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6 reflections on collaboration during Covid-19

Since April, over 70 leaders from healthcare, VCSE and local authorities have joined IVAR and SEUK-run peer support groups, sharing experiences and thoughts on cross-sector partnership working in healthcare settings during the pandemic. Last week, we hosted the fourth meeting in this series. Here we discuss the current challenges and pressures highlighted by those attending.

1. Identifying priorities for the next six months

The participants listed a focus on recovery as top of the list. Many said that the response to the pandemic has improved relationships across sectors and meant that planning is now a more collaborative process than it was before.

We’ve worked more in partnership with our counterparts than before.’


‘These last three months have been about relationships and communications and we’d like to keep it this way and focus on making this our new normal for the next 6 to 12 months.’

A social prescribing professional was concerned that their services might be used in the wrong way, or be seen as a solution to a different problem if they weren’t very clear ‘who they are for but also trying to increase the referrals and to make it possible for community groups to refer to social prescribing’.


2. Addressing health inequalities and the digital challenge

The switch to digital and virtual healthcare support has made stark the impact for those without access to digital access. One participant spoke about how they have been contacting local community networks and the voluntary sector to reach those left behind by the digital divide. This has led to good relationships being built: ‘It is important to join up with these networks and have conversations and partnerships with them, when you are trying to respond to a crisis like Covid-19’.

 

Secondly with the amount of support being provided in this way, many organisations and services had introduced new, more frequent ways of engaging with users. Whilst this has been welcomed by users, it has become overwhelming and exhausting for providers. Organisations are assessing how to continue to work this way and how to balance this with face-to-face support.  

 

3. Supporting not squashing local community action

Many were keen to support the new micro/hyper local groups and mutual aid systems that have emerged as a huge source of community strength and cohesion over the last few months. At the same time, they are aware of the potentially negative impact on drive and reach that can be caused by over control of local voluntary service councils or ‘professionalisation’.

 

Wirral CVS was able to share some excellent examples of the approach they had taken to supporting local mutual aid groups. Including connecting with groups, but standing back and only offering advice and support when needed. 

 

4. Finding time and space to assess impact

 

Working at pace and re-designing services at speed to support users has meant evaluation and assessing impact hasn’t been at the forefront of many people’s minds. Many commissioners and funders had responded to the emergency by reducing reporting requirements for funded services and organisations. One participant explained they are not thinking about impact yet, being still in the response phase, but are starting to look at recovery and realise that it’s going to be tough.

We are having to fight fires while watching our house burning down.’

At the moment it seems like local charities are just making an impact with the hope that they can assess it at a later stage. However, there is increasing demand from NHS England and NHS Improvement and others to understand what has worked and what systems and new ways of working would be helpful to adopt and retained in a recovery phase.

5. Recording impact with qualitative data and stories

A social prescriber described how she had been encouraging her colleagues to write up the case studies and stories of people they have been supporting during Covid-19 as a way of keeping the individuals at the centre of thinking, both for them and their commissioners. This approach struck a chord with the webinar group, along with the impact of simply documenting what has, and is, taking place. What is ‘normal’ is changing on a daily basis. It was noted how important it is to document this, to capture the new ways of working and support arguments for not slipping back into previous less successful approaches, systems and relationships. Furthermore, some commissioner’s mindsets are changing and becoming more open to hearing individual case studies and patient’s experiences.

 

‘Our commissioners have actually said that they want to hear more case studies than statistics! So, our quarterly reports now have a reasonable amount of case studies and I think commissioners are seeing this as the way forward.’

 

One CCG has a slot for ‘patient voice/experience’ at board meetings and sees the current digital transformation as a valuable as a way of engaging more people with the meetings in order to hear more directly from those experiencing care.

 

It feels like progress is being made if these reflective practices are being adopted more widely and those with lived experience of conditions and care are being put at the centre of decisions and planning. 

 

6. The challenges on the horizon

 

It is worth noting that these conversations and discussions are taking place against a backdrop of uncertainty particularly in statutory sector funding. Many local authorities are nearing bankruptcy making it difficult for them to support anything other than essential services and the NHS will not be able to ‘reset’ back to pre-Covid-19 levels of service and care quickly. It is increasingly important that local areas and their communities are able to leverage the full extent of their local assets, knowledge and experience through collaboration across the sectors.

If you would like to access support for cross-sector partnership in health and care: 

 

  • The next and final peer support session will take place in September 2020. Email nancy.towers@socialenterprise.org.uk to register your interest. 
  • The Building Health Partnership’s programme will host a virtual national conference, sharing best practice and developing relationships in the late Autumn, email vanessa@ivar.org.uk to register your interest.
  • You can register for a 1-2-1 coaching session with Mark Doughty from The King’s Fund here

What would enable a sustained transformation in cross-sector working in the long term?

Recognising the tremendous pressure that health, VCSE and local authority leaders are under as a result of the Covid-19 outbreak, IVAR and SEUK are facilitating online peer support groups through their Practice Development Network[i] (PDN), which supports cross-sector partnership working in healthcare settings. The aim is to create a space for people to share experience thoughts and learning, during the pandemic at a time of pressure on the health system for those working navigating and delivering in partnership.

We find them a fascinating snapshot of hope and perseverance, and it is brilliant to see connections being made in real time that can help unblock a challenging situation, in another region.

We were joined by 20 cross-sector health and care leaders on 21st May for our two virtual peer support sessions. They were from different parts of England including: Bedfordshire, Luton and Milton Keynes; Dorset; Surrey Heartlands, Northamptonshire; Worcestershire; Liverpool; Leeds; Stoke-on-Trent; Nottinghamshire; Lancashire and South Cumbria; Northumberland; and London.

 

Please join us for the next peer support session on 24th June


Building trust rapidly

It was interesting to hear the positive stories that people shared about the speed and flexibility in their processes to re-designed or developed their services to cope with the new way of working for their varied service users. For example, a mental health support service is now being run digitally and is having more interaction with people than before when it was a drop-in, face-to-face service.  Not only had this made a huge difference to many people, in some cases preventing suicide, it also offers solutions to those in rural areas facing transport issues. ‘People tend to enjoy a bit more anonymity on the call, especially those we have less motivation to physically take themselves to the clinic.’

Key to this was a change in focus from box checking governance to pursuing relationships based on trust, and an assumption by all partners that people would do the ‘right thing’. This was something that all wanted to hold onto, to sustain as areas began to look at their priorities for starting up services that had been suspended to cope with Covid-19.


‘There is a massive desire amongst a few of us to keep pushing cross-sector working.’

‘We need to take time to pause and reflect, the good stuff that is going on and plan to continue this in the future.’


Long term versus short term

This is where discussion turned to barriers in cross-sector working and how to support systems’ need to see past immediate priorities –  of catching up with waiting lists – and not ignoring equally important projects that seek to address longer-term issues through community resilience. This is the paradox that for some areas the experience of the last two to three months have made this incredibly easy, and convinced leaders within their ICS or system that prioritising community resilience and supporting the VCSE to be an equal partner in this is key, while others have drawn up the metaphorical drawbridge and have even less time and money for approaches of this kind.

It is often about the art of the possible, and perhaps this is where sharing experiences and learning is even more important, if people can see others taking a different approach, it can lead to adopting different ways of working.  


Using data to embed social prescribing and tackle health inequalities

This was further emphasized by a case study in North Dorset, shared by Dr Simone Yule. She leads on Population Health Management (PHM)[ii] for the ICS. North Dorset previously received support from NHS England and Improvement to develop their PHM skills and data. Dr Yule shared how they were using this approach to managing data to ensure those most in need during the pandemic were getting the support that they needed. Being able to search their Practice data for people with a number of underlying health conditions that might make them more vulnerable to Covid-19, and were then able to link them up with appropriate support either via a health champion or social prescriber. See matrix below for intervention.  

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Data sharing

Many people on the call were keen to understand the approach to data sharing, since this has been a barrier for many to develop a comprehensive and embedded approach to social prescribing in primary healthcare. It had also hampered people’s ability to respond in the current pandemic, with CCGs being unwilling to share shielding data with the VCSE due to existing data sharing agreements. From Dr Yules’ perspective, their CCG had been very supportive, waiving some governance control to ensure the right people were supported in a timely manner, letting link workers know that they were trusted to do the right thing. Even though some patients had withdrawn consent to be contacted, the emergency situation allowed the Practice to override this request and all at risk patients had been contacted. There have been no complaints.

Enabling transformation 

Returning to the theme throughout the discussion, many were nervous that things would return to pre-pandemic ways, with a focus on governance and reporting outputs and counting interactions which would not support an ongoing transformation of care and support within the healthcare system. As the last few months have demonstrated, relaxing governance and trusting organisations and individuals to do the right thing has enormous benefits and can support radical and rapid change for the better. We need to ensure that this can be adopted in a sustainable way to drive forward the positive benefits seen in the collective response to Covid-19.

 

Please join us for the next peer support session on 24th June


Resources

Resources for building cross-sector relationships that improve community-based healthcare can be viewed and downloaded from here.


[i] Practice Development Network (PDN): The PDN is designed to support the sharing of learning, experiences and challenges of working in a collaborative way across sectors in health and social care. Its core members are people who have been involved in Building Health Partnerships and Transforming Healthcare Together, however it is open to all who are working or would like to work across sectors to deliver better health and social care outcomes. The network consists of an email group, allowing individuals to share helpful resources and make useful connections between each other as well as regular webinars. To join the email group email: Nancy.towers@socialenterprise.org.uk

[ii] Population Health Management is an emerging technique for local health and care partnerships to use data to design new models of proactive care and deliver improvements in health and wellbeing which make best use of the collective resources