Crossing the river: re-thinking power and influence in public sector services

| Helen Sharp

“If public services are to move towards a more preventative approach then individual citizens, and particularly their communities and networks, must take on much greater responsibility for their own lives. However, that flourishing of responsibility will only occur if citizens and communities are given the power to exercise it. This means fundamentally challenging the strong tendency of public services to hoard power rather than share it.” 

Exec Summary Community Paradigm, NLGN

“Names not numbers” is the commitment Greater Manchester’s (GM) leaders have given as they set out to create the most radical overhaul of the way public services have ever been delivered – with people’s health and the NHS at its heart. 

Public Services across Greater Manchester are on a journey to sharing power with the people and communities they serve. Their success depends on communities having the power and tools to shape their own neighbourhoods. This challenges the traditional way of working and requires a different relationship between people, communities and public services.

Traditional practice, where public sector commissioners determine what is needed by large populations and statutory services deliver to them, can result in communities being ‘done to’. But local communities understand what matters most to them and which solutions will work. They know how to support and invest in these to change things for the better. Working with them, and sharing decision making, will build better public services and help support citizens of Greater Manchester to have better lives.

In September 2019, we partnered with the University of Salford and MACC to undertake a critical reflection of how successfully local initiatives in three of those areas (Stockport, Rochdale and Bury) had managed to enable the sharing of power from organisations to community. We are in the analysis stage of this reflection piece and as part of our findings, we are showcasing some of the fantastic work that is going on, through a series of blogs. 

Over the next few months we will feature stories from local commissioners, locality leads and a resident, to demonstrate the success, challenges and impact of GM’s vision. 

This blog has been written by Nick Dixon, the Senior Advisor on the PCCA (Person and Community Centred Approaches) team.  He sets out the context and environment within which this work is trying to flourish and tells a compelling story of why it is necessary.

Greater Manchester has a golden opportunity to use its devolution status to create a new Civil Society

The city can make the most of the recently published Greater Manchester Health and Social Care Partnership Prospectus and the Greater Manchester Public Service Reform Model to reshape its relationship with the three million people living in it. It can fundamentally change how services are designed, delivered and experienced by residents. 

This will mean supporting more people to become independent and self-reliant. It will mean reducing dependency on public services and growing trust. Most of all, if people are to take more responsibility for their own health and wellbeing, it means sharing power. 

Adam Lent and Jessica Studdert put it this way: “The activation of communities can only happen when power and resources are handed over to those communities. It is meaningless to demand a step change in the responsibility people take for their own health and wellbeing if they are not provided with the tools to take on that responsibility”. 

The tangible impacts of Person and Community Centred Approaches are clear: for example, workforce programmes that encourage staff to start with a strengths-based conversation, integrated personal budgets, referrals from Link Workers to non-medical solutions, or measuring patient activation. But what’s intangible is the culture change that’s needed for these approaches to work – and the power and influence that sits behind them.

Every Greater Manchester Locality intends to develop a new relationship with their citizens. But there’s a risk that, while the language of services changes, the underlying system remains the same. In every Locality there are wonderful examples of services led by passionate individuals. They embrace person and community-centred values and behaviours. They see strengths, abundance and opportunities, instead of scarcity resources and individual need. Every Locality is striving to shift this discourse and practice, but too often institutional service silos remain in place.

Imagine two riverbanks. The ‘castles’ of the service world are on one: the Clinical Commissioning Group, the NHS Foundation Trust, the Adult Social Care Directorate and the Police, for example. Chief Executives and leaders peer at each other over the parapets, knowing that working together would let them build an Integrated Care System and align public services. 

But the drawbridges are raised. To lower the drawbridge and leave the castle, each leader has to trust that the others will join them outside the safety of their own building. It’s risky to leave the castle for the more exposed land. But that’s where you can build stronger foundations for collaboration and integration, because you can more easily see and understand other perspectives.

On the other side of the river are citizens and communities, which draw on the castles’ scarce resources. There’s a steady stream of ambulances rushing across the bridge. 

From this side of the river, citizens can’t see the leaders considering lowering the drawbridges. They can only see that they’re currently raised. Public services, and its leaders, are distant and disconnected. They’re to blame when their parents receive a diagnosis of dementia, followed by inefficient and impersonal care. They’re at fault when potholes remain unfilled or litter blows through unkempt public gardens. 

But the people who work in the castles don’t live there. They live on the other side of the river, in the community. When they cross the river to work, they connect the two sides – but when they get to work, they’re trained to speak a different language: of assessment, need, risk, governance and policy. The connection is severed. At the end of the day they return home, to family, friends, hobbies, food and fun. Work and life are completely separate. But if those who work in public services are invested in as people and not simply foot soldiers, the river could be permanently bridged and the two groups on either side could be brought together.

We know there are core groups already building that critical bridge. Voluntary, Community, Faith and Social Enterprise groups can connect services and citizens because they speak both languages. They are the ones that can broker the accord.

As the Greater Manchester Voluntary, Community and Social Enterprise (VCSE) Devolution Reference Group says, “We understand our communities. We can help drive people-powered change, harnessing social action and bridging the gap that can exist between public services and the people they serve.”

What would that bridge across the river look like? In Greater Manchester, the building work has already begun. Watch this space for the next part of the story.

Further reading

To find out more about power and influence in co-production, read The ‘Power Elephant’ in the Room, a conversation with Priptal Tamber and Lauren Weinstein. 

Photo by Matheus Ferrero

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