Transforming health and care

This guest blog is from Charlotte Pace, an Associate at the Institute for Voluntary Action Research (IVAR).

Whole systems for whole people – what Plymouth did and what the North East learnt

There are no magic tricks, it is one slow struggle

Keen to explore better ways to recognise and value the great stuff already happening in communities to support people’s health and well-being, a small team of passionate cross sector leaders wondered about the best way to inspire local system leaders and bring about some genuine and much needed change.  What they knew already was that people like to see and hear:
  • a REAL example 
  • with REAL people
  • in a REAL place 
  • with REAL commissioners! 
So, as part of the North East Building Health Partnerships: Self care programme, the core steering group working with Toby Lowe (Newcastle University), co-author of  A Whole New World: Funding  and Commissioning in Complexity invited Gary Wallace and John Hamblin from Plymouth, cited in the report for their ground breaking approach, to share their insights and learning at two events in March:
  • a Community Asset Based Approaches event led by Public Health England NE and 
  • a ‘Commissioners Roundtable’ meeting in Newcastle on the 14th March 2018
What followed were some stirring insights into what had taken place in Plymouth and why. We heard about live conversations with the general public in Plymouth that took place over four months with around 400 people, where different ways of talking and listening with communities were put to good use:
  • the ‘Plymouth sofa’! 
  • surveys
  • one-to-one meetings
  • focus groups
  • open space
The results of which led to some uncomfortable truths. The exercise showed up important things that needed to change including the ‘master and servant’ approach to commissioning services, plans with mainly short-term time frames and a system focus on what isn’t there rather than what is. An overall disconnectedness. 
We learned about the sorts of things that are getting in the way: middle managers, emotional attachment to budgets, legal and procurement rules (contracts) and that in fact many of the charities that were providing the solutions to Plymouth’s social needs were aligned to a broken system.

So, what happened next?

Six commissioners, 29 services using appreciative inquiry methods and a period of intellectual playfulness around ideas based on the theory ‘anyone can have an idea’!

It took time - meeting every Friday for a year and a facilitated programme of system leadership work….

BHP image

In all of this the key approaches that stand out (and what helped the most) were:

  • the benefit/risk approaches to sharing, put into place between organisations
  • the focus that shifted to people not the system
  • the understanding that it was about culture not structures

Gary and John talked about:

HONESTY                             SHARED LEARNING                          DOING THE RIGHT THING

Plymouth thought about not just what to do next (e.g. creating a more supportive and enabling environment where organisations can share what they are bidding for) but what to stop doing as well (e.g. competitive tendering) and they agreed (through the process) that all types of measurement should be for learning and improvement.

We learnt that it takes ‘no one thing’, it’s mainly about trust and that takes time to cement.


  • Spend time together in teams, across teams, in multiple teams
  • Understand that the voluntary sector doesn’t all ‘live on the same street’
  • Take time to reflect – there will be some unthinkable conversations ‘we can’t procure our way out of it’
  • Make it a cross political party process
  • Recognise that this is as big a challenge for the VCSE as it is for the system
  • That a failed bid can be a catalyst for change to happen anyway
  • Mind your language
  • Avoid war words – using terms like front line services or services under siege, we aren’t in a battle!

Plymouth know how has been helped along massively by their appetite to learn and develop. Through this openness there have been some enlightening moments; the answers to reducing costs are in the community and our relationships are our biggest asset and that the very biggest risk is in not changing (“it’s unthinkable”).  

Gary and John urged us to learn from their experience and what it takes by borrowing their values, collective bravery, instilling ‘follow’-ship as well as leadership, by creating a permissive environment (do it anyway) and learning, learning, learning – at every level and above all; inviting people to be different.

What next for the North East?

Collaborate and Toby Lowe have secured a development grant from Big Lottery to work with local host organisations to bring together funders, commissioners and delivery organisations in three locations across the UK to establish ‘Communities of Practice’ to explore and learn together how they can work in more complexity-informed ways. 
One of these locations will be the North East supported by VONNE as the local host.  The learning communities will enable people to:
  • learn about emerging knowledge and practice from elsewhere (locally and nationally)
  • reflect on their own experiences and draw on insights from others to identify opportunities to change their own practice;
  • be ‘collectively brave’ with peers in developing, testing and sharing new approaches.
One of the key priorities for learning communities will be to explore together and test what a new more productive relationship with citizens can look like, and what it takes to do this.
Developing NE Learning Communities:
  • A North East Development Workshop will take place on 7th September 2018. The event will target commissioners, funders and providers from across the region working in different areas and will showcase examples of positive collaborative working to change practice and explore what participants may require by way of support to establish learning communities. Thematic workshops will take place at the event which may lead to thematic Learning Communities of Practice being established i.e. ‘Multiple & Complex Needs’ ‘Health & Wellbeing’ etc.
  • Toby is also supporting Building Health Partnership (BHP) North East Programme ‘test site’ development as a follow up to the BHP Commissioners Roundtable aimed at health and social care commissioners in March aimed at supporting a more enabling commissioning environment for co-production, asset based approaches and social prescribing.
  • We have also agreed that Toby will present to the North East Funders Network Symposium in September with a view to further engagement of funders in this way of working.