These service changes, often happening over a matter of hours or days rather than months or even years, are in the main being done without input from patients and communities, rather than being developed in partnership with them. In a time of unprecedented crisis, that is understandable and necessary. But when we come out the other side of Covid-19 to a new normal, the need for public services to engage and work with communities will be more important than ever, to build on the growing sense of mutual interdependence and support. What might be important lessons to have in our minds when this time comes?
Earlier this year, staff here at The King’s Fund had the privilege of hearing from a team of Grenfell survivors and the NHS community and mental health team who had been supporting the community since the tragedy. The session focused on their experience of public services working with and within communities. Natasha and Bellal are survivors of the Grenfell tragedy and members of Grenfell United, a group formed in the aftermath of the tragedy to support the community and campaign for change. Robyn is the Chief Operating Officer at Central North West London Foundation Trust who led the team in the community. And Fatima spans both worlds – as Bellal’s mother she is part of the community, and she is a mental health professional who returned to Central North West London Foundation Trust to support the community.
What was striking when listening to them was the strength within the community to drive change and the willingness of leaders of services to listen to what was needed and work differently. At the time, I had four reflections about what it means to genuinely work with communities, and they will be important for us to have in mind when we exit from this Covid-19 period.
Human relationships matter
At the heart of the dynamic of the group was a real sense of a human connection. This wasn't an ‘us and them’, a ‘professional does to the community’ dynamic. It was clear that they all brought strengths, they all listened to each other and they all acted to make things better for the community. One example really highlighted this. The team from the trust was initially carrying out ‘screen and treat’ triage calls to assess individuals. Natasha said these didn't work for the community as it was a such a personal issue, being discussed with faceless strangers at a time of intense grief and anger. Natasha said to Robyn: get your team to come to us, connect with us as humans, break bread with us. And they did – and that started to create the trust and connection that was needed to set things on the right path. It might seem obvious, but it wasn't ‘normal’ for the health care professionals to do, and they needed to see Robyn make the first steps.
Act, don't just listen
Natasha and Bellal’s view on engagement was the biggest challenge to how the system traditionally engages with communities. However well-intentioned, their experience was of engagement as a separate activity, undertaken by certain staff and then fed back third hand to decision makers. They said they often view engagement approaches as a buffer – it creates a distance between the community that needs to be heard and the people who can make change happen in response . The community voice can be sanitised, the impact diminished. It stops engagement becoming everyone’s business. The most effective engagement from Grenfell United’s perspective was with people – like Robyn – who not only listened intensely to the community experience and needs, but was able to act on the back of it. Robyn had the power and authority to change things, not just to listen. Engage, listen, act, repeat. In this case, a very senior executive was on the front line, but there were other examples of staff on the front line –the people who the community engage with every day – being empowered to make decisions to act differently.
Language and symbols matters
Robyn and the Central North West London Foundation Trust were the main NHS hub that services for the community were based around in the aftermath of the fire. Yet, in the eyes of the community, they didn't have a mental health problem – their behaviour was a completely normal response to the events that had occurred. They had been involved in a tragedy, they were bereaved, traumatised and didn’t want the label of mental health. In response to this, the teams become health and wellbeing teams. The blue NHS lanyards for staff were replaced with green Grenfell lanyards. The NHS mental health teams changed their language, their symbols and their identity so it worked for the community.
Change where the power is held
Central North West London Foundation Trust has a new tradition, where people who want to work at the Trust now undertake Lucy’s walk. Lucy is a member of the trust’s Grenfell team and has lived her whole life in the community. She takes people on a walk around the community to understand the history and the stories and to meet people from the area. Only when people understand the community can they experience what it is like to have a real connection to the community’s needs, and what a system response to this should be. Putting the voice and experience of the community so central to each member of staff's first experience shifts the power — the needs of the community are better understood first hand and drive the actions and decision of those working in public services.
There is a lot we can all take from the post-Grenfell experience of how public services learnt to be a supportive partner, to be confident the community should lead itself, to really listen to what the community wanted and to act differently, to rebuild trust and connection. When the health and care system emerges from the ferocious intensity of responding to the Covid-19 outbreak, we would do well to remember these lessons and to shift to a different way of doing things for good – a culture whereby public services work alongside communities to use all of our collective strengths to improve our health and wellbeing.