We need to move from person-centred to community-centred services

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For many years, health and social care organisations have aimed to create 'person-centred' services built around the individual. But if we want to make a meaningful difference to people's health and wellbeing, I believe there is a need to shift from person-centred to community-centred ways of working. My argument in this blog is that to do so we need to reframe what success would look like; promote more 'mutual' approaches; give community building the same billing (and resource) as public service reform and be open and honest about what gets in the way.

Reframe success by wearing reality-coated spectacles


In a person-centred world, an increase in referrals to person-centred interventions, such as social prescribing, is viewed as an indicator of success. In a community-centred world, rising referrals would be viewed a symptom of disconnection. In a person-centred world, gardening might be prescribed, whereas in a community-centred world we would start by strengthening communities, saddened to see citizens in need of referrals into community life. In 2031 in a community-centred world we would hope to hear, 'do you remember the time when we forgot to get to know our neighbours and we started to go to the doctor to help us with loneliness?'

A community-centred world doesn't mean wearing rose-tinted spectacles. Instead, the lenses have a reality coating. We know that there will always be people who need support from outside their community, but we also know that communities work best when professionals who provide this support work alongside local people.

Swap paternalism for mutualism


As the Camerados say, everyone has something to give, and everyone has something they need. If we are to swap paternalism ('I can help you') for mutuality ('we can all help each other') then perhaps we should reconsider the practice of recruiting individuals as service champions, unless it sits within broader community-building plans. Institutions can act like poachers surveying the land for 'champions', but the practice risks dividing community members into 'the helpers' and 'the helped'. I'm a befriender - you need a friend. I'm useful - you are needy. In isolation it can strip and damage the fabric of community life ('we' and 'us') and contribute to polarisation and disconnection ('me' and 'you').

Real change and power can be found in the art of community convening, creating spaces where communities can talk about and resolve problems together. I hear the cry, 'We do not have the resources for this.' Allow Ella Fitzgerald to respond: 'Tain't what you do (it's the way that you do it)'. I'd argue the resources are there, they just need a nudge and a shift from person to community-centred practice. Social prescribing, for example, reaches people who might not normally participate in community activities. Extend the focus of professionals to include hosting and convening centred on local people's passions, interests and gifts to share, and who knows what magic we might see.

We need both, but one gets all the resources


I was lucky to manage the most successful version of the Life Programme experiment (Hilary Cottam's work with families as described in Radical help) in my home town of Wigan. Behind the programme's success was the recognition very early on that community building was more impactful than person-centred services. Working with people and/or families as a unit without reference to the context they live in is akin to providing swimming aids without swimming lessons or access to a swimming pool. In Wigan, we recognised that from a community perspective, asset-based community development was more impactful than the slow, ever-changing public service reform agenda. Of course, we need public service reform, but there's little point in icing the cake if the cake needs more time in the oven. How can a community know what it needs before it knows of the strengths and assets it already has? Yet, energy and resources are primarily focused on the icing (public services), when it is the cake (community) that has the power to determine how system demand rises and falls.

Helping rather than hindering


When new services are set up to address the problems affecting people or places, shifting them to a community-centred approach can be tricky. Take the case of social prescribing as an example. It's brilliantly achieved its aims, helping GPs to connect people with non-medical support in their community. But what often happens next is that, buoyed by the success, individual services become their own greatest cheerleader. They set up systems and processes, annual awards and a vision to scale at pace. They embed themselves and the new goal (often without realising it) becomes self-preservation. In contrast, in a community-centred world making themselves redundant would be an indicator of success for the services. They might ask of itself questions such as: 'If instead of an additional staff member we used the budget to open up places for people to meet in neighbourhoods, how might that stimulate community life?'

So with this wisdom in hand, I have decided that home is where the heart is and where I live we are starting to think big by acting small. Working together on a bold vision to be a self-organised and self-renovating neighbourhood. If that's of interest you can discover more via the links below.

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