My colleagues and I were taking part in ‘the Deal training’ as part of our project looking at the Wigan Deal. This training is something that every member of staff at Wigan Council and, increasingly, wider partners undertake as part of their induction. The cornerstone of the training is learning to have what Wigan calls ‘different conversations’ with people in the community – conversations that are open and exploratory, encompassing a person’s strengths and interests, as well as their needs. Or, to put it more succinctly, to have a proper chat with someone to find out how to make a difference to their lives.
Apparently, we were not alone in finding our day taking a different turn to the one we had envisaged. The cows (and, later on in the presentation, squirrels) come as a surprise to most people who go through the training. But we were also told that this part of the training – taking participants back to the principles about how we see other people – was seen as the most valuable by staff who had gone through it.
These different conversations serve a number of functions; reconnecting those who work in the council with the community they serve, learning what matters to people and what will make a difference to their lives. It aimed to create a new relationship that looked more like a partnership rather than an ‘us and them’ approach; ‘working with’ rather than ‘doing to’.
Having the conversations is one thing, acting on them quite another. If staff were to work differently with users they needed to be given the space, permission and opportunity to act on what they had learnt. Staff needed to know that they could take initiative without being blamed if things went wrong. This personalised approach to delivering services meant devolving power downwards not only to users but also to staff. Leaders in Wigan Council recognised that to give staff agency to act they had to change attitudes to risk by changing the culture of the organisation.
The word ‘risk’ can feel loaded in a health and care setting, often coming with negative connotations, but the council needed staff to start seeing the positives of taking risks, of trying new approaches based on what users told them – and also to see that sticking with the status quo carried its own risks. There was a view that, in the past, services ‘had gone too far in protecting people from risk’ and in the process had prevented those people from doing things that could be beneficial and that they themselves wanted to do. The leaders at the council knew not everything would work but they also knew that if they were really going to have an impact this was what they needed to do. They had to back their staff.
It took time, and initially staff were not sure that managers would stick to their word, but they did, and the benefits soon started to show. Staff told us time and time again that they were now doing the job they had always wanted to do because they were making a difference to people’s lives. Staff engagement scores across the council have increased significantly over the past few years, providing evidence of the difference the new approach is making.
Aspects of the Wigan approach can be seen in the NHS long-term plan. There is a recognition that there needs to be a ‘fundamental shift in how we work alongside patients and individuals to deliver more person-centred care, recognising…the importance of “what matters to someone”’. The plan commits to supporting and helping train staff ‘to have the conversations which help patients make the decisions that are right for them’. The further expansion of social prescribing and link workers also reflects a move to this different model. It certainly feels like the right direction, but what it takes to make this kind of shift is not always fully appreciated.
For this model to work, we saw in Wigan that context, culture and leadership style are key. This is where I agree with many of the people we spoke to who said this way of working can feel counter-cultural to the NHS, which remains hierarchical and where blame culture is still all too present. Is a model in which managers spend more time looking up to national bodies and regulators than out to the populations they serve one in which this approach will thrive? In Wigan, putting users at the centre felt like a reality, whereas in the NHS it can still feel like rhetoric. Patient and public engagement all too often feels tokenistic rather than being at the core of how to work differently.
One thing we learnt from Wigan is that the vision at the top has to be absolutely consistent with practice throughout the organisation. To put it another way, if you are going to talk about the importance of listening to the people you serve, you better be prepared to act on what they tell you.
I was delighted to read about the Wigan Deal, although frustrated that it has taken the authorities so long to come to this realisation!
Our CIO aims to take this concept a stage further and involve the local community as we believe that the most important thing to each one of us is the people in our lives. We therefore aim to draw these vulnerable people back into the heart of their communities where they belong as we believe this will greatly enhance their well-being and thus reduce the many ailments related to depression and loneliness
We also believe that it will reduce the cost of Care
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