Neighbourhood working in Doncaster may appear to be in its early stages but will have a significant impact on the local population.  In this blog, Ruth Bruce, NNHIP Coach at South Yorkshire ICB explains how the team are using relational public service methodology to co-design a radical new model and reform the system.

As part of the National Neighbourhood Health Implementation Programme (NNHIP), we were initially asked to focus on people with multiple long-term conditions and those at risk of developing more complex needs.  We knew that our approach needed to be able to not only cope with complexity but also have a role to play in prevention.  We also knew that far too often, and despite multiple existing services and pathways, people’s needs were not being met.  Something was missing.  This work could not be about redesigning or co- locating existing services first.  It had to be about understanding people.

Putting relational public service into practice

Ruth Bruce

At the heart of our approach in Doncaster is relational public service methodology. Relational Public Service focuses on meeting people where they are and working outwards from there, asking what matters most to people in their own lives and communities.

The model is based on caseworkers getting to know residents on an individual basis, working with them in a bespoke way.  It pulls on specialisms when needed, with an intentional shift away from referrals and pathways reliant on eligibility criteria.  This is a fundamental shift, which relies on services and partner organisations being curious and open to adapting their existing ways of working.

A hyper-local approach

We’re working across several prototype neighbourhoods – small, hyper-local communities where we can test, learn and iterate.

The work in each neighbourhood reflects the needs of its local population and we are starting with different cohorts in each of the prototypes.  Mental health is a common theme, but it is explored alongside issues such as obesity, chronic pain or men’s health depending on local priorities. In the city centre, for example, the focus includes people experiencing homelessness and those from diverse ethnic communities who often interact with multiple services in disconnected ways.

This variation is intentional. Every neighbourhood has its own context, strengths and challenges and so we will the draw out the learnings from each location and share across the prototypes.

Seeing the whole person

One of our overarching principles has been the importance of understanding people’s lives beyond individual conditions.

By bringing together data from multiple partners, we’re developing a rich, contextual picture of people’s lives and how they interact with the system. What we’ve found is that clinical need rarely exists in isolation and that a person is not defined by the clinical conditions that they present to services with.

This has reinforced the need for a relational approach to sit at the heart of the work; one which focuses on the whole person rather than single conditions or diagnoses.

Connecting organisations around communities

The programme has brought together partners from primary, secondary and community care, social care, public health and wellbeing teams, housing and the voluntary, community and social enterprise (VCSE) sector.

A key learning has been that multiple organisations are already supporting communities, but often without strong connections between them. Services can operate side by side, working with the same people while remaining disconnected from one another.

A significant part of neighbourhood working is therefore about building relationships between organisations, creating more coordinated support and learning together.

Challenges on the journey

Like any transformational reform programme, there have been challenges.

It is important to resist the pressure to move quickly to implement ready-made solutions and service design and implementation before fully understanding both the community and the cohort.  Language adds a further challenge with terms such as “co-design”, “neighbourhood” and “left shift” meaning very different things to different partners, and easily leads to confusion.

Learning by doing

We describe this work as a series of prototypes rather than pilots or projects because we’re not testing a predetermined solution.

Instead, we’re learning directly from residents and iterating ways of working as we go. Every interaction helps us understand not only what matters to an individual, but also what’s working, what isn’t, and where service and system change is needed.

Our goal is to develop an approach that can be adapted across other neighbourhoods and cohorts, with the subsequent learning and resultant change improving services for all.

Successful and sustainable system change is dependent on having the necessary supporting governance.  Dedicating time and energy to sense-making as well as delivery and having a senior leadership group to enable the work (clear the runway) is of paramount importance.

For places or organisations beginning their own neighbourhood health journey, our advice is simple: take time to understand your communities, avoid assumptions, be curious and open to living with a degree of uncertainty and develop a mechanism to prioritise learning through the work.

Residents must be at the heart of the work because neighbourhood health isn’t something we design for people – it’s something we build with them.