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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

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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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’.