Three local partners in York (Together for Mental Wellbeing – who deliver the York Pathways project – Changing Lives and HealthWatch York) have been working together to try to catalyse a system-wide Multiple Complex Needs network to address the service fragmentation often experienced by users of services. We’ve just had the second meeting, and the progress over the past couple of months has provided much food for thought.
The first meeting of the network had been open, blank-sheet, and frankly somewhat rambling. People were frustrated and wanted some direction. We responded saying that it was their network not ours, and we all collectively needed to provide that direction. They said fair enough, we’re now telling you to go away and provide us some direction please. As I left that meeting one of the key partners said “good meeting Neil, but the next one will make or break this”.
No pressure then.
So, we did a few things. We did some research. We created a pro-forma to circulate to all participants to gather both perspectives and hard data. And we used that information to create a presentation and framing of the second meeting around some key discussion topics (people voted for the 3 they wanted to discuss from a longlist of 7 potential topics that we provided). We made sure that the discussions were highly action-oriented, recognising the extent to which people were impatient to get on and do something, not just explore something.
The second meeting worked beautifully. The presentation sparked interest, insight and debate. The discussion topics proved to be the right ones and were highly focused, leading to some key actions which people got quite excited about and are keen to get involved in supporting. “Really great session Neil, spot on, can’t wait for the next one”, said that same key partner.
So they had their chance to co-produce everything and shunned it in favour of some direction from the front. Which actually I was quietly OK with if I’m honest, because people could have potentially taken it in a direction that Lankelly Chase might not have been comfortable with. People probably felt that the information they provided had driven the discussion topics and the subsequent actions, but we came up with the questions in the pro-forma in the first place, so in reality the whole thing was framed and nudged in the direction that we really wanted to see it go.
This begs a wider question that has been starting to trouble me for a while. Our methods are flexible and emergent, which makes a genuinely place-based approach possible, and we hesitate to impose values and ideas. I have even been corrected in the past when I referred to ‘the Lankelly Chase approach to System Change’ (in a powerpoint slide) – “We don’t have an ‘approach’ ”. I felt suitably abashed at my faux-pas.
And yet, actually, I don’t think that is true. We have lots of things. We have a framing around severe and multiple disadvantage. We think that the failings of the system to support people experiencing that level of disadvantage is a window into the failings of the system as a whole. We increasingly think that a place-based approach is necessary to address system change. We have 9 System Behaviours that we have learnt seem to underpin successful system change and we want to promote them. We believe in complexity and in relationships, and we think that we should commission for both of those things.
It can be tough to tread the tightrope – facilitating open and exploratory conversations, refraining from referencing too much of the Lankelly Chase approach (there, I’ve said it again….), but all the while knowing that there are some paths that people could collectively choose to take which we would be super-excited about, others that we would feel were red-herrings, and others still which could be deal-breakers to our involvement.
And so when people are busy and shun the opportunity to co-produce the whole framing of a new network, but respond well to our own gentle nudgings, maybe that’s OK? Do we spent too long trying to build a consensus sometimes? Do we ignore the signals when others are authorising us to take a lead? When does it become legitimate to down the marker pens and post-it notes and start to take action?
This all makes me wonder – did we waste a couple of months just creating a void that we then filled, or was providing that space initially actually an essential pre-requisite, even if people expressed frustration and impatience at the time? Guess I’ll never really know.
Neil Berry is on of our Place Associates