learning and the need to work more across sectors, we are looking at developing a local Social Prescribing Network in Lytham.

Sign up for our virtual Transforming Healthcare Together Conference to hear more stories about cross-sector partnership working during Covid. We’ll hear from some amazing speakers who will offer local, national and system perspectives.

How can small charities be heard?

We recently hosted a conversation for small charities with those who fund and support them, to explore their social change role over the next 12-18 months. This was partly to build on our recent publication of Small charities and social change, a study which describes the approaches of 11 small charities to advocacy; and partly because through our work in response to Covid-19, we’re hearing a lot about the need to strengthen the sector’s collective voice: ‘We have to have some real conversations. We’re lots of voices, collective voices, but we’re being drowned out with all the noise’.

The pandemic has presented many and varied challenges for small charities – and uncertainty is now part of the new normal. Alongside this, we have all been affected by the events that followed the killing of George Floyd – the protests, the debates, the anger, the pain, the calls to action. Profound questions are being asked about diversity, equality and inclusion – these need to be front of mind as we turn our attention to the process of recovery and renewal out of the crisis that we have been living through.

We were privileged to hear from four people with different experiences of social change: Raheel Mohammad, Director of Maslaha; Christopher Stacey, Co-Director of Unlock; Debbie Pippard, Director of Programmes at Barrow Cadbury Trust; and George Barrow, Civil Servant at The Ministry of Justice.

Seven things stood out from their reflections and the discussions that followed:

  1. ‘Covid-19 has pulled back the curtain and demonstrated the number of people that have been marginalised’ by previously unfair and closed decision-making processes. Small and medium charities undertaking social change work have to look at ways in which they can link up with other groups who are led by and/or represent individuals and groups whose voices and experiences are going unheard.

 

  1. ‘Majority white-led organisations do not have the specialist knowledge or expertise to understand how certain social issues affect communities of colour.’ Work to unpack and respond to the experiences of communities of colour must be led by or run in partnership with them so that it ‘registers emotion, vulnerability, heritage, culture and religion’. If this social change work is being carried out ‘through partnerships between black and brownled and white-led and organisations’, it is most effective when based around something tangible: ‘it’s in the action that you open up new parameters and new horizons’.

 

  1. Ensure that you are actively and demonstratively accountable to the individuals, groups and communities you are advocating on behalf of. We must avoid being the creators or perpetuators of ‘artificial examples of good practice’, only putting forward solutions for policy and practice that are based on the genuine experience and voice of those you represent Always ask yourself: ‘Do you know what good looks like?’ for a particular group or community.

 

  1. Collaboration is essential, particularly between large and small charities. Larger charities are often more likely to have a seat at the table and have their voices heard, and they have the time and capacity to engage in decision making processes. But small charities tend to have the proximity to lived experience and in-depth knowledge of how policy and practice plays out on the ground.

 

  1. We must continue to work both inside and outside of the system. For example, building relationships with local and national government, but also being willing to mobilise and challenge where necessary. Recognise that it’s about understanding what is the most appropriate and effective strategy for the change you are seeking to influence at a given point in time.

 

  1. When attempting to influence central government policy or legislation, there are three things it is useful to keep in mind. First, develop personal relationships with key civil servants, or work in partnership with an organisation who can build or has these relationships. Second, work together in loose networks: ‘If you’re all on the same page we do get the message’. Third, understand that government moves slowly, so being able to commit and be in it for the long term is important. Small charities also have a very important role to play in being able to bring the ‘corporate memory’ on certain social policy issues and previously tried and tested solutions.

 

  1. More funders need to commit to funding social change work and understand what it takes to fund this kind of work. Be willing to fund over an extended period of time, stick with social change processes for the long term, and allow those doing social change work the freedom and opportunism to act in a responsive and adaptive way. More work may need to be done with trustees of trusts and foundations to help them to understand the importance of investing in social change work alongside service delivery.

 

You can read more about how and why small charities are challenging, shaping and changing policy, practice and attitudes here.

Thinking about merger in 2020

This blog is complemented by the perspectives of four practitioners who have led merger processes.

IVAR has learned much over the last two decades about what makes a merger successful. How much of this can applied in the current circumstances?

23 years ago, as chair of an alliance of regional HIV charities, I asked colleagues a simple question about our futures: “If we were to design a voluntary sector response to the challenge of HIV and AIDS from scratch, how would we organise ourselves?” The answer was a single, national organisation. A vehicle with the potential to achieve two essential public benefits: enhanced equity and quality of services; and a louder and more powerful voice with policy-makers and funders. 18 months later, four of our organisations merged into Terrence Higgins Trust, followed a year later by London Lighthouse and, over time, others.

This approach was rooted in a belief that organisations are a means to an end, and that there might be a better way of meeting charitable objects.  We know that mergers entered into out of strategic choice seem most likely to yield benefits to beneficiaries (e.g. more and better services) and organisations (e.g. greater influence). However, even this ideal kind of merger requires time, money and an element of risk-taking: after all, mergers are an inexact science. For all the due diligence in the world, they always require a leap of faith.

Through the work that we have been carrying out over the course of the last few months, tracking and supporting the response of smaller VCSE organisations to the Covid-19 crisis, we have observed their extraordinary resilience, creativity and integrity. This is a precious resource and needs to be understood, valued and nurtured. At the same time, we recognise that, for a myriad of reasons, the possibility of merger is beginning to loom large for many of these organisations. Leaders are feeling frustrated, worried, and unsure about how to shift gear out of crisis and into recovery. Faced with daunting challenges – funding cliff edges and sky-high demand for services – some are beginning to look at merger as a way of continuing to deliver for their beneficiaries.  The challenge is that the conditions and resources for careful, constructive mergers are less likely to be in place at the moment: organisations are feeling anxious, and the space for thinking creatively about the future is squeezed.

So, when thoughts turn to merger, how can leaders respond in ways that feel authentic and useful?

If we strip the insights and guidance of Thinking about Merger  down to their bare bones, five things stand out:

 

  1. After the 2008 financial crisis, we found that organisations were more likely to survive and, over time, thrive if they were open to asking themselves fundamental questions such as: Who are we? What are we trying to achieve? What is the best vehicle to make that happen? At a moment of crisis, there may also be an opportunity to focus minds and bring the possibility of merger into discussions about the future. 
  2. For organisations with their backs against the wall, the proposition may be: the preservation of something versus the gradual disappearance of everything. But even if you enter merger explorations on the back foot – preoccupied, say, by survival rather than growth – it’s still important to identify and then pursue a positive agenda about change. Keeping a service going might not feel like the most compelling vision, but that may be the vision that is possible right now.
  3. However bleak your prospects, merger may not be the answer. In addition to a shared vision, you need a feel for the fit with your potential partner(s). Do you have enough in common, enough shared values, to trust in the potential of a merger to work? There is no shame in concluding not. We have written before about the importance of having an ‘awareness of mortality’. For organisations whose aims are no longer appropriate, or for whom sources of public funding on which they were overwhelmingly dependent no longer exist, or who have not been able to make a transition to a new environment or find a sustainable alternative business model, it may be more responsible to close down rather than compete with others or struggle on, hand to mouth. Or there may be steps short of merger that can at least preserve some of what has been achieved – such as hiving off a non-loss-making service, or simply much closer collaboration.
  4. Under normal circumstances, we would encourage possible merger partners to think about possible deal breakers upstream. These might include questions of identity (including name and brand), location, service model, and staffing. Without the luxury of time, or resources to support a staged process, it will still be important to articulate and be mindful of what each partner is not prepared to give up or take on. Without, at best, addressing these ‘red lines’ or, at worst, putting in place plans to do so, the risk of failure will increase.
  5. Finally, there is one key deal breaker which will need to be resolved as early as possible in the process: leadership. Here, as with all design considerations in a merger, form needs to follow function. In other words, what kind of leadership will the new, merged entity require to give it the best chance of succeeding?

IVAR and Bates Wells are working on a new edition of Thinking about Merger to support charities navigating the particular challenges presented by Covid-19. Sign up to our newsletter and be the first to know when this is released.

The key features and stages of merger are outlined in Thinking about Merger, and described in more detail in the Locality and TACT case studies.

Merger: Practitioner perspectives

This blog shares four perspectives of practitioners who have led merger processes. We asked them to share their reflections for other leaders contemplating merger in the current context.

Laurie Rackind is CEO of JAMI (Jewish Association for Mental Illness), which merged with Jewish Care in 2012:

Isolation and distancing may be great weapons in the fight against Covid-19, but they are far from ideal concepts for those already experiencing significant mental health problems. Organisational isolation and distancing are just as unhelpful when responding to the pandemic, and the current challenges are causing many charities to contemplate closer collaboration or merger.

Where the drivers behind mergers are the needs of charities’ beneficiaries, such collaboration should be applauded. For many, though, the drivers will be institutional or professional survival: this is understandable, but may not be enough to see organisations through an inevitably challenging process. Whatever the context, improvements for beneficiaries should always come first. 

Jewish Care and Jami came together seven years ago with a very simple vision – a single mental health service for the Jewish Community. Our challenge was to make one plus one equal more than two. In terms of income, one plus one now equals four. But most importantly, in terms of output, one plus one now equals nearly seven.

During the pandemic, Jami has been able to adapt and respond to the needs of the community with agility, creativity, innovation and speed. It is highly unlikely that, as two separate organisations, we could have coordinated our efforts to the same outcome.  This is thanks to a collaboration which was initiated not by a crisis, but a simple vision of more effective services.

Society is full of vulnerable people who have been isolated for many years. Arguably, this is also true for many of our charities. As lockdown is eased, let’s hope that, as a society, we can all thrive by rising from isolation together.

 

Ben Hughes was CEO of bassac which, in 2011, merged with Development Trusts Association to form Locality:

I remember being asked by a civil servant, once news of our ‘merger exploration’ was out, which model we were using. At the time I blagged it given they were a significant funder, seemingly wanting surety that all was OK. In truth, of course, I had no model up my sleeve. I had little idea – beyond a sense of creating something more resilient to the onslaught of looming austerity – of exactly where this process might take us.

But, of course, mergers aren’t about deciding on a tidy plan. People aren’t machines, and merger advisers aren’t cartographers. It’s a fluid process and one I found took time to get used to; step by step process working is different! I had to trust, a lot. But the collegiate support I got from our tight knit group of chairs and CEOs gave me invaluable confidence to navigate every step of the journey. Helped by a clear and strong process, I felt contained and able to raise difficult issues.

For me, though, there was another, important element. I was clear from the outset that I didn’t want to be CEO of the new organisation. With 11 hugely rewarding years behind me, this was my time for change. This stripped out personal competition and tensions between creating what I’d want to lead, and what was right for the organisation.

Was there any loss? Bassac had a special quality. Our quirky settlement members, impossible to pigeonhole; the slightly maverick network of characterful individuals, achieving remarkable things in their way. So yes, there was loss – of that movement; and for me too, in sidestepping the excitement of the new creation and in letting go of the role I’d inhabited for all those years that had given me so much. But like parenting, doing what you know is the right thing, and seeing the flourishing consequences, brings its own, unique rewards.   

 

Leah Swain is CEO of Community First Yorkshire, which was formed out of a merger in 2017 between North Yorkshire & York Forum and Rural Action Yorkshire:

Covid-19 has created all kinds of local heroes – NHS staff, social care teams, and key workers keeping going utilities, logistics, retail. Let’s add to the list small, local charity Chief Executives who are on the frontline of community support for so many vulnerable and isolated individuals and their families. I’ve watched them demonstrate their own special super powers – the power to give laser-like focus to changing overnight to find, reach and support hundreds of people needing food or company. The ability to transform new volunteers into efficient delivery teams in days. But they also seem to have the most frustrating power of invisibility. Invisible to national bodies who parachute in assuming there is no local support, invisible to the MPs calling for local volunteer infrastructure, invisible to Government departments with limited understanding of the incredible small charity ecosystem that exists.

Even as these small charity leaders continue their hard work totally focused on their beneficiaries’ wellbeing, we know many are starting to question how long their reserves will last when their previous income plans are unlikely to recover. And that’s where that frustrating power of invisibility might have a use after all.

The funding environment is going to get tougher. Many charity leaders will have to actively consider mergers if they are to ensure the valuable services they provide in so many communities will continue after their own funding runs out. Contemplating a merger is hard – you feel you are losing the organisation you have poured every part of your soul into. Boards are loathe to mention the M word to the Chief Executives they value and respect – knowing a merger may mean there is no longer a role for them. It’s tricky.

When my Board started to explore merger they found it much easier to know that both existing Chief Executives did not expect a job in the new organisation. We both provided guidance and support in the background, but made sure we gave our Boards clear permission to put us, and our current way of doing things, to one side. The success of mergers depends on a clear vision for the charities’ beneficiaries, looking beyond current staff and structures. Mergers can open new possibilities – different, but potentially as powerful at supporting local communities.

Many small charity leaders will need to put on their cloak of invisibility and give Trustees freedom to contemplate merger – to move on without them in the picture.

 

Joanna Holmes is Co-Director of Wellspring Settlement which was formed out of a merger in February 2020 between Barton Hill Settlement and Wellspring Healthy Living Centre:

Merger on 1st February 2020 and Covid-19 in March is quite an ask of any organisation. However, we are more than surviving, we are doing some quite extraordinary things. This last two months have shown up very distinctly the underlying issues we knew we had to deal with and the differences in organisational culture. We had thought we might have a year to sensibly integrate all staff and systems as a new organisation, but following the extraordinary Covid19 period – in which we have restructured to provide a community hub with all other services switched to operating from home and phone – we now have to sort them out much more quickly.

The main learning for me is that having one common underlying driver, which is deeply held, gets you through what could be deal breakers or show stoppers. In our merger, this was a strongly held belief that two similar size organisations in one area serving the same community can do this better for the community by being one organisation. In difficult situations everyone can return to this and regroup to move forwards again.

The second thing is that mergers are never easy for lots of reasons. I have had to face the worst things about myself and the organisation, as well as the best. This isn’t too pleasant, but is useful in the vein of: “if it doesn’t kill you, it will be the making of you”.

Thirdly, we took a long time to work through the feasibility stage and, with hindsight, if we had done this more quickly we would have been further ahead with integration now. We also found that the costs of merger are much higher than is recognised, but this is widely known.

I think all organisations should consider merger as an option. And while it isn’t simple or easy, neither are the issues we are trying to tackle in our communities or with the people we are here to benefit. Extraordinary times demonstrate the need for extraordinary responses. Merger could be part of this. It’s not always easy, but  if it’s the right thing to do, it’s the right thing to do.

 

This blog is complemented by a practical piece on Thinking about merger in 2020 from IVAR Director, Ben Cairns.

 

From disused bus stop to community hub

Stainsacre is a Yorkshire village 2 miles from Whitby where transport via bus has stopped due to cutbacks. This has had a big impact on the people living there causing some to relocate. As a Totally Socially Development Worker and Stainsacre resident, I wanted to get the community talking about solutions to the transport issue, but where could we meet when there was no obvious place? If I tell you that we first met at a bus stop, surely you would be intrigued to know how this came about and where we are now.

Why a bus stop?

I was walking my dog and walked past a disused stone-built bus shelter. It occurred to me what a great little space it was and made me wonder if people would meet me there to discuss our local transport issues. I asked my mum (and fellow Stainsacre villager) to come along for moral support to help me start a meet-up. We started by cleaning out the bus shelter to make it a place that one wouldn’t mind passing an hour or too. We added cushions, chairs, stools, fairy lights and a trolley full of tea, coffee, cake and biscuits. Then we made a basic leaflet and spent three hours walking around the village talking to people about our intentions and posting the leaflet through doors.

At the first meet-up, 20 people arrived. In fact, they came early and left late! People discussed how the lack of transport had effected them and people they knew – some of who were now stuck in the village or facing a long walk (often pushing a wheel chair) down unsuitable paths or roads. It was a really happy event and we decided to do it all again and meet once a month.


Unexpected results

In terms of progress in dealing with the transport issues, many solutions have come out the meet-ups – not just the one! For example, small pockets of people have begun to share taxis, a conversation with the local community transport organisation was held and an offer made, and some neighbours help each other out by giving lifts to town or doctor’s appointments.

Our monthly meet-ups have become more than a way to solve local transport issues now. Parish Councillors have made a good connection with the group and are now a huge part of running it. It’s used as a way to feedback from council meetings to people who were unable to attend and to ensure that people are able to have their say and their views are taken back to the parish council meeting. Organisations focussing on health and security, such as the Fire Service, have also shown an interest in attending. It is seen as a great way to access the views of a group of local people and get knowledge to them.

The community has become generally more connected – people now know each other and, in some cases, by their actual name not just “the egg lady”! At the meet-ups, those attending talk about many things such as the history of the village and their past. They swap vegetables and books. Some of the elderly people have begun to mix with people they didn’t before and it’s become a gathering to look forward to. As people began to know one another, they decided to host in their own homes (not just the bus shelter) and assisted those who might struggle to do this. In one instance, a meeting host struggled to walk, so his neighbours made the tea and helped him to set up. What is great is that people from nearby villages have also started attending, often with a view to setting up something themselves or to feedback to the group because of their own community connections.

As a result of the unexpected popularity and success of the group – now known as the ‘Stainsacre Social’ – the reason for meeting up has widened to not just be about finding a permanent solution to transport, it now aims to connect people in order to form their own solutions to wider local issues. Looking forward, the group would like to formalise and work on other things like running a village hosted event. Who knows where the Stainsacre Social will go next!

Taking a risk and not having an initial ‘outcome’ has been liberating. It is very much the Totally Socially way! People create their own aims and form their own solutions based on the knowledge and skills they already have. They have their own strengths and ideas and they should be allowed to try these out and, if necessary, fail and learn for next time. Being part of the Stainsacre Social has been great on so many levels. As a resident I now know many more people, some well enough to offer a lift to the local shops. On a professional level, it’s great to see that people only need the seed of something new in order to mould it into something far better themselves.

The Totally Socially project is funded by The National Lottery Community Fund and run by Coast and Vale Community Action. For more details, please check out Totally Socially on Facebook or www.cavca.org.uk.

Closing well: Ending the work of a ‘spend-out’ trust

From the outset, the Trust was designed as a spend-out organisation. From day one, we have been planning for closure. Working as a time-limited organisation creates opportunities, but can also present challenges. Closing an organisation, and ending partnerships with grantees, can be complex and time-consuming. Honest, open dialogue combined with a clear plan and willingness to be flexible can help ensure that grant partners, and the programmes they deliver, are left in a strong position.

Sustainability has always been at the core of the Trust’s programmes, ensuring that the work we deliver with our partners will continue long after we close – as a lasting legacy in honour of The Queen. As such, our approach has focused on integrating our programmes into government policies and supporting work that will be able to continue into the future. We worked with established partners to deliver a number of programmes. Concluding these partnerships, efficiently and effectively, was one of our priorities as we approached closure.

We found it important to state, clearly and unequivocally, that we intended to spend all of our funds and close. We wanted to avoid any level of uncertainty of behalf of our partners. It was most helpful to talk through all the details of our closure plans with partners from an early stage. The more fully partners were able to understand the logistical and legal intricacies of closure the more they were able to prepare. Each step was discussed several months in advance to allow each partners’ financial and legal teams to feed into the process. Although we had a standard process, each relationship was unique and required a bespoke approach.

We chose to close all the Trust’s programmes six months before the Trust’s public closure. This provided us sufficient time to address any challenges and complete the grant closure process. Our experience has shown that we needed the full six months in order to complete closure responsibly. The Trust had a comparatively small portfolio of 28 grants, although several of these involved a significant number of organisations working in consortia in multiple countries.

We maintained frequent contact with all our grant partners throughout the grant period to track spending and ensure that all funds would be responsibly spent by the time the Trust had closed. In the months running up to the planned closure date we needed to be flexible to allow partners to reallocate small amounts of funding. This ensured that all funds could be spent effectively on programme priorities within the Trust’s lifetime.

Our lawyers helped us to put together grant closure letters that summarised various legal, reporting, communications and data issues into one document. We then shared a draft with each grant partner to allow time for their own legal teams to suggest and edits. This process helped both sides to understand their rights and responsibilities. It also highlighted any outstanding issues, such as ownership of intellectual property, which were still to be resolved.

The overall process of closing all of our grants was intended to be comprehensive but straightforward to implement. Final reports from partners would be reviewed at the Trust, followed by a meeting or call to discuss the overall impact and if any issues remained. Once all parties were satisfied that the programme had been completed a letter would be signed by both parties, whereupon the grants would be considered officially closed.

Operating as a spend-out organisation has provided us with a clear focus on what we wanted to achieve. This approach has guided our strategic and operational decisions throughout our lifetime. We have remained focused on our mission and we have been forced to make sometimes difficult decisions about how we can create the greatest impact with the time and resources available to us. Having sufficient time and resource dedicated to closing our programmes, and concluding our relationships with our partners, has enabled us to leave the stage confident in the legacy of work and hopeful for the future of the Commonwealth.

5 things that help system leaders ‘have difficult conversations’

In order to change the culture within a health and care system, health, voluntary, community and social enterprise sectors (VCSE) leaders need to be open-minded, build on the diversity of people around them and have conversations that are engaging and curious, rather than sparking debate. However, the very nature of developing creative partnerships aiming to disrupt the status quo means that from time-to-time it is likely you will need to have a difficult conversation with someone. So, it is no surprise that delegates at our BHP leadership workshops – attended by health and VCSE sector leaders working to re-shape their local health and care systems – regularly raise the question ‘how do I handle tricky conversations?’  

Here are the five things we suggest will help:

 

  1. Ask the right questions (appreciative inquiry): Leaders must aim to have instrumental conversations and employ the practice of asking constructive and open-ended questions that help to identify a positive core among the group. You can then use the responses as a basis for building meaningful strategies for change. 
  2. Start a dialogue, not a debate: A debate assumes there is only one right answer (the one you have), tries to prove others wrong, defends assumptions as truth and seeks closure around personal views; whereas a dialogue assumes that many people are a part of the answer and fosters an environment of collaboration with others to find common understanding. Through meaningful dialogue, a system leader can listen to understand and seek agreement; and discover multiple options from others in the system. 
  3. Manage polarities in partnership working: System leaders operate in complex environments, and most challenges they face are not problems, but rather dilemmas or polarities. Problems have an end-point, are solvable and use either-or thinking, whereas polarities are ongoing, unsolvable, have interdependent solutions that must be managed together. They require ‘both and’ thinking. So, the next time you are faced with a polarity, ask ‘how do we ensure we access the best of both while avoiding as much of the negative as possible?’ 
  4. Avoid unconscious bias: Be aware of generalisations and understand that we don’t see things as they are, rather we see them as we have been conditioned to see them. We as leaders must openly and continuously challenge our decision-making in our respective systems and organisations, to work towards better and more inclusive conversations. 
  5. Make time to reflect: Making time to be self-reflective, before and after difficult conversations, helps in the long-term.

“I learnt the need to be more self-aware.”

“I will use open ended questions regularly and find time to reflect and practice reflexivity”

 

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Building Health Partnerships

Visit www.ivar.org.uk/transforming-together to access free support including:

 

  • Online resource library
  • Workshops and webinars
  • Coaching delivered by The King’s Fund
  • Practice Development Network
  • Practical and individual support

 

We are currently working with four areas for 2019/20. Please get in touch if you are based in one of the following: Bedfordshire, Luton and Milton Keynes; Surrey Heartlands – Guildford and Waverly; Dorset; and North Cumbria.

 

The leadership workshops referred to in this blog were delivered as part of the Building Health Partnerships (BHP) programme by Mark Doughty, The King’s Fund and Helen Garforth, Institute for Voluntary Action Research. They are attended by leaders from health, voluntary, community and social enterprise sectors, help to develop the skills, behaviours, attitudes and resilience that help in being a ‘change agent’.

Drowning in jargon? Squeaky ducks may be the answer

Given all the attention we are paying to co-design and co-production these days – some of the language we are using around health and care is not helping. In short, it has become a barrier to getting things done. People are put off and alienated, even avoiding opportunities to attend meetings and events for fear of not knowing what’s being talked about (or of not having the time to translate!).

What’s the problem?

Now more than ever we are faced with a blizzard of acronyms, whizzing past us at pace with often little or no opportunity to question (or at least feel safe to) or better understand what is actually being said.

 

Through the national Building Health Partnerships: Self-care programme, cross-sector partners are working hard to address the problem – and are being guided by community leaders and lived experience patient representatives who are helping us all get better at the way we communicate and get things done.
One of the more fun ways we are keeping people on their toes with language, for participants and presenters and facilitators, is to have a few squeaky ducks on each table – for squeaking when abbreviations or language needs to be explained a bit more.

IMG_0186

 

One thing I have noticed is that the number of ducks is diminishing but the use of language is improving!

Getting it wrong, then right

In a recent invitation co-produced for a partnership session in the South West, one community leader fed back that the wording was too statutory, academic and high-level and that it may not attract the smaller, very grounded voluntary and community groups we are so keen to involve and give a voice to.
For example; let’s take the term Sustainability & Transformation Partnership – what is that? If not known then groups may be excluded.

 

‘Who cares what ‘programme’ this initiative is part of, isn’t it the outcomes, differences or impact that the idea or development wishes to achieve that is the hook to get a range of players (and different players) to engage?’

Some more examples from the North East

Some concerns were raised about what we call things and what we are really trying to do here:

 

‘The terminology ‘self-care’ could be a barrier in itself’

 

‘The language of social prescribing pushes activities into medical language’

A new language altogether?

It’s funny to recall, in a recent session at the Pioneering Care Centre in Durham, after showing The Parable of the Blobs & Squares video – the language in the room changed quite a bit and we had GPs talking about the need to be more ‘blobby’ and voluntary organisations recognising their ‘square-ish’ tendencies – but somehow this language worked better. Perhaps it helped us find more common ground. At the end of the day, that is the whole point isn’t it?

Three public sector leaders on why they work with the voluntary sector

Three public sector leaders taking part in our Building Health Partnerships: Self-care programme share why they work with voluntary and community organisations. 

 

 

Professor Mark Pietroni
Director of Public Health, South Gloucestershire

 

‘Working with the voluntary and community sector is a great way to deliver local solutions in the areas in which people live in the ways that they want.

More importantly perhaps, it is a great way to hear from local people and understand what the issues are and what a local solution looks like and how the capabilities of the local population can be supported to deliver local solutions. Doing this well requires a commitment to listening and change on both sides but the potential to do good things for our communities is great.’

 

 

 

Susan Harris
Director of Strategy and Partnerships (Worcestershire Health and Care Trust) and Sustainability and Transformation Plan (STP) Communications and Engagement Lead

 

‘As a community and mental health provider, Worcestershire Health and Care NHS Trust has always worked in partnership with the voluntary sector to improve outcomes for local people.

We engage with our voluntary sector partners on a regular basis and in a variety of ways, both informal and formal. For example, we are a member of the Carers Partnership which brings together all local health and care partners to work together to advance the support offered to carers and a member of staff from our local Carers organisation is involved in our Equality Advisory Group which offers advice on the impact of proposed service changes on various groups so that additional engagement work can be undertaken if necessary.
We have a contract with another local voluntary sector partner to provide the local Well-being Hub which is integrated into the clinical triage function for secondary care mental health services and they also broker a range of local community groups to deliver a menu of services for the Well-being Hub to signpost into. When we undertake service re-designs, the local voluntary sector is key to the co-production process and always feed in their thoughts, ideas and concerns. They also help extend our engagement reach by communicating proposed changes to people on their database, and inviting them to offer their views and thoughts. As a Trust, we have learnt and benefited from these initiatives and we believe it is important to recognise all the value that the sector can bring. For example, in operational services, having volunteers at our Stroke unit as well-being strategic partners offering a broader view, often advocating on behalf of patient groups and communities. As part of our Sustainability and Transformation Plan we see these opportunities increasing and the benefits of cross sector working being better understood and core to the future delivery model of health and social care across our local area.’

 

 

 

 

 

Tom Hall
Director of Public Health for South Tyneside

 

‘The challenge for a modern health and care system is to be greater than the sum of its parts.

In South Tyneside we have recognised that to achieve the best we can for our population we can only do this by working together and making best use of the South Tyneside Pound. The South Tyneside Pound is the collective finite resources we have as a system and we have to use it wisely. It recognises that there is no new money and indeed that resources are reducing, and that there is no benefit from grappling within South Tyneside over that resource, bouncing it around for no real gain. The concept of the South Tyneside Pound is important to us and our local Alliance (a model we have pinched with pride from Canterbury New Zealand). We have a mantra that says “what is best for the person is best for the system”. We have recognised that this can only be achieved through strong system leadership and we have an Alliance Leadership Team which consists of the third sector, clinical commissioners, care commissioners, care providers, health providers (including acute, community, mental health and primary care). Our leadership team is focused on four areas: role modelling the behaviours we want to see in the system, coaching the system in these behaviours, challenging ourselves and the system to act in line with those behaviours, and learning from our successes and challenges.’