Building Collaborative Places: How to make system change real

Report from the North East Social Leader’s Network  meeting on 5th April 2017, by our Business Development Manager, Neil Shashoua with thanks for the photos to Carol Botten of VONNE (via Twitter).

The event

The Network hosted Dr Henry Kippin, Director of Collaborate launching, in the North of England, Collaborate’sBuilding Collaborative Places’ , a report that draws on a year of action research in Greater Manchester, the West Midlands and the South East. It offers system leaders a framework to reboot strategic partnerships and change the culture of collaboration across services to the public in a place.

Takeaway

Everyone talks about collaboration, system change, and asset-based approaches; often these words are used as part of rhetoric resulting in little actual change. The big systems that operate in planning, funding, and delivering public goods need changing; for at least two reasons:

  • Money to run them – the old social contract of an exchange of economic growth for the improvement of everyone’s living conditions, no longer operates. The gap between rich and poor; in our towns, cities, countries and the world, is increasing and a new politics of ‘permanent austerity’ is in the ascendency in this country.
  • Power – the shift in providing welfare services from the state to individuals and businesses means that we are all less confident in continuing to do things to people in which they have little or no say.

New principles for place based change include

  1. Stop thinking about public services and start thinking about services to the public – it’s not just about what local authorities, the NHS and other public bodies provide
  2. Collaboration by default should be our mode of thinking and acting
  3. The people who are the end users of the change get to define the scope/location of the change – top down grand plans tend to fail to bring about lasting change.

The activities that system change need to succeed are to do with setting up the conditions that make change possible. Collaborate have identified nine building blocks of infrastructure for local collaboration. A key insight from their research is that, in the main, the separate, silo infrastructure of each organisation in the system that needs to be changed tends to undermine collaboration, thereby fracturing the local system. Furthermore, the role of collaborative infrastructure to enable system change is often overlooked, misunderstood and underplayed.

Leaders need to lead by example; which is why leadership is hard. Thinking beyond the concerns and boundaries of the organisation you lead is a personal journey.

Why this is important to the Consortium

Here at the Consortium, we have a big vision around assisting our members to collaborate with each other and with commissioners and funders to improve the health, care and well being of people in Gateshead and Newcastle. Increasingly, the organisations and programmes with which we collaborate are pushing the system to change so that’s people who are already disadvantaged in our area are not disadvantaged further by the failure of the system to respond to their needs and that their response does not disadvantage those people further.

Collaborate’s analysis and tools are refreshing and inspiring. We think they are worth exploring to help us change the conversation (and therefore our approach and thinking) in how we assist our members and supporters to change the systems within which they operate and help their beneficiaries to improve their lives.

The full report

Q: Why is collaboration a lot like teenage sex?

A: Because everyone says they are doing it; everybody thinks everybody else is doing it. And the reality is that no-one’s doing much of it at all.

Dr Kippin’s opening joke led onto him talking about the language we use around system change; he finds it disheartening and challenged us to come up with different terms. In his view, collaboration, system change and asset-based are terms used a lot of the time, and a lot of the time these terms are used to sustain a system with very little change.

Whenever we think of system change we need to ask ‘for whom and on behalf of whom?’ In this way we can find out whether the collaboration that we talk about holds the weight of the work we do.

Where are we now?

Woody AllenThe current international scene as well as what’s going on in our towns and cities everyday feels like ‘the end of days’. We have a new politics of permanent austerity. There’s been a shift away from public management and the marketisation of public services has not led to better services nor got us out of the fix we are in. The cost of welfare is being deliberately shifted from the state to individuals and businesses. Not many of the models we have for service provision feel sustainable.

There is no point in trying to save public services as they were in Nye Bevan’s day when a bedpan dropped in hospital reverberated in the corridors of Whitehall. We’re not in that world (and perhaps we never were).

The gap between the demand for public services and the spend gap is estimated at £7bn. we can’t change the system by throwing money at it. Demand is more complex than that anyway because we (an ageing population) have all the characteristics and complexities that we do.

This is also where we start to question the growth model – it doesn’t make sense to keep thinking of our economy as growing and that services to the public will be funded from that growth. Our economy has undergone a structural change enabling an increasing gap between rich and poor in this country (and the world).

How we manage change – we know less than we think we do

Evaluations of big change programmes, such as Troubled Families, shows that however good the theory and however good the practice, the outcomes may still end up to be very poor.

The public’s experience of public services

This can be encapsulated by the Groucho Marx quote “I’ve had a perfectly wonderful evening. But this wasn’t it.” The public’s engagement with the state’s services to a level where they are influencing and controlling them is very low.

The welfare state now

If William Beveridge, architect of the welfare state, arrived in the North East now, what William Beveridgewould he find? If the five Giants of the post war Country which Beveridge addressed were want, disease, squalor, ignorance and idleness; what are the new Giants today?

On Dr Kippin’s list of new Giants are housing, domestic violence, loneliness, social isolation, mental ill health, and poor aspirations. They are all the drivers of pubic spending, poor service outcomes, and miserable lives of people who experience them. And none of them are the gift of any one organisation to solve.

But we have a vision gap for the future of public services because our current politics deals with very short-term phenomena. We need place based system change and Collaborates report makes the case for what place based change needs to happen and why it is important. Let’s start with principles for place based change.

Principles of a new model of place based changed

These might look different in different places.

principles of new modelFirstly a shift from public services to services to the public. We needs to stop thinking only about public services and instead to think about what people need to ensure they have access to the world eg a smartphone and wifi connection.

Secondly, trying to be collaborative by default – a lot of the dysfunction in our society is reinforced or created by failure demand created by the fragmentation of public services for mostly historical reasons. If we look at the Public Health England sponsored Commission for Health and Social Care Integration in the North East, it is less about public services and more about what it would take to get consultant doctors to live in Sunderland and how to reduce the high proportion of agency staff in our health & social care services. It very much echoes The Marmot Review into health inequalities in England about the world we want to see.

There are things we always need to do when thinking about system change

  1. Change the starting point of these conversations. Places mean different things to different people. Brexit told us that. Agencies usually start off having mapped out their focus for the location where they want to see flip the starting pointchange – rarely do they ask what does that mean for the people who live there.
    Similarly social support mean different things to different people. Researching into families under the Troubled Families programme showed that what positive change means for families can be different from what it means to professionals.
  2. Learn from practice – take this notion of collaboration seriously. It is nice to have a sense that you are working togpracticeether and the more you talk about sharing power and risk, the better it will work.

None of this happens by accident – there are some places doing it really well

  • Coventry – Ignite: VCS system led change
  • Oldham – innovative work around primary care, GPs doing less work for less income and bringing in people do to do other things to improve health
  • Sheffield Money; the City Council set up a rival to Wonga.
  • Suffolk – model for how community development, economic growth and public sector reform work together.

All of these things have one thing in common – that they are pushing against the grain. We don’t need more plans/more design. We need to focus on what are the conditions that need to be true for what we want to happen. We need to ask ourselves what needs to be true in order for this behaviour to change? When we are thing about system change it is about pre-conditions.

And when we talk about the conditions that need to be in place the change to happen, we are talking about infrastructure to underpinning those conditions. Infrastructure is about the rewiring that needs to be in place for change to happen.

Collaborate have boiled this down to nine building blocks to system change to create a way to have a diagnostic conversation about system change.

Building blocks

What does all this mean in terms of leadership?

Since this is the North East social leaders network, Dr Kippin wanted to pose the question of what does all of this mean for leaders. Increasingly he finds himself agreeing with the old adage ‘A fish rots form the head down’. Most transformations of big organsations fail- one prominent leader has estimated that 70% of them fail. Businesses fail to transform themselves because leading this agenda is a personal journey. Perhaps the nearer you are to the top, the harder it is to make that personal journey.

People in positions of responsibility and power need to take responsibility. CEOs of hospital Trusts need to think beyond the next CQC rating.

He gave as a good example of leadership Mick Cornett, the Mayor of Oklahoma City, who concerned that his city was too obese, found that he was too. His response was to go on a diet and took the city through his diet. His influence made a significant difference to obesity rates in Oklahoma. You can watch him talk about it here

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