The space-maker: introducing Samira Ben Omar
Our newest board member, Samira Ben Omar, has dedicated her career to addressing inequalities in health and other spheres. She talks to Katy Oglethorpe about why the NHS needs to stop talking about people being hard to reach; her groundbreaking work with health champions and why she’s stubborn when it comes to community power.
Your work has focused on the space between public institutions and the communities they serve. Why has this been such a calling?
I suppose my career is defined by my personal story. I came to the UK at 15 as an immigrant, and so had to learn a new language and adapt to a new culture.
In the NHS, we keep asking why people are not engaging, or how you reach certain groups. I know why – because that’s who I am, that’s where I come from. I can tell you why my mum, my siblings, my community won’t reach out to you, because there’s a disconnect between their reality and your reality.
I’m interested in how we create spaces where you begin to create a paradigm shift in the way we connect with communities. How do we make sure that their voices are really at the forefront of what we do?
The rewarding thing for me is the ability to be able to facilitate spaces between communities and systems, and to see those conversations emerge, and people beginning to shift their thinking. You are always going to have a division, but what you do is grow the ‘in-between’ space.
If we change ‘hard to reach’, to ‘easy to ignore’, how does that manifest itself in our strategies?
We can start by challenging the language that we use within systems. If we change ‘hard to reach’, to ‘easy to ignore’, how does that manifest itself in our strategies? How about if we stop talking about ‘reaching out’ and say ‘reaching into’ instead? ‘Reaching out’ assumes we are at the centre of power. Whereas if we think about communities as where power is centered and we are ‘reaching into’ that power, that creates a different type of conversation.
This is about really being brave in beginning to think about your strategies. Are they truly reflecting the voices of your community, or are they just reflecting the voices of your leadership?
How have the latest reforms to the NHS helped – or hindered – efforts to tackle health inequalities by engaging communities?
I worked in the NHS for a good 25 years, and I know how much we love a three-letter acronym. But we need to recognise that an ICS, a CCG, a PCG, a PCN only exist in our institutional psyche. What’s real is our communities, so how do we work with them differently to create a paradigm shift?
We need to recognise that an ICS, a CCG, a PCG, a PCN only exist in our institutional psyche.
I think the reforms do provide an opportunity to bring organisations together to address health inequalities. But reforms like this tend to focus on structure – on activities and processes, rather than on people and outcomes. Reversing this will require conversations and building relationships. It doesn’t start with a strategy and a program – I’m not saying that strategy and a program are not important, I’m saying that those come afterwards.
Sometimes the NHS might have to make difficult decisions around doing less. Things are really tight. So what do we need to stop doing for us to enable us to do what we really need to? That requires some unlearning, it requires some undoing, and it requires brave strategic leadership and a different type of thinking.
The Community Champions programme you co-founded in Kensington and Chelsea recently celebrated its 11th anniversary. How did it come about?
The Community Champions work was very much born out frustration. I was working for an NHS public health team at the time and saw a desperate need to take a different approach. We had a little bit of funding from the London Health Commission – around £6,000 – and we worked with a resident’s association to bring a representative group of local people together to decide how we should spend it.
Our promise to them was, whatever comes out of this conversation, even if it means line dancing, we’ll fund it. In return, we asked that each of the people speak to at least to 10 people in their neighbourhood to gather their views too. They ended up speaking to hundreds of people. They decided to use the funding to put on a big community dinner using local produce and local staff. It was a big success.
Our promise to them was, whatever comes out of this conversation, even if it means line dancing, we’ll fund it
Then it was a question of how to nurture these people and how to work with them to really connect to the healthcare system? This is where Community Champions began.
Each champion receives accredited training in public health. It is voluntary but can lead to a paid position as a community consultant. Most people end up in employment in local health and care organisations. That’s the real selling point for the champions and for the system in growing our own workforce.
Their impact was clear from the start. We did a lung cancer awareness campaign where we asked them to speak to 600 people and they spoke to 2000 people. We did a campaign around child oral health, as our area had the highest tooth extraction in London, where the champions helped run education programmes in local schools.
The community were really the first responder the night [of the Grenfell fire], and continued to be.
We grew hubs, targeted in areas with the highest health inequalities who weren’t engaging with the formal system. Today, there are 13 hubs across two boroughs, with local authorities providing most of the five-year funding. The champions have also developed a maternity champion programme, in response to real issues around access to maternity services, and we have diabetes champions. It’s almost become a social movement.
One of the hubs was in the area of the Grenfell fire. The community champions were completely phenomenal at bringing people together, supporting, mobilising, finding out who was doing what in the immediate aftermath. The community were really the first responder that night, and continued to be.
How do you measure the impact of this work?
As soon as we began to do this work, we began to think about how to evaluate the impact. I’m mindful that these types of activities are invested in during times of plenty, but they’re the first things to go when budgets are tight. So how do we evaluate the programme so robustly that everyone is sure of its value?
We co-designed the evaluation frameworks with the community champions. It was challenging to get right, but the last evaluation found that for every time you spend a pound on this work, you save six pounds. The champions argue that this actually underestimates the impact, but I think it is quite a strong finding.
Why did you decide to join New Local’s Board?
Working in this space can be lonely because you’re trying to push an agenda that can feel very radical for people. The NHS particularly is used to thinking of community outreach in terms of engagements – ‘Tell us what you think and we’ll go and do something about it’. But I’m talking about transforming the way we work and how we connect with communities.
I am absolutely convinced that working with communities is absolutely the only way we’re going to address our public sector challenges.
For me, New Local provides something that fills the gap between system and community. A big moment for me was when I saw your table on community power and the NHS [below], and I thought, that’s what we need – I can use this to help mobilise others. It gave me the validation to speak to the system in a language that they might understand. It was exciting.
I am absolutely convinced that working with communities is absolutely the only way we’re going to address our public sector challenges. Imagine if we began to think about our communities as part of our wider workforce. Imagine the shift in how we develop our strategies, how we connect differently, how we cede power, and how develop and support our communities to help them deliver their aspirations, not ours.
I think that that’s the only way we’re going be able to deliver against huge challenges. Because financial challenges are not going to go away, and money is not going to be the only answer – it doesn’t matter how much. So what is sustainable and self-sustainable? What is permanent? It’s the people who live in our neighbourhoods. That’s where we should be investing above everything else.
For me, that’s the future. I can be quite stubborn about that, like a dog with a bone!
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