The last few months have been a rollercoaster ride. We have seen NHS Commissioning Board (NHS CB) roles on structure charts become real people – for example, the Director of Patient and Public Voice and Information has become Giles Wilmore; the Patient and Information CCG Lay Assessors hotline has become Sian; and the CCG Lay Assessors themselves have become Ghzala, Huw, Madeleine…
New voices in the room are resulting in new exciting, yet testing discussions. These amazing people are breathing life into ideas, processes, systems; they are beginning to challenge what has happened already and are starting to carve out and shape the future.
In the midst of this frantic period at the NHS CB, one of the fantastic people working at the Board sent me a link to the Radio 4 programme Four Thought. She gifted me a powerful story, written and read by Christina Patterson. To cut to the chase, it’s a poignant story of how the system has become, in many ways, more dominant than the people it is delivered by and for whom it exists – and how we all have an individual responsibility for our words, our actions, our relationship with others whether it be in our personal or working life. This really resonated with me!
In my opinion, whilst a system is helpful, surely people – no matter what their role – should always be put before the system. The journey of participation, on which we are taking the first wobbly steps, is truly based on this principle.
In the last few weeks, I’ve heard two key questions being asked: Can you briefly explain this ‘participation’ approach; and what is the rationale and evidence behind it?
There is a huge and growing body of evidence relating to ‘participation’ or the other names used, such as co-production, public and patient voice, involvement or engagement. Each of these are often defined in certain ways, eg the well-known Arnstein’s Ladder.
We could look at it in a slightly different way using the unsung hero of health based theories and research – salutogenesis. This amazing research-based theory, led originally by Antonovsky in the 1970’s, is a strength-based approach which explores why some people are able to stay well despite hardships and stress. The conclusion is that some people have a greater ‘sense of coherence’, ie a sense of control, positive outlook and ability to use internal and external resources. As common sense and now evidence tells us, with this ’sense of coherence’ comes better quality of life and health outcomes.
There have been many incredible research studies, action learning programmes and the like which have focused on different aspects under the umbrella of salutogenesis including empowerment (eg Community Health Champions), self-efficacy (eg Family Nurse Partnership) and co-production (eg NESTA) and many more.
The model of participation below is an early attempt to bring all of this learning together into an-easy to-understand model, which is really a hypothesis of the potential if we should move from piecemeal innovation to the tipping point of a social movement.
Just to be clear, this model is not NHS CB policy. It is simply a convergence of ideas, a frame to help us connect individuals and organisations with a shared purpose around building a new powerful relationship between people and their own health and the health system.
Using a real life case study to explain this model, Altogether Better used a model of empowerment which incorporated increasing confidence, knowledge, connections and challenging current cultures and behaviours. The resulting evidence suggests that this approach facilitates individuals to become more empowered, leading to increased civic participation, improved health outcomes and a more productive and better utilised health system. Altogether Better built and tested this model with over 20,000 workplace and community health champions who supported over 100,000 people in their communities.
In the past few weeks I have heard the commitment and passion for this agenda from many sources including CCG Lay Assessors, other active citizens, pioneer leaders of CCGs, academics, staff across the NHS CB – as well as from many of the experts in the various approaches to participation we have in England and beyond.
Twitter is becoming a huge source of information and inspiration in this area. See @jeremytaylorNV and @GBDOC to name but a few champions for active citizenship and participation, or follow some of the #conversations such as #nhsconstitution to listen to interesting discussions.
People, no matter what role they are playing, are talking a passionate language with real integrity of purpose, soul food indeed!
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No, no, there isn’t a huge and growing body of evidence. There’s a huge and growing body of conjecture, unsupported by evidence of long-term outcomes. To Altogether Better’s credit, they acknowledge this. Take note.
People should always be put before the system? That’s not really in the nature of systems, as the system-first models in your subsequent paragraphs illustrate nicely. Still, it’s early days. I look forward to part 2.
Good post Roz – like the diagram!
Great Diagram
All together now : and a One, and a Two, and a Three :
The dosh in our NHS goes round and round
Round and round, round and round
The dosh in our NHS go round and round
All through to the Bank
(Roll Fivers over each other)
The workers in our NHS go “Swish, swish, swish,
Swish, swish, swish, swish, swish, swish”
workers in our NHS go “Swish, swish, swish”
All the way to the dole.
(Put arms together in front of you and beg for a Handout)
The doors to our NHS go shut and shut
Shut and shut, shut and shut
The doors to our NHS go shut and shut
Unless you’ve got the cash
(Cover eyes with hands on ‘shut’ , and take out a pay-day loan)
The money in our NHS goes “Clink, clink, clink,
Clink, clink, clink, clink, clink, clink”
The money in our NHS goes “Clink, clink, clink”
All the way offshore.
( Put money in the Cayman Islands)
The people in our NHS say, “Shh, shh, shh,
Shh, shh, shh, shh, shh, shh”
The people in our NHS say, “Shh, shh, shh”
We’ll have no whistle blowers here!
(Put finger to mouth to ‘shhh’ , or get sacked)
This is arrant nonsense.
If you look at the dates, you’ll see that he’s NOT referring to my ditty, but to the main article!
[I M H O]
Josef K
“taking the first wobbly steps”??? Your organisation is a car crash and doesn’t even realise it!
Stop writing this drivel and wake up to the risks of what is happening!
I had to look up ‘arrant’ but am now on Reg’s side.
This is an interesting and persuasive discussion. It is reassuring to read that the NHS is at least thinking about putting people at the heart of decision-making, More importantly, these are not just fancy words but arguments supported by reference to established theories and existing practice. Whether we agree or not with the changes to the NHS, I welcome this diversity of thought.
The NHSCB, like any new organisation, is still establishing itself and is also at the mercy of political whims. It seems it is an organisation full of differing views and cultures and I am glad that there are people like Roz who do have a citizen centred approach (as the NHS Constitution says the NHS belongs to the people) and are trying to learn, understand, change and improve an organisation that is full of clashing cultures, with much of the ‘old ways’ of working still too dominant.
‘Action learning programmes, salutogenesis including empowerment (eg Community Health Champions), self-efficacy (eg Family Nurse Partnership) and co-production’ !!
I can’t believe you people are wasting your time with this rubbish! Cuts to vital services and you are drawing diagrams about participation and writing about empowerment.This is what should be cut.
” Just to be clear, this model is not NHS CB policy.”
Phew,
For the 6 hours it took me to plough through the text as far as this, I thought it was, given the Logo it’s published under.
I hope that this is churned out in your spare time, not in the time that I’m paying for?
If not, I want my money back, please.