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Rewriting the DNA of Health and Care (Episode IV: A New Hope?)

23 Feb 2017 - 11:50 by Mike Wild

You know that game where you have to pick the people, living or dead, you’d most like to have round a dinner table? Being a bit of an ideas geek, I have a similar thing about who I’d like to hear speak at my dream conference. I’m lucky that I occasionally get to hear some brilliant speakers from the world of charities and social enterprises. Hearing someone like Kathy Evans or Neil McInroy or Debra Allcock Tyler speak is something I need every so often as a shot of fresh motivation and challenge. It’s like having a “gumption guru” who can help you keep that blend of compassion, outrage, frustration, determination and optimism topped up. A few weeks back I was delighted that I got to hear Debbie Sorkin give a fantastic talk about system leadership.

The term “system leadership” sounds a bit like something out of a management degree but at its core I think it’s about being a real, authentic person. Debbie introduced us to Myron’s Maxims one of which suddenly struck a chord: “The process we use to get to the future determines the future we get”. This is the sort of conclusion I’ve been reaching towards for a while. In my last blog I wrote about remembering why we’re here and some of the opportunities ahead for 2017. What I gained from Debbie’s speech is this need for authenticity in collaboration is the important thing to understand at the moment because changing the way things are done is the only option available to anyone involved in providing services for the public. So the way we get there like a kind of a self-fulfilling prophecy. (I’ve mentioned before that I once heard someone say without a hint of irony “We’re writing our co-production policy at the moment and we’ll share it with you when it’s finished.”)

When collaboration is at its best, you’ll see people who are able and confident enough to say if something didn’t work or if they don’t have all the answers. That trust and the confidence to try new things in the full knowledge that not everything works is a very powerful expression of a culture of collaboration. I’ve been very glad to see that as one of the key behaviour of the Our Manchester approach which the City Council and others are working towards. A lot of it is familiar ground to anyone who’s worked in any capacity in the voluntary, community and social enterprise sector – build on the good stuff, focus on the person, listen first, collaborate and have a sense of purpose about improving lives in the place you’re operating in. (Though I think it’s important for our sector to question whether we’re always as good as we say we are at these things).

As I mentioned in my last blog, I think there are huge opportunities ahead with devolution and the development of the “Local Care Organisation”. From all the conversations and meetings I’ve had about this over the last year – and, oh, there have been many! - I’m convinced that the potential for it is enormous. One of the reasons Macc was originally set up in the early 1980s was because the boundaries between what is “health care” and what is “social care” are so confusing and constraining that they unintentionally get in the way of people getting to whatever it is they need to improve their wellbeing. A Local Care Organisation could potentially solve that problem by placing the responsibility for handling that complexity in the hands of a single body. That’s a breathtakingly bold idea even though it might seem absurdly simple. But as I’ve said before among everything I’ve seen about Health and Social Care Devolution, the best feature is not the new powers which have come to Greater Manchester, it’s the sense of ambition it has unleashed.

Ambition should feel a bit scary: after all it needs a leap of faith which people agree to take together. In this case, it’s one which involves huge amounts of public money, jobs, organisation, services and so on. But where I think it catches light is when you put it alongside those “Our Manchester” ideas – take all the good things we can do, build genuine collaboration across the traditional boundaries between organisations and disciplines. That’s when the whole can add up to more than the sum of the parts.

Sometimes with all the cumbersome process of very formal meetings it can be hard to keep that vision in mind. I have a lot of sympathy for those trying to make it all happen – particularly NHS organisations for whom this might feel like yet another reorganisation exercise and we have had more than enough of those in Manchester. But if that’s all it turns out to be, then it will have failed.

And it will have failed if it doesn’t realise the ambition for a new relationship with the local VCSE sector. There is so much untapped potential – I know from having spent a long time trying to build conversations between different parts of the complex ecosystem of health and social care. There are good signs: we are finally getting the conversations with GP practices, with neighbourhood teams and a range of care professionals which are essential to making this work. That’s an important starting place. If you’ve not been involved in any of the Community Explorers meetings we’re running, it’s well worth taking a look. Change by doing.

The same can be said for the relationship with carers, patients, service users and the people who live, work and study in the city’s very diverse communities. However this new organisation is ultimately formed, it will be a provider of support to many people for whom it will be life-changing. They should be at the heart of how it is led, managed and operates. All the right co-production principles are being discussed: now we need to see that designed into the culture of the organisations at all levels.

The LCO will also be a major employer, control a lot of buildings and have enormous purchasing power – the way it goes about all of those things can make a huge difference in Manchester. There’s an opportunity for this new organisation to use every means at its disposal to improve the wellbeing of people in the city. That means not just thinking about the provision of services but exploiting the social value it can create from day one.

I’ve still got enough of a sense of this ambition to keep pushing to write all of this into the DNA of this new organisation as it takes shape. Stuff will get in the way, processes will be frustrating and complex and confusing and mistakes will be made, but this may be the best chance we’ll get for a very long time to improve the way we support people’s wellbeing in this city.

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