By Fiona Weir, Community Partnerships Manager Kirklees Council

I have been thinking about asset-based approaches to developing health and well-being, and asking why organisations sometimes struggle to use them, even if they want to…

I know I am not alone, because I have been to three conferences in the last three or four months, all focused on asset-based approaches in health and care. Interest is growing, and quite right too. What is health all about, if not people?! So, when we want to improve health and well-being (or any other public services), we should of course start with people, and build on what people care about and do.

There are lots of experts better qualified than me to explain what ‘asset-based approaches’ are, if you don’t already know. If you want to know more, I suggest reading information from Nurture Development or the ABCD Institute. There are now several different methodologies described as ‘asset-based development’, but the shared pillars and principles are clear:

• People – They are at the heart of communities, health and wellbeing.
• Development – When change is happening, it should be driven by the people affected by it.
• Passion – People care about stuff. Passion drives change, and a key question for both community development and health improvement is, “What do you care enough about to change?”
• Relationships – It’s vital to understand who knows who, and who can influence who. And the more people know each other, the more gets done.
• Power – Services working in communities need to recognise the balances and imbalances of power and resources, and ask: who is making the decisions, who has the money, who has the time, who has the knowledge, who has the passion…?
• Assets – Focus on what’s strong rather than what’s wrong.

None of this is difficult to understand, and we’ve been talking about it for a long time – decades, in some places. There’s no significant disagreement that asset-based working is the way to achieve the best outcomes for individuals and communities, and for public service organisations too. There are fantastic examples of UK health/care good practice, including shared lives schemes, some community-led social prescribing services and self-care at its best. So why isn’t asset-based development happening systematically, across all health and care services? Why are asset-based approaches still more talked about than used?

There are some obvious answers: lack of money, lack of time, lack of understanding and training. Budget pressures are making it hard for public sector organisations to prioritise anything that does not produce immediate or very rapid savings. But there are some subtler reasons, which I think are rooted in the psychology of organisations and the people working within them, often hidden not surfaced, and therefore harder to tackle. It’s always useful to ask questions when development isn’t happening as expected, and here are some of mine…

What underpinning attitudes and beliefs get in the way of asset-based development?

Ambivalence – Ironically, budget pressures are simultaneously a reason that asset-based approaches currently seem too difficult to try out, and a reason why they are growing in popularity. Public sector leaders know that they simply do not have the money to do everything they did before, so as services face closure (call me cynical!), the idea of getting more people to do more things for themselves becomes increasingly appealing and necessary. But this gives rise to some complex feelings, including guilt and questioning of motives: managers ask “Are we introducing asset-based approaches because we believe in them, or because we need to save money?” or “Will asset-based approaches really save us money?” And staff ask “Are asset-based approaches just a sneaky way of leaving communities without enough support?” This kind of ambivalence stops organisations from genuinely adopting asset-based approaches, or slows them for months or years until the questions are resolved.

Anxiety brought by changing notions of ‘public service’ – Most of the people working in public sector organisations are committed to the idea of ‘public service’ – which means they believe in serving the needs of their communities and clients. Asset-based approaches don’t always come easily to staff and managers who have been trained and expected to help, serve, avoid risks, care for and protect people. ‘Looking after’ people can feel much safer and more familiar than enabling people to look after themselves. ‘Doing for’ people can feel kinder or more helpful than empowering them to do things for themselves. Staff who are asked to adopt asset-based approaches often need to go through a process of ‘letting go’ or ‘stepping back’. It can take a while to recognise and truly believe that asset-based approaches will enable them to serve the needs of their communities or clients as well or even better. A useful question for leaders planning change can be “What positive or well-intentioned emotions are stopping our workforce from using asset-based approaches?”

Failure to treat staff as assets – This is a hidden issue that I do not see much acknowledged. In organisations where there is not much progress despite a theoretical commitment to asset-based approaches, it seems this is sometimes because of the way staff are being treated. We can revisit the principles of asset-based development outlined above, and sometimes see that staff are expected to apply these principles in their work, without ever actually experiencing them themselves. Organisations need to ask, “Are we taking an asset-based approach to developing our staff?”

What other questions can public sector leaders and managers usefully ask?

People – We are committed to people-powered change, but do we recognise that staff and managers are ‘people’ too? Do we recognise that health workers are also patients, and that all other public sector staff use and pay for public services, as well as providing them? Do we know how many of our staff also live in our local communities or use our services? What extra knowledge or commitment does that bring to our organisation? How can we make the most of the ‘double-commitment’ that many staff have, to improving their organisations and their communities?

Development – Do we recognise how staff are affected by public service changes? Are we supporting them with change, so that they can more effectively support communities and service users? Are we involving staff in planning for changes that affect them, especially if we want them to involve communities? How can we grow the skills and the commitment of our staff? How can we translate that into growing the skills and the commitment of our communities and service users?

Passion – Do we see passion as an asset? Do we see it as complementing hard-headed planning, or threatening it? Are we asking our staff as well as communities and service users “What do you care enough about to change?” How can we harness passion and commitment?

Relationships – Are we investing in building relationships, in every part of the system and cross-system too? Are we aware that every neglected relationship is an opportunity lost or put at risk? Do we know where relationships are weakest, inside and outside our organisation? How can we strengthen these? Do we know where relationships are strongest? Are we, for example, making the most of front-line workers’ fantastic relationships with communities? If you are a manager, ask yourself “Do I know my team and where each person can make the biggest impact?” If you’re a commissioner, ask “Who else needs to be round the table with me to make the best decisions?” and “Am I investing in relationships that strengthen commissioning?”

Power – Do we know who is making the decisions, who has the money, who has the time, who has the knowledge…? Are we recognising and acknowledging where staff and managers feel they have power, and where they feel powerless?

Assets – Are we focused on “what’s strong not what’s wrong” in our workforce? Is our workforce development strengths-based? Are we giving messages – deliberately or unintentionally – that staff or managers are a problem or barrier to change? How can we better give staff and managers the message they are part of the solution, not the problem? If we use external consultants, will we create the impression that our own people aren’t up to the job, and if so, how can we counter-balance this? How can we use the skills and knowledge we already have in-house? Are we making the most of workforce assets? Does our leadership or management act as if staff are not important? Does this reveal or suggest that they privately think communities aren’t very important either? Are we sure?!

Practical tools and resources to help develop your workforce and your thinking, can be found online, including the ABCD Institute’s toolkit, Nesta’s collection of health and care resources, the enabling social action resources produced by the New Economics Foundation and the Office for Civil Society.

Asset-based approaches are here to stay in health, care and other public services. Chapter 2 of the NHS Five Year Forward View makes clear that organisations must change relationships with patients and communities, in ways that see people as assets and co-creators of health. But trusts, clinical commissioning groups, service providers and councils all have some way to go… I suggest that asset-based approaches in communities and with individual patients must start with asset-based workforce development; and that sometimes, if asset-based development is not happening as expected, an organisation needs to change its relationships with its workforce too, and consider – Are we asking the right questions about asset-based development?

This blog was first published on LinkedIn on 11th June 2017 

Photo by David Martin Jr.