Strengthening Local Voice – The real Health Inequality Challenge?

At the heart of “Due North” is an argument about the need to establish a pan-Northern collaboration which is built on closer relations with the people who live in the North of England.

So, I welcome the call to help communities to develop capacity to participate in local decision making through investing in the VCS and training and action to engage community members. But as I said in an earlier blog we need to do much more than this.

Reading Due North I asked myself the question:

Question – “Does Due North help me champion grass roots action in Sheffield?

Answer –  “yes it does bit – but I need more”

Many of us know of good examples at a very local level – the problem is these are not being systemised and local voice is not heard consistently enough at the top of organisations.

The very local story

In Sheffield 4 General Practices now have over 100 practice champions who are working on a voluntary basis supporting GP’s connect with their communities. These are all practices serving very disadvantaged communities.

I am a trustee of one of the voluntary organisations – Darnall Wellbeing – who deliver this service and their Practice Champions are part of a wider volunteering network that connects with the Somali, Pakistani, white working class and Roma communities in that area. Local people in disadvantaged neighbourhoods are working on the ground sorting out community cohesion, advocacy and access to health services. They are capacity building for themselves.

Nonetheless the challenge remains –  translating this local energy and expertise into powerful influence at place level. I think that one of the reasons this is difficult is because the city wide commissioning and provider bodies struggle to change their practice to make it easy for community activists to contribute at an organisation or system level.

At the recent Due North/Health Equity North one year on conference Tony Dylak from Royds Community Assocation in Bradford helpfully summed up these challenges calling for among other things – a greater recognition of the contribution that ‘patients’ can make and the need to see the voluntary sector as an equal partner.

Service and System

So, system level organisations and agencies need to consider what they can be doing to strengthen citizen voice. I think that this is where it gets really hard. A lot of the structures that operate at a system level are dominated (with the exception of local councillors) by professionals who speak on behalf of local citizens. By professionals I mean primarily managers from public sector bodies (mainly the NHS and Local Government) and the Voluntary and Community Sector.

Of course they are well intentioned people – but they are constrained by their own organisation and services (they don’t usually have whole system view) and by their responsibilities for meeting their targets and contracts. This too often leads to relationships that operate within a paradigm that ignores conflicts brought on by competition and mistakes activity for systemic action.

Again, in Sheffield the Sheffield First Partnership has been trying to get to grips with this. They set up what was in effect a select committee process to seek to understand what good might look like with regard to community cohesion and voice; taking evidence from a range of witnesses – including voluntary sector organisations, the police, fire service and private sector.

The outcome of this investigation is a “Fuzzy Framework” that seeks to provide a platform for a more self aware collaboration on this agenda across the city. It is very much a work in progress – but is a positive attempt to try to be more self conscious about this issue.

When Trade Unions are mentioned there is an awkward grin and shuffling of feet

Finally, at the recent Due North/Health Equity North conference in Chester someone in the audience raised the point that well established forms of collective solidarity such as the trade union movement are too easily ignored when it comes to seeking to strengthen public voice. Its interesting because public health and the NHS are often keen to develop relationships with the private sector – there is a hard edged glamour to this. Yet when the trade union movement is raised the response is usually an awkward grin and shuffling of feet.

The role of grass roots community organisations and Civil Society

So, I think we need to be much harder on ourselves if we are to make progress here. This agenda is moving on rapidly – in an excellent blog  Catherine Foot from the Kings Fund calls for  “not forgetting engaging patients and communities” in the implementation of the NHS England 5 year forward view.

At the moment it is striking that few local Health and Wellbeing Boards have clear strategies that set out how they will create an environment where grass roots community organisations or volunteering can flourish.

I think we need to be more self aware about how we connect with citizens – this means doing more than talking about apparently value free ‘interventions’ such as ‘building capacity’ or ‘funding the voluntary sector’.

I would also go a bit further than Catherine – if we are to rebalance our relationship with citizens we must see this work as sitting within the wider responsibilities that local government has for local democracy.

It means generating a debate with a purpose – what sort of civil society do we want and why?

Then taking action to strengthen it.

What do you think?