Developing Neighbourhoods
UK Neighbourhoods – geographic areas of about 50,000 population – are expected to develop local communities for health and care. What might they look like?
Communities for health and care do not happen simply by co-locating people. In a previous blog I argued that cycles of collaborative reflection and coordinated action help to develop a sense of comm-unity, especially when participants see the effects of their collective actions and can shape new developments. A sequence of shared developmental spaces (‘umbrellas’), help participants take small, coordinated actions towards their shared vision. This causes ‘Horizontal’ and ‘Whole System’ integration – very different from ‘Vertical’ integration that usually dominates policy.
Cycles are important. One-off interventions rarely help because they do not facilitate ongoing co-creativity across boundaries. Cycles of learning and change have been advocated by many disciplines, calling it praxis, participatory action research, organisational learning, community development…. I have successfully used them Horizontally (to improve health centres, homes, localities and a whole city); Vertically (for system change for diabetes and education); and for Research (combining quantitative with qualitative and participatory research). Change happened when participants felt that they co-created it and witnessed their collective effects.
Umbrellas help participants to interact with others and make sense of their different insights, building trusted relationships. Louise Younie calls them ‘flourishing spaces’ “(where we can) engage with our humanity, honour each other’s individuality while also learning from each other” (p14-16). David Colin-Thome, former National Programme Director for Primary Care, says that “relationship lies at the heart of our shared humanity and the clinical encounter itself”…. he cites research that concludes: “if all practices in England provided continuity of care at the level of the best 10% of practices it would lead to a 5% reduction in total consultations without making the average consultation longer” (p44-47). Neighbourhoods can use cycles of learning & change to develop a 21st Century model of healthcare.
The problem is: everyone lacks training and experience to achieve this. Including:
- Primary and social care practitioners, including GPs and nurses
- Professionals, including doctors, politicians, journalists
- Citizens, patients, voluntary groups… and everyone else
So how can Neighbourhoods do it?
There is much to learn about developing local communities for health and care. BUT… everyone, through their different spectacles, knows that they are important. It will improve Cost of Care (by reducing hospital episodes), Quality of Life (by empowering self-care & shared care), and Job Satisfaction (by seeing the positive results). It can be done modestly at first, then with increasing confidence.
Neighbourhoods can become comparative case studies that learn from each other. They can use comparative data as ‘food for thought’. For example, data about:
- Emergency Hospital Admissions & Place of Death (illuminating the impact on healthcare systems)
- Trust, Teamwork & Social Cohesion (illuminating the effect on community-development)
- Participant Understanding of the Processes & Skills needed to facilitate collaboration (illuminating empowerment of individuals and groups)
Shared projects that emerge from shared developmental spaces help to focus the attention of participants; and seeing the positive effects of their collaborative working motivates them to do more. There is one shared developmental space that all Neighbourhoods can, and should, use to explore this territory – Carers.
Carers. 10% of the UK population is an informal, unpaid Carer. They relate to people with great needs. They are often un-supported, un-appreciated, invisible. The NHS and society itself would collapse if they disappeared. When their period of caring ends, Carers are often exhausted and un-prepared for the next steps in their lives. If the practitioners who relate to them (GPs, District & Palliative Care Nurses, Social Workers, Pharmacists, Specialists…) were to provide continuity-of-care for their households, multi-disciplinary professional teams could develop, with the Carer as a team member. Carers could develop communities of support around their homes including friends, family, neighbours, schools….
Arithmetic. If we assume that there are about three people in a household (the Carer, the cared-for and one other), then 30% of households could engage in this model of healthcare. Each GP has about 2,000 patients, so opting into this approach will provide continuity-of-care for 200 Carers – 600 patients in 200 households. Their other 1,400 patients would receive usual reactive care. This would improve job satisfaction of practitioners, disease management for those who most need it, and the skills and understanding needed to change whole systems.
Neighbourhoods could evidence the effect of collaboration on overall cost, quality and professional time, and use it to develop similar initiatives in their area.
Further Resources:
Karl Weick. Sensemaking in Organizations
Journal of Holistic Healthcare & Integrative Medicine, Spring 2024. https://bhma.org/product/many-ways-of-knowing/:
- Louise Younie. How might we cultivate flourishing spaces? (p14-16)
- David Colin-Thome. 21st Century health and social care. (p44-47).
This blog can be seen as a video podcast at https://youtu.be/hiZxEcjJj8o.