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Understanding how we are doing – building solidarity and excellence for health and care locally

July 20, 2015

LHW QS Blog

Increasingly we are on our own. As the government promises us further austerity targeted at the most disadvantaged, we are are also to get greater devolution (see Local Solutions for a Healthy Nation and The Local Health Service?). It is therefore our responsibility to ensure stronger collaborations between services and most importantly with citizens.

We know that we need to integrate services – not just across health and social care – but more widely in order to address the social determinants of health

One of the biggest challenges we face is that the organisational cultures and behaviours we have been trained to use work against co-production with citizens, integrated service delivery and shared responsibility.

A key part of this are the performance management systems that all statutory agencies work within and that define the relationship (through contracts) that statutory funders have with local voluntary organisations.

One of the most eloquent critiques of the deficit of current performance management approaches comes from Toby Lowe – who has worked for many years in the voluntary sector in Newcastle but is now an academic at the University of Newcastle.

Toby gave a presentation of his analysis at the recent ESRC funded Politics of Wellbeing Group conference in Sheffield.

In essence Toby argues that the performance management system we use starts from simplistic definitions of the outcome that is desired (which has to be measurable) and then works back to identify actions that will produce that measurable outcome.

He argues this can lead to actions that:

  • don’t address the real problem
  • gaming to achieve targets
  • reclassifying what counts as success (see recent government changes to Child Poverty measures)
  • Making up the figures

(You can listen to Toby run through a more detailed account of his work here)

I would go further and say that this approach also:

  • Pushes agencies to only worry about their targets rather than taking a shared responsibility for the wellbeing of communities. So, hospitals worry about their performance targets but don’t take responsibility for what happens to people once they are discharged back to the community.
  • Takes attention away from the strategic and pushes it towards the operational. So, in the health world we often spend time at the highest strategic level on performance measures that focus on tiny operational failings such as trolley waits or failures to hit 4 hour targets in A&E while at the same time we devote less time to real strategic issues such as the relevance or quality of whole services or the reduced life expectancy of whole communities.

Devolution

In this new devolved world we have the responsibility, incentive and opportunity to develop a local performance management system that is better than the bean counting Westminster driven system.

The work that I have been doing recently as part of my work at Leeds Beckett University offers some solutions. We have been working with Health Watch England to develop a common approach to helping local Healthwatch and their stakeholders understand whether they are effective or not.

This has involved developing a set of Quality Statements which we have produced through working with over 40 local Healthwatch. The Quality Statements cover the range of local Healthwatch activities from the operational to the strategic.

The idea is to use them to create a platform where local stakeholders who have some responsibility for making Healthwatch work can have a shared dialogue about the effectiveness of their local Healthwatch.

The aim is to move away from trying to measure impact and instead trust the expert opinions of a range of stakeholders who work with and are affected by local Healthwatch.

We think that responsibility for local Healthwatch does not just rest with Healthwatch or with the local authority commissioners but with a range of other stakeholders (we are not prescriptive here because local circumstances vary) but they are likely to include:

  • The Healthwatch Board
  • A range of local authority officers – not just the contract managers
  • Members of the Health and Wellbeing Board
  • Healthwatch staff
  • Local Voluntary Organisations
  • Advocacy Agencies

The approach we have trialled involves using confidential questionnaires sent to individuals from the above groups followed by a facilitated discussion based on the survey.

Early trials have been positive. It provides for a collaborative discussion about effectiveness and impact and as importantly a recognition that there is a shared responsibility for the Healthwatch function – which is ultimately about using citizen experience and knowledge to improve health and wellbeing.

I think that this sort of approach has a much broader application. It could be used with other key services – for example General Practice or a Citizens Advice Bureau.

It helps to develop a more inclusive approach to understanding and improving how services work to meet need. Along the way it also builds capability and understanding about services and how they work – and can help unite service providers, commissioners and citizens in a shared view about what is important and what is possible in present circumstances.

What do you think?

(with thanks to Jennie Chapman, Toby Lowe and David Walmsley for collaboration and inspiration!)

From evangelism to system change? Citizen Led Approaches to Wellbeing

June 15, 2015

Blog Asset Prophet 1

(With Acknowledgements to Mr Lowry of course.)

I recently had a good chat with Simon Rippon who with Trevor Hopkins wrote an article on assets for this blog. We agreed that it is positive that there is a growing debate about how we develop a more citizen led approach to co-producing wellbeing. In part this is because the issue has moved into the mainstream, its no longer – why should we do this but how? Another reason is because of the undoubted success that some players have had in promoting their ideas – in particular those of Asset Based Community Development.

Nonetheless, this debate will have passed most people by, largely because its between a very small group of people who promote and develop citizen led change in health and care.

I think that this small group consists of four main types of stakeholder – and it is the nature of this work that some individuals (like me!) occupy more than one of these roles. These roles are:

  • Academics
  • Practitioners – often professionals within the health or voluntary sector
  • Consultants and some voluntary organisations – who are funded to promote and develop citizen led approaches to wellbeing.
  • Citizens who are active within their communities – ironically, I think that this is the smallest group at the moment.

They all share a strong personal commitment to citizen led approaches to wellbeing, but it is also true that the overwhelming majority of those above earn some or all of their income from the local or national state – in other words many are Asset Based Change Professionals.

The Debate

This seems to circle around the following areas:

  • A reliance on services provided by the state disempowers people and creates dependency
  • Asset Based approaches can provide a useful and necessary challenge to professional self interest
  • Asset Based approaches could allow governments to justify reducing statutory support to the most vulnerable
  • Asset Based Community Development was developed in a different social and political context (the USA) and does not reflect the hard fought for public services that we have in the UK
  • The UK has its own traditions of Asset Based working that is rooted in community work and in collective social movements such as trade unionism, tenants movements, elements of the voluntary sector etc, these have been and are under attack

Some of this discussion is set out in more detail in the following:

Does any of this matter?

As I said this debate is happening largely within a tiny group of people so; it is tempting to say that the debate does not matter at all. By definition most citizen led activity is happening already within communities – and most of those activists are oblivious to this debate. Indeed as Trevor and Simon say in their earlier article ‘go down the pub and no one would know what you mean by participatory budgets’ in my view the same applies to terms like Asset Based Community Development!

Its about power

In centralised states like the UK (England in particular) a tiny group of leaders in Public Health England and NHS England determine future policy and funding. The rise in interest in citizen led approaches has generated a desire by some of these and their equivalents in Scotland to drive this work forward.

Many of these people would not claim to have more than a limited knowledge of grass roots citizen led change, they are insufficiently aware of the rich histories, struggles and scale of what already exists. They work in an environment that likes clear models and requires simple messages that can be given to politicians.

Its contradictory – but a tiny number of leaders at a national level can have a profound influence on approaches to citizen led change at a local level.

The Money

There is little funding available to promote development and system change, so access to resources is hotly contested. While there are positive examples of thoughtful and inclusive attempts to commission work there are also cases where national health agencies have instead chosen to develop funded collaborations without any recourse to transparent commissioning.

I think that this often happens when the evidence base is not very clear and people are searching for innovation, enthusiasm and simplicity.

… and the grass roots?

There are many organisations who have long track records of successfully supporting citizen led change, but they have their heads down; getting on with working on the ground.

Some of these feel frustrated and threatened by the way that policy makers appear to be too easily seduced into backing and promoting specific models rather than recognising the diversity and strength of existing good practice at a local level.

As Jane South notes in said in her recent publication (A guide to community-centred approaches for health and wellbeing) for Public Health England and NHS England:

“A diverse range of community interventions, models and methods can be used to improve health and wellbeing or address the social determinants of health. UK community health practice is rich and diverse, encompassing national programmes through to small local projects.”

I am not convinced that leaders in Public Health England and elsewhere are sufficiently clear about the actions they need to take to respond to Jane’s analysis.

What do you think?

Small and increasingly influential – local Healthwatch

May 26, 2015

Blog LHW

Local Healthwatch have been around for just over two years – and have an increasingly positive story to tell. At Leeds Beckett University we have been working directly with local Healthwatch in Leeds and Wakefield and more recently with Healthwatch England developing Draft Quality Statements – which we are now helping trial.

Earlier this year the Kings Fund produced a good report (Progress and Promise) based on a survey of local Healthwatch. In general terms this confirms our experience.

Focus and Impact

Local Healthwatch are unique – they are the only organisation that has a helicopter view of an entire local Health and Wellbeing system. In the world of localism and integrated health and care this is key.

The challenge that local Healthwatch face is matching this strategic leadership position with the resources they have at their disposal – which are very limited. This is compounded by the broad range of responsibilities that were placed upon them by the Health and Social Care Act.

Some of these responsibilities are more important than others in helping local Healthwatch fulfil their responsibility to use public experience to drive service improvement.

In the table below I give my opinion on the relative importance of four areas of local Healthwatch Activity and include the findings from the Kings Fund survey in the last column.

LHW Table.001

So, I think that while Enter and View and Advice and Signposting have some utility – the main opportunities for system impact rest with investigations and reviews and contributing to making the local system architecture work better.

Investigations and Reviews

While Investigations and reports are flagged up as areas that are progressing well the Kings Fund report notes:

“we were struck by how many local Healthwatch cited producing a report as evidence of impact, without any evidence for commitment to actions or actions taken as a result …. this is understandable, but reports ultimately only have real value if listened to and acted upon”.

We share this analysis we have worked with local Healthwatch supporting them develop capability on investigations and report writing. Our learning based on the experience of local Healthwatch is captured in the report ‘Local Healthwatch Investigations Briefing’ which provides a simple how to guide to conducting investigations that lead to change.

Local System Architecture

We are supporting Healthwatch Leeds as they use their mandate to strengthen the focus of the local health and wellbeing system on the experience of the public. Healthwatch Leeds already chair a ‘Peoples Voice Group’ that pulls together officers responsible for engagement across the health and and wellbeing system in the city.

This grouping includes engagement leads from the:

  • 3 Clinical Commissioning Groups
  • local authority adult social care
  • voluntary sector networks
  • NHS provider organisations – hospitals and community care

This group meet approximately every 2 months – sharing good practice, agreeing joint approaches to producing engagement publicity and developing ways to co-ordinate a shared approach to building relationships with citizens in Leeds.

Healthwatch Leeds have taken this further in another part of the local health system architecture. Rather than just commenting on individual Quality Accounts from all providers they arranged for all Quality Account leads to come together to share their draft findings. Again, some of the thinking is captured in a joint report we produced with Healthwatch Leeds – Local Healthwatch and Quality Accounts

“Sharing quality accounts across providers is a great thing to do – we have never done it before.”

Hospital Quality Account lead

Supporting continued development

The Kings Fund report suggests that in the majority of cases

“re-commissioning of local Healthwatch should focus on further refining the process and outcome performance expectation of existing providers and supporting them to improve.”

I would support this – but go a bit further.

Joint Commissioning – I think that Clinical Commissioning Groups need to be sitting down with local authorities to co-produce a forward commissioning plan – which they both resource. The logic here is clear – the direction of travel is towards integration and the two leading local commissioners need to take a shared approach – this is about engaging with the public in a coherent way across the health system.

Independent Challenge – It seems increasingly clear that an effective local Healthwatch is best placed to bring an independent, evidence based challenge to key public health concerns on health inequalities, service access and effectiveness. If public health teams wish to make a substantial contribution to keeping these important items on the agenda they should be funding local Healthwatch to provide this analytical expertise.

What do you think?

Between a rock and a hard place – Turning Asset Based Approaches Inside Out

May 6, 2015

Introductory Noteblog assets 3

My last blog (Asset based working – its not just the community bit around the edges) looked at some of the challenges and possible actions required to mainstream asset based working. I was pleased to get a friendly critique from Simon Rippon, Trevor Hopkins and Jayne Hopkins who are doing interesting work in this area. Just to be clear – I don’t agree with everything they say (especially the point about people in my local not understanding participatory budgeting!) but its worth reading and helps develop our thinking. So I have republished their comment as a blog piece below – over to them…….

Thanks Mark, but what a position you put us in! How to champion asset-based thinking and working at a locality level while actually changing the way that health and care systems work.

In Chapter 4 of our new report, ‘Head, hands and heart: asset-based approaches in health care’ published by the Health Foundation in April, we set out and respond to the principal challenges and criticisms of asset-based approaches. This chapter covers many of the points you make in your blog.

Not wishing to re-cover this ground, as our perspectives are there for people to read, we would like to add to this discussion by responding to your call to consider some of the factors that drive current deficit culture and hence behaviour in the current system.

Your blog seems to be aimed at an audience mainly in the ‘public health’ system. Whilst these are important players they are not the sole agents for systematising asset-based approaches.

Positioned in local government, public health has a huge potential to develop asset-based approaches, and some are doing just this. But the majority are stuck in a risk-based delivery model still attempting, not very successfully, to persuade people to change their lifestyles or health risk behaviour. We would argue that PH is complicit in perpetuating this emphasis. Our colleague Lynne Friedli has argued this too in recent published articles and seminars.

Asset based working is not just another public health ‘intervention’ it involves a paradigm shift in thinking about the health and wellbeing of individuals, families and communities based on ‘salutogenic’ principles.

You rightly say that this challenge to community development is not new and requires a “shift in power between professionally led public sector bodies and citizens and communities.” The recent report from Public Health England by Professor Jane South (A guide to Community Centred Approaches to Health and Wellbeing) articulates this well. But this is only part of the problem: power also needs to shift within organisations if professionals and practitioners are to work in asset-based ways.

Research sponsored by The Royal College of Nursing Group found that distribution of power in health and care systems is often hierarchical, based on professional status and gender. Driven by patient safety the NHS especially has attempted to challenge these imbalances in acute services over recent years with very limited success.

It is no better in many voluntary and community organisations as there is often a split between the frontline who ‘get and do’ asset-based working instinctively and the culture and systems within these organisations, often driven by public-sector commissioning procedures and outcome frameworks that are about process inputs and unhealthy behaviours, a deficit based emphasis. In our field work for the Health Foundation report a Community Development Leader commented that his organisation had spent years investing in community and voluntary services to do community work which in turn had built a parallel system and infrastructure that had become dependent on commissioning to survive – with little evidence they had made any impact in community-led action.
Participatory budgeting is a classic system-led response. It is, as John McKnight one of the originators of Asset Based Community Development would contend, building communities from the ‘outside in’ while asset-based working seeks to build community from the ‘inside out’. Even the words are exclusive, ‘participatory budgeting’ – try bringing that topic up for conversation at your local pub on a Friday evening.

Another factor driving current deficit culture is leadership that relies on positional power, direct control and organisational outputs. To support asset-based approaches we require new models of community leadership based on credibility and earned authority rather than positional or professional power. These characteristics will allow the building of new sources of power and influence and “…concentrate on enabling systems, organisations and people to work simply and seamlessly together, maximising the synergy of the collective rather than the individual. They also draw the best from diverse groups to enable a source of collective or shared governance where felt responsibility for achievement is stronger than imposed systems of accountability.” (A real paradigm shift in NHS Leadership? By Robin Douglas and Jane Keep. HSJ – May 3, 2012)

While agreeing that we need ‘a more systemic approach’ – it just depends on what you mean by ‘the system’. In many places local people are active, volunteer, form clubs and associations, help each other out and support more vulnerable people – organising what is seen as asset-based working! This has been happening for centuries and has sprung from local action not service-based ‘system’ action. And may have occurred due to lack of confidence in communities for established ‘mainstream’ public service delivery.

One of the approaches we suggest in our new publication is the use of a ‘Theory of Change’ to understand how asset-based change occurs. Theory of Change is about the central processes or drivers by which change comes about for individuals, groups or communities. This can be based on a formal research methodology and is well suited to asset-based approaches given the iterative and collaborative nature of the process, which involves aspects of systems and complexity thinking.

Our proposition for as Theory of Change toward asset based practice has four key stages

• reframing towards assets
• recognising assets
• mobilising assets
• co-producing assets and outcomes

The stages are not linear, but may be ordered to suit the particular situation and context of the initiative.

In the context of your blog and in response to your challenge to move asset-based approaches, indeed all forms of community work, into mainstream action we suggest we are still in the early days of Stage 1. The reframing of thinking is an obvious but critical stage in the move toward asset-based working.

Understanding how the public health system contributes to such activity is vital – is it to be a joint participant in local place based action? A commissioner of system development? It’s the inside-out or outside-in perspective that is part of the real politic of this agenda.

Reframing can signal a shift in practice culture towards an asset-based model and is a significant step. In our case-study research reframing towards assets was mostly described as an explicit activity or event in teams, groups and organisations. Often the reframing is a systemic action. Against this backdrop, current practice and priorities can be reassessed and new outcomes defined.

Whatever the trigger for the rethink, or the scale of the change envisaged, the first challenge is to change the culture.

Reflecting the values and principles of asset-based working we are growing this approach from the inside out at project and locality level. We would contend that it is too soon for this to be mainstreamed.

“Changing to an asset-based approach offers and creates a new relational perspective. It is not a set of tools or techniques that can be applied without a change in organisational culture and individual practice. It must be a process, not a top-down plan.”

(‘Head, hands and heart’ p.23)

What do you think?

Asset Based Working – Its not just the community bit around the edges

April 27, 2015

blog assets 2

While there are a growing number of examples of asset based approaches most of these are at project and locality level. What concerns me is how to move to a more systemic approach that actually changes the way that systems work.

This is not new – community work and community development have always faced this problem – trying to translate activity with people on the margins into mainstream action. Of course the biggest problem is that – like much community work – asset based approaches require a shift in power between professionally lead public sector bodies and citizens and communities.

Unlike in the past the ambition and rhetoric of asset based rhetoric can now often be heard at the top of local systems – among elected members, chief executives and so on. The challenge is that systems have a huge inertia and cultural baggage that means that even when people are well intentioned their behaviours and management techniques do not equip them to set in train actions that will allow asset based approaches to flourish.

So, the risk is that these will stay in the project or local community work box.

I think that an effective approach to achieving system change has to do two things:

  • Have an analysis of some of the deficits presented by the current paradigm – so we don’t fall into the same ways of behaving.
  • Use change techniques that play to strengths of asset based working – rather than to those that reinforce current system behaviours.

So, we need to consider some of the factors that drive current deficit culture and hence behaviour in the current system. If we do not recognise this we risk either reinforcing it or becoming frustrated by what might feel like unhelpful and obstructive responses.

A strategy for failure

When we present arguments about the need to shift to a more asset based approach it is assumed that:

  • decision makers have the best analysis of what needs exist and how to allocate resources to respond to these – yet we know that much community led activity is not recognised in commissioning
  • we will make our case to commissioners because they are the key decision makers and custodians of service outcomes – yet most of the resources they are responsible for are already allocated to big providers who are the ones actually responsible for delivering the services
  • we will be able to demonstrate how asset based approaches by themselves will help meet government targets and make savings to the current system – yet many government targets focus on simplistic measures that have little relationship to lived experience – for example trolley waits and A&E waiting times, and asset based approaches are only part of the solution. Asset based approaches can  help existing services and pathways be better – but they are not the solution in themselves and should not be judged in isolation.

This is not territory where we will win. We need a different set of arguments – that will release asset based approaches – I think that some of these are:

Vision – We need to set out our own view – building from the grassroots of what makes a fair community for all. I think that Fairness Commissions organised by a number of local authorities provide an important, alternative and local view that stands outside the sound bite policies of national government.

Information – It is crucial that local voluntary and community organisations have access to the data that allows them to locate their contribution into the wider context. This is a bit like a JSNA – but starting from the perspective of grass roots organisations rather than commissioners.

Imagine if all the community dance groups (or running clubs, advice centres etc) in an an area could each see how they contributed to the total number of people taking part in dance (or whatever) in a local authority area. They could use this information to apply for funding and be better able to make the case for themselves, rather than relying on commissioners to do so for them.

Flourishing community sector – we need decision makers across commissioners and providers to answer this question “what can we do to help grass roots voluntary organisations flourish in our area?” I suspect that part of the answer is to make it easy for people to come together to set up and run their own community organisations – key to this is making small grants easily available, but other examples exist such as the participatory budget process developed by Durham County Council.

Service and Pathway redesign – we need a different dialogue with provider organisations like big hospital trusts or GPs. We need to get round the commissioner/provider divide and support these big providers shift to a wider world view – engaging with the ‘citizen’ rather than the ‘patient’. Part of this has to involve these big providers developing collaborations with their local voluntary and community sector to together design pathways of care and support.

What do you think?

Not the way to fund a care pathway – the role of the voluntary sector

April 7, 2015

blog vcs pathway

Recently I was on a panel making decisions on grant applications by voluntary organisations to a one off fund commissioned by Sheffield Clinical Commissioning Group.

Of the total fund just over £400,000 was focused on CCG health priorities – the fund was four times over-subscribed. Applications had to meet one or more of the following criteria:

  • Reducing Urgent Hospital Admissions
  • Support People with long term conditions
  • Move provision of care to a community setting
  • Reducing Life Expectancy inequalities in people with serious mental illness or learning disabilities
  • Help all children have the best possible start in life

The selection process was organised efficiently and professionally by South Yorkshire Community Foundation – who gathered together a diverse panel which contributed to the competence of the overall process.

Details of the fund are here; I was struck at the number of applications from:

  • organisations who support small groups of people who have very substantial needs. For example people who are homeless, substance misusers, women who have experienced domestic violence and people with complex learning and physical disabilities.
  • groups who support people who while their clinical health needs have been addressed by NHS services continue to experience the impact of their health condition once they have returned home – such as people who have had a stroke.
  • neighbourhood organisations who provide a bridge between people in communities and local health services – in particular primary care.

I realise that this is not a scientific survey, but I was left with the following thoughts – and these are general ones – not specific to Sheffield.

Easily Ignored Groups

The perfectly understandable focus on providing services for the whole population too easily leads to insufficient attention being given to small vulnerable groups with complex needs. This is particularly the case for groups of people whose poor social and economic circumstances are have a negative effect on their health. I think this is driven in part by the tyranny of population level targets but also by a default emphasis on clinical services which means that the crucial role of services that help people connect, build confidence and engage with mainstream provision is insufficiently recognised.

Care Pathways.

One of the things that worries me is the way in which mainstream commissioning can still ignore the complete care pathway. I set this out in an earlier blog – when I told the story of Stroke Action in Enfield. Its just not good enough to address peoples physical health problems and then put them back into the community – less physically able and less confident – this is a recipe for social isolation, poorer mental health and early re-admission. There are growing number of positive examples – such as Stroke Action and the Voluntary Action Rotherham Social Prescribing work which we need to be building on systematically across all commissioning pathways.

Prevention

We need to be much better at taking into account the role of community anchor organisations with regard to helping build local community infrastructure that allows people to access support services in their communities, use public services more effectively on their terms and most importantly contribute through volunteering in their neighbourhoods.

Action

Despite government imposed austerity I do think that commissioning organisations and big public sector providers can do more to address the deficits above.

I think that some of this is recognised in the NHS England 5 year forward view, with models such such as the (rather long winded) Multi-Speciality Community Partnerships being proposed. These could provide a mechanism for designing service models that have the voluntary and community sector in at the beginning.

In order for this to happen local commissioners have to raise their game this could mean:

  • Local Authorities and CCGs developing volunteering and voluntary sector funding strategies through the Health and Wellbeing Board.
  • CCGs pushing NHS providers to develop service pathways that reach out into communities and to do this in partnership with the voluntary sector.

I think that this could not only help build better local services but through stitching these services into the fabric of local civil society  it helps to build an alternative narrative to the one that says that marketisation is the most effective and efficient way of improving health and wellbeing.

What do you think?

The Voluntary Sector makes little contribution to wellbeing

March 11, 2015

vcs data blog

You would believe the above heading if you were to rely on Joint Strategic Needs Assessments and Joint Health and Wellbeing Strategies for your evidence. Of course this is not the case at all.

I recently facilitated a workshop for Public Health England on “strengthening the voice of the voluntary sector in Joint Strategic Needs Assessments”. As I said at the workshop – I think thats the wrong question.

The key issue for me is how can the experience of the Voluntary and Community Sector be used to improve local commissioning to tackle health inequalities and improve wellbeing?

While I welcome the ambition in plans like the NHS England 5 year forward view and the Due North report on Heath Equity which aim for greater investment in the voluntary sector neither of these quite hits the nail on the head.

Its not sufficient for statutory agencies (local government and NHS commissioners) to try to make it easier for the VCS to bid for contracts. Treating the VCS purely as contractors will fail to allow the experiential wisdom of the voluntary sector to contribute to strategic change for the better.

In order for this to happen the system needs to be much more permeable to the voluntary sector perspective. Crucially, statutory services cannot treat the VCS as though it works to the same rules as big public sector bodies – because it does not.

  • VCS organisations use a wide range of different data sets – which do not easily read across to local systems.
  • VCS organisations are worried about sharing service data with potential competitors
  • Many are not convinced that providing data into JSNA processes will justify the effort involved in providing it, a recent report (In Good Health) by the Royal Society of Public Health supports this view.
  • Most importantly, much VCS insight is based on relational rather than quantitative data.

As I noted in an earlier blog statutory agencies and the voluntary sector need to be using approaches that allow the VCS to to share a perspective on its terms.

In an earlier blog I wrote about one methodology that I have developed with Involve Yorkshire and Humber  (Rapid Reviews) which led to real change in commissioning priorities, but there are plenty of other examples. Here are some that I have found out about recently.

Real Life Reform

This is an amazing piece of work undertaken for peanuts by a consortium of Housing Associations with support from the University of York. The organisations involved use the relationships they have with tenants to capture and share a small scale but in depth perspective of the real life impact of welfare reform. Keeping track of 100 households over a period of two years with tracking reports produced every 6 months.

Real Life Reform Report 5

Real Life Reform Report 5

Data for Good

This is an important report from NESTA sharing examples of how voluntary sector data can be used to provide insights into real time and future challenges. One example is a collaboration between Citizens Advice and St Mungos – a homeless charity based in London. There are a number of things that are interesting:

Data Science expertise – through a collaboration with Datakind UK volunteers from the data science community did an initial scoping over a period of two days – this lead to a smaller team of volunteer ‘DataCorps’ working over a longer period of time to resolve tricky issues.

In this case the work led to St Mungos and Citizens Advice working together to share data on clients, and led to three principles:

  1. Embracing openness – especially ways of sharing data across organisations that did not sacrifice confidentiality
  2. Democratising access to data – supporting others to have the skills to analyse the data – this has similarities with the GP Patient Survey dashboard that I have mentioned before.
  3. Emphasis on questions and exploration – Placing analysis and data into the public domain and creating opportunities for others to consider what this data might mean for their area of interest.

More Rapid Reviews and Local Healthwatch

I have already mentioned the Rapid Review work that I have done in Wakefield and Sheffield – another example I came across recently was a project led by the Sheffield Parent Carer Forum which captured the views of parents of children and young people with disabilities.

I am currently completing a piece of work for Healthwatch England and have been impressed by the number of local Healthwatch who are increasingly using this sort of methodology in their investigations.

What will help?

Local Commissioners

Local Public Health teams should have an explicit longer term and funded strategy (which includes CCGs) to support the local voluntary and community sector build analytical capacity and competence. This could be built around addressing specific priority at the same time allowing it to build competence.

Public Health England and NHS England

These two agencies need to develop a robust long term programme to support sharing of good practice and raise the expectations of local decision makers – in particular CCGs and Directors of Public Health. It is frankly not acceptable for local leaders to assume that current systems and capability need to mirror existing statutory practice.

What do you think?

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