Shift happens: reimagining health and care today for health and care tomorrow 

The change in government has brought renewed political energy to the challenges in health and care, and there’s been no shortage of ‘hot takes’ on the issues or repairs required to mend what is, in the words of the new Secretary of State, ‘broken’. The world almost certainly doesn’t need another analysis of the problem, but the task of rehabilitating the health and care system can't just be about hospitals, funding and waiting times, as important as these things are. So, here’s a slightly different perspective on the challenge and opportunity presented by this moment. One grounded in a collective experiment we hope you can be persuaded to join, because the task before us requires as much imagination as money.

Specifically, we need to reimagine what we consider a resource to be. Money, time and people dominate conversations about resourcing in health and care because they are material markers of ‘progress’ that we can count. But there’s an abundance of non-material resources that are habitually overlooked and neglected that we also need to get more serious about. One obvious example is community. A wellspring of lived expertise and insight into people’s needs and strengths, participation in community life also promotes belonging and solidarity, protecting and creating good health. Community is obviously a vital resource in the nation’s health and one we should invest in. 

The health and care workforce is a place equally rich in under-acknowledged and under-developed resources. But to be clear, we are not talking here about the goodwill and discretionary effort on which the health and care system relies. We mean instead social qualities such as trust, compassion, inclusion, creativity and entrepreneurialism. These qualities are assets we must understand as essential to the work of repairing and reimagining health and care, not least because we are going to need an ongoing supply of them. The good news is that in teams and organisations up and down the country these resources exist already, and even where they are suppressed by poor leadership, culture or circumstance, it’s always possible to cultivate them – if the will is there. And unlike money and buildings, ‘human’ resources like these are renewable – if we invest in them.

What about leadership, then? Well, leadership is also a resource, and the key to unlocking the enormous human potential in our organisations and communities. But here’s the problem – and opportunity: our ideas about leadership also need a reboot.

We badly need to reimagine leadership, but we don’t need another leadership model to do it – there’s more than enough of those. Instead, we simply need to see it in a more realistic and tangible way. Because the vast majority of us working in health and care don’t experience leadership as coming from abstract and socially distant senior leaders we rarely – if ever – meet (and certainly don’t know). Almost all of what we experience as leadership in our daily lives comes instead from the relationships around us, in the everyday acts of support, challenge, compassion and co-operation of our close colleagues. Viewed this way, leadership is more about the quality of the teams and collectives we belong to, and the influencing behaviours within these that facilitate and shape our work each day. The leadership resource we don’t cultivate nearly enough of has nothing to do with job titles and status, and everything to do with the distribution, quality and prevalence of these ‘leadership’ behaviours in groups and teams at all levels of the health and care system. 

If we can recognise leadership in this distributed, collective and everyday way, and develop more of it, we will simultaneously encourage the emergence of those other resources like trust, inclusion, creativity and enterprise in our relationships and teams, making health and care work more humane, fulfilling and attractive, and ultimately more inventive and capable.

Rehabilitating the health and care system so that it’s fit for the challenges of the 21st century will only be possible if we decentralise our gaze and shake off the scarcity mindset created by our narrow definition of a resource. There is an abundance of ‘human resources’ suppressed and wasted every year in local communities and across the health and care workforce because the system and its leadership are much too hierarchical and centralised. We don’t need a league table of heroic leaders competing to ‘fix’ NHS institutions top-down – there are no heroes or quick fixes, anyway – we need new forms of collectivism in and between communities, sectors, services and the people who work in them. And with this, a decentralised attitude to problem solving that is much more local, collaborative and experimental. As the great American philosopher and activist Angela Davis once said, ‘It is in collectivities that we find reservoirs of hope and optimism.’  

And so, to our own experiment.

Over the next year, we are testing out an idea for an online learning movement called ShiftWorks. Open to anyone working in health and care, regardless of sector, role, rank, age or experience, ShiftWorks is our attempt to encourage the growth of more ‘human resources’ through community building and learning. By bringing together as many people as possible from all corners of the health and care system to learn together, and about each other, we hope to build mutual understanding, help dissolve sectoral myths and siloes, and encourage a new generation of distributed and collective leadership. It’s an experiment with a bold ambition, but we make no apology for that. Bold is something else we now really need to be.