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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

A place-based approach

A group of Cumbria Funders supporting community-led emergency response work share their deliberations over what a sustained response to Covid-19 might look like. The group includes independent funders, local authorities, NHS commissioners and infrastructure organisations.


Initially, Cumbria Community Foundation drew on learning from grant-making in previous emergencies such as the 2001 Foot and Mouth outbreak and flooding between 2005 and 2015.  They launched the Cumbria Covid-19 Response Fund at the end of March 2020. Several of the independent funders in Cumbria donated to the fund and joined the grants panel. This multi-agency approach was able to act quickly and flexibly to distribute funds to third sector groups – emergency response funding, agreeing to changes in what existing funding is used for, and assessing applications regularly: ‘Looking at applications on a weekly basis has definitely been a high for me, in terms of the capacity and pace in which we have responded in Cumbria. It has been a really definitive response to need’.


As a group of funders, we were keen to look at the emerging community needs regarding covid-19 and to consider this collectively. Now our attention is starting to turn to longer-term collaboration given the ongoing and uncertain nature of this pandemic. IVAR facilitated a conversation to support our thinking about whether and how we could continue working together.


Challenges

The situation remains fluid, but there are three concerns already on our minds:

 

  1. Funding: Some funders ‘have to raise our own money in order to give it away’, others are dependent on dividends that companies have suspended giving out: ‘We don’t know yet when we can look at grant-making and our situation in the long-term’. And for statutory funders in particular, internal processes are a barrier: ‘We are constrained by our funding guidelines and we try to support our third sector providers as much as we can … Even if our guidelines change, we will probably not be able to be anywhere near as flexible as other funders can be’.

  2. Organisations surviving: Some organisations doing good work will be unable to sustain themselves ‘because of a combination of possible long-term reductions in funding and fundraising activity’. This is exacerbated by lack of capacity in the third sector to think about and plan for the future, with most people either busy in emergency response work or furloughed. So, we’re not sure whether now is the time to introduce new funding pots: ‘Seen from previous emergencies, most groups would be too immersed to step out and write a proposal at this time’.

  3. Speed vs strategy: We have been busy with emergency responses, and worry that ‘we haven’t had a chance to stop and pause and look at the breadth of grant-making are we doing. Are we missing out some of our rural communities and underrepresented groups?’. There may also be a missed focus on sectors beyond healthcare and emergency, like the arts and climate change: ‘Once the dust settles, we will need to re-look at priorities’.

Shared vision with a collaborative approach

We want to work through these challenges together, to collectively support the third sector in Cumbria now and for the future – and to work with people who have ‘lived experience’ to develop a long-term vision for recovery: ‘This helps ensure panels are listening to communities and are able to then fund the actual need’.


We expect different priorities to emerge – financial hardship, children and young people, vulnerable groups, mental health issues: ‘Sharing our thinking around these priorities will be important, so we can spread out and fund different initiatives’.

 

Next steps

We believe it is ‘important not to lose the momentum and adrenaline with which we have all been working, and as we move away from lockdown to whatever the new normal looks like, we need to be practical about the collaborations built and continue to share information and work together with the same energy and vigour’. We have explored partnerships between funders who would not normally work together, and there is a need to preserve this for the long term. There is a definite appetite for working collaboratively in future. At the same time, we need to build the case for this collaboration through both hard data and softer, anecdotal data and stories. Through the Cumbria Funders group we will explore ways for future collaborative working.


‘Through this we have found that
[for all partners, funders and others,] prioritisation and collaboration is our common strength – how can we hold onto this good practice and make it our new norm? We have all been good in crisis mode, stepped up and worked together for recovery, but we must explore how we continue to do this in the long term. It is important to hold onto the positives.’ 

 


This briefing is co-hosted by Cumbria Community Foundation. It is based on a peer support session facilitated by IVAR with 16 Cumbria-based funders,  infrastructure organisations and statutory partners, namely: ACTion with Communities in Cumbria; Barrow Borough Council; Copeland Community Fund; Cumbria Community Foundation; Cumbria County Council; Cumbria CVS/Cumbria Community Resilience Group, Cumbria Exchange; Francis C Scott Charitable Trust; Frieda Scott Charitable Trust; Hadfield Trust; Lake District Foundation; Lloyds Bank Foundation; Morecambe Bay CCG; North Cumbria CCG; Sellafield Ltd; and Sir John Fisher Foundation

 

 

How can we – as funders – help communities to deal with the pandemic?

Over the past 15 months, we’ve been supporting grassroots, community-based grant-making in each of the four home nations through Comic Relief’s UK Intermediary Funders initiative¹. Learning has been key to our approach as we want to understand how we as funders can share and shift power to people in communities through ‘lived experience’ and community-led approaches, both in the grant-making process and the grants themselves. Now, in the midst of a pandemic that is deepening inequalities and creating an environment of prolonged uncertainty, how can we continue to do that? What are we learning as a group of funders that we can hold onto as we move into recovery and renewal?

Through this blog, we wanted to share some of the questions being discussed amongst our grassroots intermediary funders.

Emergency vs the longer term

Most charities are really anxious about funding – they may have some money now for emergency work, but with no fundraising and limited grant-making for non-emergency work, there will be a gap very soon. We are really conscious of this, and know there is a role for us, our partners and other foundations in protecting charities for the future.

However, this comes with a set of challenging considerations: 

  • Should we stall some emergency funding, in case there is a second ‘lockdown’ in the autumn and winter? Or should we hope that we will be able to meet future needs through additional fundraising?
  • How can we work to ensure that emergency funding is accessible to those who need it and supports organisations on the frontline to deliver crisis support whilst sustaining them so they are able to provide in the medium and long term? What’s on the horizon?
  • We can’t yet predict when something vaguely resembling normal life will resume, and what exactly that will look like. What does that mean for the timing and focus of our support, and our expectations of charities in relation to plans and activities? When should we seek to shift from emergency to recovery?
  • We do know that the pandemic is exposing and deepening inequalities, and that both the charity and funding sector will need to adapt – to both changing needs in communities and shifting priorities. What will that mean for future grant-making processes? What can we do to retain the flexibility and collaboration that has emerged between many funders over the last few months?
  • Many organisations are providing emergency support beyond their particular area of experience – like mental health support or working with women affected by domestic abuse. Can or should this work be sustained over the long term, ensuring those intervening in such complex issues have a ‘do no harm’ approach as a starting point? This will ensure those doing this work have the proper expertise to deal with the issues responsibly and effectively.
  • Many emergency funds ignore so-called ‘nice to have’ things in the community, like cultural arts, theatre and sports – in the long run, how is this going to impact on people’s lives and social values, especially young people’s education and mental health?

What will the role of unconstituted community groups be?

 

New community groups have formed across the UK in response to Covid-19, and they aren’t waiting for funding – they’re just getting on with it, driven by empathy and with little ambition to be constituted organisations. Some of us have funded residents’ groups even though, in the past, we would have preferred something more structured; others are looking at whether this could continue beyond emergency: ‘I don’t think there is anything stopping us, it is us that strangle ourselves’. How do we support these groups as drivers of community change? And will they want to continue or disband after the pandemic? ‘In a time of crisis and chaos, there has been a new order established around shifting the power which has communities and their responses at the heart’.

 

As funders, while appreciating the myriad of amazing community responses, we need to be mindful of the groups that already exist doing responsive work. We must not forget them, and we must remain alert to the possibility of duplication – between longer-standing activities and newer, emergency responses: for example, established food banks working on ending food poverty, alongside newer groups doing similar work, could lead to an over or under supply of food.

 

Doing the right thing – ask funded partners or potential funded partners to help us think about the future

 

Communities have shown tremendous power in leading from the front, reacting first often ahead of both established charity and statutory organisations’ responses and support. They are becoming first responders by asking for feedback from people on the ground to understand local needs. As funders, we must find ways to support and embed this shift in power right down to the local community level. And we must also be conscious to proactively reach out to those groups who are disproportionately affected, may not be well represented in broader community responses, or may not have the means and avenues to be able to directly ask for help? (For example: BAME communities, LGBTQ+ communities, young carers, and people dealing with loss and grief.)

 

Grassroots organisations are already thinking of ways they could deal with the challenges lockdown has thrown up, for the longer term. Things like mental health, isolation, increased inequalities and child poverty, and domestic abuse. After the pandemic, how can this surge of community action help us to understand what is needed and how can we support this community response for resilience and rebuilding?

 

So…

 

Like many funders, we have adapted our processes and made them simpler; we have been flexible in our grant-making; and we have set up emergency funds quickly in response to Covid-19. But it feels like we’re at the start of a period of sustained evolution and adaptation. We hope to work closely with people, communities and other funders as we face the future together.

 

Please do share your thoughts in the comments below.

 


[1] The four intermediary funders are The Community Foundation for Northern Ireland, Corra Foundation in Scotland, Wales Council for Voluntary Action and Groundwork in England.

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’.

What works for setting up cross sector partnerships?

Two voluntary sector leaders taking part in our Building Health Partnerships: Self-care programme share what they think works when setting up cross-sector partnerships. 

 

Dr Simon D Hankins
CEO, BS3 Community Development (formerly Southville Community Development Association)

 

‘Patience, building trust, respect, recognising the expertise that exists within each partner organisation, identifying and working to achieve mutual benefits, stumbling across people with the appropriate mind-sets and attitudes and people that you feel that you can work with and, overlaid with a huge dose of realism are, for me, all key components in establishing partnership working between the voluntary and public sectors.

From my experience at BS3 Community Development charity, to achieve a targeted, short-lived or enduring working relationship with parts of the public sector, it takes time, lots of time; it requires patience from all involved as we get to know one-another and build trust and confidence in each other, after all, why would you work with someone you don’t know or with an organisation that you have no idea how good a quality their services are? However, the rewards can be immense for all parties and particularly the people that you are setting-out to work with, support, help or whatever it is that is being developed; so it can be worth the effort as long as the statutory sector and VCSE (Voluntary, Community and Social Enterprise) sector partners approach the development of the working relationship on an equal-voice and mutual respect basis.’



 

Jacqui Bremner
Herefordshire Carers

 

‘I think true partnership working is when you know that you both work as hard for your partner to succeed in the joint venture, as you do for your own organisation, because you know that failing impacts on you both!!’