Putting communities at the heart of place – why a shared vision isn’t enough
PPL share their lessons from 15 years of supporting better outcomes by developing effective place-based partnerships.
The place-based partnerships currently forming across the UK are exploring new ways of working between health, social care, and voluntary and community sector organisations.
Many place-based partnerships say they want to put communities and local people at the heart of their work and to collaborate with local people to tackle entrenched inequalities differently. Actually realising community power in practice will be key to the future of place-based partnerships, and vice-versa.
At PPL, we’ve worked with place-based partnerships across the UK at various stages of their journeys toward integration, strengthening partnerships between organisations and communities.
Our top lessons from developing place-based partnerships:
1. It’s all about people
There’s been significant investment and advancement in areas such as Population Health Management as ways to better understand, predict and respond to local needs.
These techniques and data can be enormously powerful but are no substitute for understanding the diversity, wants and needs of the individuals who make up our organisations, systems and communities.
Early, broad and authentic conversations are key to understanding why – when we all want to do a good job – such positive intentions often fail to overcome the barriers to better ways of working and don’t translate to real improvements in people’s health and wellbeing.
2. A shared vision isn’t enough
We’ve been talking about integration in health and care services for long enough that most people involved in local partnership development can articulate strong and similar visions for what “good” might look like.
But, without a clear narrative that connects this vision to the daily experiences of patients, carers, service users and frontline professionals – that explains how “tomorrow is going to come to the aid of today” – it’s likely to remain just that, a vision of what could have been, always just out-of-reach.
Through co-designing a clear and specific narrative built around lived experience, we can help establish a clear roadmap based on the priorities and outcomes that matter to people’s lives, and the broad coalitions that are needed to deliver.
In Surrey Downs, we’ve worked with the Surrey Downs Health and Care Partnership to support the development of place-based partnership working.
The question “but what are we going to do about the mould?” has become a powerful cultural symbol of what integration can mean at place. This phrase came from a clinician as part of a programme of place-based Organisational Development we co-created and delivered. On leaving a home-visit, a clinician realised he should have looked beyond immediate symptoms and needs and also addressed the mould that was inevitably affecting the person’s health.
3. Working in partnership is hard
The pandemic has seen a step-change in how we work and how all those involved in health and care have engaged with each other, with voluntary and community sector partners, and with communities themselves.
But we can already see how the pressures on individuals and organisations are starting to re-assert themselves and threaten some of the shared purpose and ways of working that have developed in this period.
While there are huge benefits to working in partnership, we must also recognise the costs – and the importance of being able to resolve conflicts, negotiate complexity, make and implement joint decisions, and share risks and rewards.
The most robustly structured partnership agreements are no substitute for developing a culture of joint working that extends beyond the exceptional leaders that often sit at the heart of the best of our current integrated care systems. Empowering people to acknowledge the challenges and to work through them will help them achieve the benefits of better integrated care.
4. Build to scale
There is nothing wrong with starting small and it’s critical that partnerships can evidence the benefits of people working differently. Be that in delivering “quick-wins” for local people or through prototyping new ways of working that show the possibilities of change.
However, too many of our partnerships stall at this stage – establishing ‘walled gardens’ where we feel comfortable working together whilst most people’s experiences of care remain unchanged.
Scaling means having in place the shared governance, infrastructure, funding and organisational development to enable the many to benefit, not just the few.
5. It’s still all about people
For too long, our partnerships have been structured around statutory institutions and a belief that, if only they can construct the right ‘pathways’ of care, then better outcomes will follow.
The experience of Covid-19 has been a painful reminder of the terrible effects of inequalities on people’s health and wellbeing, the vital role people play in their own health and care outcomes, and the impact of failing to hear what people are saying they need from local services.
In Lewisham, we provided support to health and care partners to co-develop a shared approach to community and citizen engagement, with a focus on ensuring previously seldom-heard community voices form a key part of partnership development.
Only through this kind of effective and ongoing community engagement and empowerment will we achieve real and lasting improvements in people’s health and wellbeing and, in turn, ensure our health and care systems are sustainable for the generations to come.
PPL is a social enterprise and B Corp that exists to promote better health, wellbeing and economic outcomes across the UK working with individuals, communities and the organisations that support them.
In 2022 they were named one of the UK’s leading management consultancies by the FT. Read their 20/21 impact report.
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