How shifting mindsets helps shift power

| Rachel Berry

This blog has been written by Nicola Wood, Programme Manager – Person and Community-Centred Approaches, Tameside & Glossop Integrated Care NHS Foundation Trust.

“I have realised that I am not the solution. The answer to most of the issues I see lies with people and communities and not my prescription pad.”

As lightbulb moments go, this was a pretty special one. This reflection from a GP came at the closing event of our first 100-day challenge in Tameside and Glossop. It was the first evidence that our efforts to shift the emphasis towards more person and community-centred thinking might be having an impact.   

But let’s start at the beginning. In early 2017, Tameside and Glossop were awarded transformation funding to develop and deliver an ambitious system-wide self-care programme. The aims were clear: to create the conditions for a shift in power from institutions to communities; to build a different relationship between “professionals” and people; and to give equal value to ‘More than Medicine’ approaches that address the wider determinants of health.  

Our first response was to allocate the majority of the investment for communities, by supporting a strong infrastructure for the Voluntary, Community, Faith & Social Enterprise (VCF&SE) sector. We commissioned a social prescribing and asset-based community development programme and team. The teams are based in the voluntary sector and act as the important bridge between the public sector institutions and the communities where people live.

It was important to create the conditions for social prescribing to operate, so grants were made available to help communities build small ideas into reality. All ideas are considered. So far, we have invested in everything from bereavement and life-limiting illness support to musical theatre, allotments and animal assisted therapy groups. It was important to position this provision alongside general practice with simple referral routes and flexible access criteria. Three years on and the existing team is now enhanced by additional posts funded via our Primary Care Networks (PCNs).

With the help of NHS national network organisation Altogether Better, we extended the concept of people-powered health into the land of general practice. Practices collaborate with the community to improve the health and wellbeing of people in the local area. As a result, dozens of Wellbeing in Practice Champions have offered their skills, talents, interests and time to support the practice patients who have non-medical concerns. They have offered waiting room support (form filling, a listening ear, signposting), done Tai Chi and gone on health walks, and run a Parkinson’s café, quiz nights and craft groups. The Wellbeing in Practice model is active in nine practices, with a commitment by the PCNs to involve all practices over the coming year.

Making space for others

The shift in power is subtle. There hasn’t a community-led revolution or coup to seize control of their health and wellbeing. But all these activities and messages are challenging mindsets of those working in our health and care services. They are realising that they don’t have to hold all the responsibility, or to continue to feel so overwhelmed by the sheer scale of the task at hand. They can let go, take a risk and open up space to invite in others to take control, whether that’s a social prescriber or even the person themselves.

As mindsets start to change, that’s our opportunity to offer space for staff to learn, gain new skills and experience different ways of working. We bridge that divide between institutions by bringing staff, volunteers and the public together with no hierarchies, just a common appreciation of the skills and experience of the humans in the room. 

It’s working. In fact, the first 100-day challenge we ran was so successful that we worked with innovation foundation Nesta to do the whole thing again. Six cross-sector teams have participated, using person and community-centred approaches as a framework to approach health morbidity in a different way. Those taking part gained a better awareness of the value of person and community-centred approaches, a shift in the relationship between statutory and voluntary sector providers, and a greater appreciation of the talents and skills of volunteers and patient representatives. 

From fixer to facilitator

There’s a better sense of awareness and trust between colleagues. The next step is to establish what skills and mindset they need to shift that power dynamic in their consultations. In Tameside & Glossop, TPC Health have trained a team of health and care practitioners to facilitate a two-day workshop in person-centred coaching. It’s free and open to anyone working or volunteering in Tameside & Glossop. It’s brought together volunteers working alongside hospital consultants and domiciliary care staff working alongside mental wellbeing practitioners and patient representatives. The result is a shift from rescuer, master problem solver and fixer to coach, facilitator and enabler. People and communities are resourceful and solutions are usually obvious if we step back, recognise the potential and give the space and prompts to unlock new ideas. 

As well as engaging the existing workforce we are also looking to the future by incorporating a 16th Standard into our Care Certificate delivery for non-affiliated staff, particularly new health care assistants. This introduces the concept of person and community-centred approaches into the standardised programme, and positions its importance alongside fundamentals, such as safeguarding and health and safety. This Standard has since been adopted by our domiciliary care providers and there is potential for its inclusion in the Health and Social Care offer of two of our local further education colleges.

This is a snapshot of some of the activity we have developed in the past three years, and it has been successful – in pockets. There is no doubt of the positive impact social prescribing has for someone struggling to manage long-term health conditions in the context of overwhelming loneliness and social isolation, or for the Community Psychiatric Nurse who, in their words, has changed their whole perspective on care planning conversations to ensure the person is in control. 

But it hasn’t always been easy. The shift we are describing can feel overwhelming, or even threatening. When we say self-care, there is a danger that what the public hears is no care. When we say people and community-powered health, the workforce may perceive a threat to their professional integrity and the dumbing down of their experience and expertise. Some of the issue lies in the language we use to describe person and community-centred approaches. We need to challenge ourselves to re-connect everyone with our common humanity. We are the community; this doesn’t switch off between the hours of 9am and 5pm. So far, we have created a shift among those who have participated in some of our initiatives. But it’s difficult to translate the new-found inspiration fostered in learning environments into the real world when describing a new relationship and change in ways of working. Often the system and processes within organisations make it difficult to apply. 

To overcome this, we need to move our thinking from individuals to organisations, and we need to think of the system as bigger than traditional health and care organisations, to include all those that have an impact on population health. Our next ambition is to consider how person and community-centred approaches translate from interactions between two people to interactions between whole teams and organisations. A person-centred organisation is one that weaves person and community-centred approaches into the values and behaviours of the entire organisation. A person-centred organisation has people at its heart – both people it serves and people it employs. Imagine if the organisation, its leaders and managers were allowed to lead and behave in a person-centred way.

Further reading

Read more about person-centred organisations at Helen Sanderson Associates


Photo by Aziz Acharki

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