‘The more we concentrate on merely reworking our existing institutions, the more we fail to see or understand the nature of the new challenges that surround us.’
Hilary Cottam, Radical help
If there was ever a time for thinking differently about health and care, it is surely now. The Covid-19 pandemic has served as a graphic reminder that people’s health and wellbeing is shaped by the broader circumstances in which they live and the opportunities that are open to them, or not. But it has also demonstrated that people are not simply victims of circumstance – over the past 14 months many have taken matters into their own hands by helping neighbours and getting involved in community activities that support the health and wellbeing of local people.
In this context, it would be a huge missed opportunity if the development of integrated care systems (ICSs) and place-based partnerships becomes reduced to an exercise in linking up existing institutions more closely. Rather, they should also be vehicles for creating a more active relationship between services and communities that builds on the civic participation seen during the pandemic. This is a core part of what it means to work in a ‘place-based’ way but is something that debates around the future of ICSs and the forthcoming legislation have said little on so far.
In our report, Developing place-based partnerships, we argue that building a closer relationship with communities should be one of the key principles underpinning the development of partnership-working at both place and system level. Partnerships can help support a shift in the relationship between public services and communities towards one in which people are treated as active partners rather than passive recipients of services.
Examples such as the Wigan Deal provide illustrations of what a fundamentally different relationship between citizens and public services could look like, based on closer collaboration and sharing of power and resources. Across England there are countless other projects and initiatives that show how community power can help to improve population health and wellbeing. We’ll be showcasing some of the examples we find most exciting at our virtual Community is the best medicine conference in June. ICSs (and, importantly, the more local place-based partnerships that their work will depend on) could play a critical role in driving this kind of innovation forward because of their ability to help local partners take a co-ordinated approach.
There are several ways in which communities can act as partners in improving population health. As we have recently outlined, this includes community development work that builds local strengths and capabilities, involvement in commissioning decisions and service design, and community-led provision of practical and social support. ICSs and place-based partnerships have a crucial role to play in enabling this broad spectrum of community activity.
One of the tangible steps that partnerships can take early on is to change how the experiences of local people are measured and understood. Organisations need to move from understanding patient and service-user experience of individual services to understanding people’s experience of the health and care system (or public services more broadly) as an interconnected whole. In the coming months, we will publish a practical guide for partners working in local health and care systems to support them in making this shift.
There are also opportunities through place-based working to change the way that community engagement and involvement takes place, establishing a co-ordinated approach to this between partners. Instead of involvement being limited to discrete engagement and consultation exercises, public services across a place can move towards a culture of working with communities on an ongoing basis to understand their priorities and to build on local strengths and assets.
The public sector is often in its comfort zone discussing structure and process – in the NHS, repeated reorganisations have meant local leaders have accumulated hard-won expertise in institutional re-wiring. And of course, getting the wiring right is important. But the renewed interest in place-based working needs to be about more than allowing professionals to work together more closely. It needs to also involve re-examining the relationship between professional expertise and the lived experience of local people, in a way that values both and creates new opportunities to improve population health.