Whose uncertainty is it anyway?

Healthy Communities Together is entering its third year, with five partnerships across England exploring how they can reduce health inequalities in their local populations by rebalancing relationships between the statutory sector and the voluntary and community sector (VCS).

The sites regularly come together to reflect on their learning with us, and what has struck me in our most recent conversations is how much uncertainty partnerships are dealing with. Some of the challenges they are facing include adapting to apparently never-ending crises; finding the energy to experiment with working in radically different ways when what’s valued can differ greatly between partners; engaging with HCT projects among competing pressures; and dealing with dramatic changes in funding arrangements as the cost-of-living crisis bites.

As people talked about their experiences, I started thinking about whether partners were sharing the burden of uncertainty equally. It seemed to me to be VCS partners – who talked about wanting more honesty from their partners, or were feeling the consequences of abrupt funding reductions – who were grappling with the highest levels of uncertainty. This reminded me of the work of Peter Marris, a 20th century sociologist, who was interested in how the instinct to seek security we learn in infancy plays out in organisations and societies. One of his key ideas was that that people with relatively more freedom and autonomy will unconsciously safeguard their own sense of security by obliging those with fewer choices available to them to bear the greater burden of uncertainty¹. In the HCT context, this might mean that partners in stronger positions may instinctively – and only sometimes consciously – prioritise reducing their own uncertainty rather than seeking a collective response that keeps uncertainty shared out among partners. The consequences for those kept ‘on the hook’ can be high levels of anxiety or psychological withdrawal.

Partnering as leaning into uncertainty?

'How much of HCT might be about learning to tolerate uncertainty together in new ways as groups work towards their goals?'

So, I wondered: how much of HCT might be about learning to tolerate uncertainty together in new ways as groups work towards their goals? Looking back at the HCT reflective learning framework, actually, lots of the questions we suggested partnerships consider early on – about exploring purpose, roles, contributions and constraints – encourage collaborative efforts to temporarily scaffold work. Could these questions be about managing anxiety because the work feels more uncertain than usual? The framework emerged from work that happened during the Covid-19 pandemic, which of course was a time of great uncertainty. However, it (like other crisis situations) also created a single energising focus that offered hope of more equal relationships with the vaccine drive actually providing great clarity about how partners could make the most of each other’s unique contributions.

In contrast, the cost-of-living crisis seems to be drawing partners towards their core business activities and sometimes away from their partnerships. In addition, the recent tightening of governance as difficult choices have been made, after the relative freedom to innovate during Covid-19, has left some feeling a little hopeless. It would be logical to suggest that, among time and resource pressures, people focus on the priorities they have most direct control over. Alternatively, (and following Marris), perhaps even when we could tolerate more uncertainty, we stick to the things we already know how to do, because we unconsciously prefer to do so. This might mean, for example, putting off decisions or communications about changes that might significantly affect partners, rather than leaning into potential breakdowns and collaborating to work through them.

What can we learn from this?

'Their experiences and insights raise helpful questions for anyone working in situations where things feel more unpredictable than usual.'

What advice would HCT partners have given themselves about dealing with the recent social crises, had they known what was coming?

• Really listen and empathise with partners, understand their constraints and potential contributions. Keeping these in mind, could have helped to maximise partners’ contributions and mutual esteem, acknowledge people’s limits, and mitigate frustrations when things didn’t go to plan.

• Be honest with each other. Even when messages were hard to share, being frank could have helped avoid rumour and misunderstanding that can derail fragile relationships.

• Keep revisiting purpose, goals and ambitions – especially when faced with the unexpected. Reiterating what partners can do together as equals could have helped cope with the uncertainty of shifting sands partnerships were standing on.

While we hadn’t been talking about managing in uncertainty directly, these points resonate closely with how Marris suggested those in stronger social positions could take more of their share of uncertainty. Rather than always passing uncertainty to members of society whose choices may be more limited, Marris advocated for styles of governing in which stronger and weaker parties create reciprocal commitments; increase predictability whenever possible; and keep the wider social goals in mind – pretty much what the site leads said. This suggested to me that a wider pattern maybe playing out in the site leads’ experience, and so their advice might be useful whenever uncertain is heightened.

None of the HCT leads imagined that doing these things on an ongoing basis was easy, and no one thought they had complete freedom in what they chose to do. Instead, they highlighted how difficult it could be to stay true to the principles agreed at the start of the HCT programme and the creativity and stamina needed to keep going. But their experiences and insights raise helpful questions for anyone working in situations where things feel more unpredictable than usual.

• If I’m in a traditionally stronger position in the hierarchy, how can I take on more of the uncertainty that I could easily push away?

• If I’m a traditionally weaker position, how can I draw attention to how I’m being asked to bear the uncertainty that could be shared out differently, accepting that it might be risky for me to do so?

• Together, how can we explore how we tend to share the burden of uncertainty and how that helps and hinders us as we work together towards the outcomes we want for the people and communities we are trying to serve?