Health debates must move beyond a focus on dollars and scarcity to looking for abundance within communities, and to building sharing economies.
These are some of themes in the discussion below about how to build a responsive, resilient health and care system in the city of Sheffield in South Yorkshire, England, which may be of interest for other places too.
Many thanks to Roz Davies, founder of We Love Life, a social enterprise dedicated to “unlocking the combined potential of citizenship & digital to improve well-being”, for permission to cross-publish this article from her blog.
The Guardian has named @roz_davies as one of England’s top bloggers and tweeters on chronic illness. She has type one diabetes.
Roz Davies writes:
Sheffield is an amazing place to call home. Big enough to offer opportunities, small enough to feel the warmth of community, green enough to enjoy the outdoors, built up enough to have a diverse range of facilities. Something for everyone!
Sheffield is not without its challenges. Health inequalities, homelessness, poverty, youth unemployment and mental health issues to name a few.
Set in the context of significant changes for health and care, Sheffield has developed a plan it is calling ‘Shaping Sheffield’ which is an attempt to bring together a complex web of strategies and services.
Towards the end of last year, Greg Fell (Sheffield City Council Director for Public Health) and Judy Robinson (Sheffield Healthwatch Chair) asked me, along with Mike Simpkin and Dr Ollie Hart, to share our insights on how we might do things differently in Sheffield to achieve better health and well-being outcomes for all in our city.
We were given five minutes each to get our messages across! This blog is an extended version of the presentation I gave on moving from ‘Shaping Sheffield’ to ‘ShaRing Sheffield’.
In preparing for this presentation, I asked three inspirational leaders from very different backgrounds for advice on how I could deliver a presentation which doesn’t just get a well done and a clap (if I’m lucky) but also leads to real action.
Rob Webster, CE of South Yorkshire Partnership NHS FT said ‘show the added value’.
John Farenden, Director Health Advisory, Ernst and Young said ‘keep it simple’.
Chief Inspector Umer Khan, Greater Manchester Police said ‘get a small public commitment’.
So with that in mind here was my tuppence worth….
Having worked for local government and the NHS, I have a great deal of respect for our city leaders. The challenges they are grappling with are incredibly complex. This is a time for visionary and radical collective leadership and transformation.
We must also consider the wider context and ‘wicked’ issues around us. Austerity has hit public services and citizens hard. According to Joseph Rowntree Foundation, we now live in a country where 13.5 million people are living in poverty.
The latest Mori Poll Trust Survey shows a further dip in the public trust of politicians down to 15 percent (although they do still trust nurses at 93 percent).
Elections and referendums are being won on populist spin and soundbites. In the 1980s, multi-year ice made up 20 percent of the sea ice cover. Now it’s only about 3 percent,
Children spend an average of 6.5 hours a day in front of a screen. The fourth industrial revolution has arrived. Economic, political and environmental uncertainty are all directly or indirectly having an impact on health and care services.
On one level with transport infrastructure and digital communication systems, we are more connected with the rest of the world than we have ever been but on another level, we are increasingly lonely, isolated, fragmented and divided.
We are living in a time where the old systems are breaking down, locally, nationally and globally and quite possibly we are at a sliding doors moment.
Moving the deckchairs on top of the Titanic is not an option. We need to look up, use every resources and tool we all have to identify what’s ahead and navigate a clear path to a destination we all want to get to.
One thing is for sure, the world around us is changing and Charles Darwin had some very wise words on survival in the context of change:
It is not the strongest of species that survives, nor the most intelligent, but the one most responsive to change.”
Most of my work over the last 20 years has been about building stronger, more resilient, sharing communities, which are more able to be responsive to change.
A book I would recommend to read about this is Resilience; Why Things Bounce Back by Zolli and Healy. They talk about resilience as being:
The capacity of a system, enterprise or a person to maintain its core purpose and integrity in the face of dramatically changed circumstances.”
So as the old system breaks down around us and significant change occurs, the big question for those of us who can imagine the best possible future where people of all backgrounds, ages and abilities can thrive is:
How do we build more responsive and resilient communities and health and care systems together?
We need to develop a local sharing economy, build connections and sustainability from the grassroots up and focus our collective efforts on unleashing and sharing everything we have in our communities which will help build more responsive and resilient communities.
The first step is to understand what we already have in our people, place and organisations which will help us to achieve our goals.
It took me less than a minute to come up with a short list about the abundance that exists in Sheffield. We have thousands of trained and motivated community health activists in our city, unknown numbers of wonderful informal grassroots groups and a vibrant formal third sector.
We have at least three homegrown digital health community resources – Sheffield Flourish, Patient Opinion and Move More Sheffield and one of the largest local health and social care systems with enormous recruitment and procurement power, not to mention their patients, carers and volunteers.
We live in the greenest city in the country, have two big universities and a number of excellent colleges. Sheffield also hosts a number of national cultural events, e.g. DocFest and World Snooker and has thriving cultural community.
Understanding how to create the conditions where we can share what we already have in our local communities, and unleashing the potential of all of this abundant resource to improve health and well-being is where the added value comes in.
The resources to improve health and well-being are not just tied up in formal health and social care services or even in voluntary sector services.
Some principles for creating a ‘Sharing Sheffield’
Coproduction: The first place to start is with building trust, understanding purpose and responsibility. Genuinely listening with intent to understand to people who feel disempowered and vulnerable, creating safe spaces for real dialogue where different opinions, insights and ideas can be voiced and valued.
Learning together what we all need to live well, what gets in the way and what are the resources and restraints we have to work with. At its best this is called ‘Co-production’. Many ‘professionals’ worry about this term and others complain that it is ‘jargon’, it is a very simple concept, but very complex and difficult to achieve.
The biggest barrier is that we don’t all understand the value of sharing power or understand how to share power. My top tips are to start small, early and quietly and be genuine with intent, respectful and open to diverse opinions and ideas. Here are some useful resources:
A Book: No More Throw Away People, Edgar Cahn
A Video: The Parable of the Blobs and Squares
A Blog Post:Co-production, Radical Roots, Radical Results, Ally Cameron
Skills, knowledge, connections: As someone who lives with a complex long term condition (type 1 diabetes), I have really valued having the opportunity to develop the skills and knowledge to self manage my own condition through evidence based structured education (DAFNE) and I have had an amazing amount of peer support from being connected to my community and used digital technology in many ways to improve my blood sugar control and lifestyle.
In so many of the health-related initiatives I have been involved in, from Community Health Champions to Sheffield Flourish, peer support has been a key theme for improving well-being. Salutogenesis theories including Self Efficacy provide evidence-based explanations as to why this should be an important part of health.
Unleashing Potential and Self-Sustaining: Whilst there is scarcity in formal health and care services, there is abundance in resources in communities.
There is most certainly not abundance in financial resources, austerity has hit the most vulnerable hard, but there is an abundance of talents, ideas and insights in our people, which is untapped because of where we place value in our society.
Imagine if we valued a whole range of contributions from time spent chatting, cooking a meal, mending a fence, showing someone how to Skype their overseas relatives…This idea is not new, sharing economies are being (re) built in many places.
In Sheffield we already have a brilliant Timebank led by St Mary’s Church, we have Sheffield Soup and many different volunteering activities where people are sharing their skills, time and energy across the city.
With a little financial resource and a lot of shared efforts, an amazing amount of talent and resource can be unleashed.
Alongside the informal sharing economy, the formal public and commercial system has an incredible amount to share, from formal purchasing and procurement power to opening up facilities to local community groups and corporate social responsibility volunteering.
Imagine if Sheffield took on the Incredible Edible idea across the whole city with the public sector and commercial organisations releasing land and other under utilised resources.
We already have the amazing Regather and Abundance and a whole bundle of new food ‘pay as you feel’ projects flourishing like Real Junk Food and the Food Hall Project.
Brave Leadership: Geo politics shocked the world in 2016. One of the more positive resuIts has been an increase in powerful, thoughtful leadership from many different places. Henry Mintzberg has written an excellent call to action post and there was one particular tweet which stood out for me over the US elections written by J.K. Rowling:
Now, more than ever, we need brave and visionary leadership which imagines the best possible future, holds the line on our values and creates the conditions where everyone feels included and valued and able to contribute to building that future.
I think this is going to mean feeling empowered to bend or even change the rules which don’t make sense and negotiating a new contract between citizens and government. Like it or not, health and care is at the forefront of this complex change. Check out Helen Bevan’s twitter feed for insights on leaders of the future.
There is no doubt that digital technology is part of the future, for better or for worse. It is disrupting every area of our lives: taxis (Uber), holidays (Air BnB), shopping (Amazon) and health is no exception.
In the last year I have begun sharing how digital has had an impact on my life and how it has helped me manage my condition. Digital is changing how we are connecting with each other and given us new channels for sharing, including through ‘Peer Support’. One excellent example is #BPDChat set up by Sue Sibbald who from her base in Sheffield has created a supportive network which reaches out all over the world every Sunday evening.
There are issues with using digital, which need to be understood and resolved. The biggest one is ensuring that individuals are empowered to use digital in a way that is helpful not harmful to them.
Jamie Bartlett of Demos has carried out some interesting investigations into the dark net including in health. The Good Things Foundation explores more on how to improve digital literacy. We have trained and support Digital Ambassadors to go out into communities and waiting rooms and help others to go online and use Sheffield Flourish.
Wider Determinants of Health: A running theme through this post is that it is really important to understand that most of what affects our health is not in the gift of a clinician to resolve, but the health and care system must understand and influence where it can.
Where we live, our sense of purpose, our social networks, culture, environment, access to food and good education, our sense of self-efficacy all play a role in our physical health and mental well-being.
We have been using the concept of ‘Sharing’ to build Sheffield Flourish, a digital well-being hub that helps people connect with others and the resources they need to (re)build the lives they wish to lead. Over 180 people helped shape it before we launched it in the summer of 2016.
Since then the site has had over 4,000 users. More than 40 volunteers are helping to shape, edit, create content and support others to go online.
We have received over £50,000 worth of in-kind support from partner organisations. People have shared their time, talents, food, venues, compassion for others and stories.
The feedback has been incredible, including the results of our first insight panel interviews which show that 100 percent feel that Sheffield Flourish has helped improve their confidence and self esteem. This is surely added value!
In conclusion
So to simplify what is admittedly a complex message, I believe to create a responsive and resilient health and care system (and society) fit for the 21st century, we have to move beyond the money game and build ‘Sharing Economies’. Locally this means building #ShaRingSheffield.
The good news is that we are not working from a blank page. In Sheffield there is an abundance of people and activities who are already part of this movement. I hope that I have given some insights into the added value of this approach to how we are currently planning future health and care services.
And so for the small public commitment…well I’m pleased to say that the Director of Public Health, Sheffield City Council Chief Commissioner and Chair of the CCG all agreed to meet up with a group of community health activists to discuss taking forward the above three top ideas and I think there was a spark of interest in the idea of moving from Shaping Sheffield to ShaRing Sheffield!
2017 is going to be a year of change. Collectively, we have all the resources we need to imagine and build a better future.
• Note from Croakey: minor edits were made in cross-publishing this article. Some of the images were also changed from the initial article.
