What is the Healthy Communities Together partnership?
Healthy Communities Together is built on three hypotheses.
- Outcomes for communities (especially reducing inequality) are better served by VCSE sector and statutory bodies working in equal partnership towards a shared agenda.
- Investment is required to support the participation of VCSE organisations as equal partners.
- Effective and sustainable partnership working is an active learning process that benefits from expert support to work differently through shared leadership of change.
Following an initial phase, in which sites developed and agreed plans, Healthy Communities Together provides three years of support from 2022 to 2024. The National Lottery Community Fund provides investment to support partnership working. The King’s Fund provides ongoing input from its leadership and organisational development consultants and facilitates the identification and dissemination of learning.
As the partnerships make progress, they are sharing their learning via The King’s Fund’s events, on the website and through publications.
Learning reports from Healthy Communities Together
Year one – 2022
In 2022, we published a reflective learning framework. This is a practical tool with worksheets. It should be useful for any organisations developing partnerships and is particularly designed for those at early stages. It draws on:
- challenges the partnerships faced
- how they needed to change or refresh their approaches
- how they developed understanding of each other as partners
- what options they explored and what they found useful.
Year two - 2023
In November 2023, we published our observations on power imbalances in partnership working. This long read sets out the key ways in which power imbalances hare showing up in the five partnerships and how they are trying to address them. It also includes some reflective questions that partnerships across the health and care system can consider if they want to explore the role of power in their work.
- Video transcript
Willenhall is a neighbourhood in South East Coventry of around 17,000 people.
Valerie De Souza
So this work in Willenhall is really frontline, really grassroots, really looking at residents, looking at communities, how they work with each other to support and protect their health and wellbeing.
Often the public sector does things to communities, and I think for a while as public sector we've been thinking that we need to work differently with communities and the ambition of the partnership is to learn how to do that.
Valerie De Souza
As a system, we want to recognise how important the voluntary and community sector and community groups are and make sure that they're funded appropriately and sustained properly.
Willenhall is an area that experiences difficulties. Under the bonnet and under the cover of that, we knew we could find a lot of strength and a lot of capacity for change in people and in associations in this area.
One of the groups being supported by this work is the Willenhall Mens Group.
The Willenhall Mens Support Group is a group of men who come there because they feel isolated, because they need something, who also come there to give, because they have something to offer.
Coming to this group has... It's saved me in a huge way because I've been able to open up to the guys how I'm feeling and they've listened to me, and I've always found not many people do listen, but here in these walls, in this group from five till seven, we're just one band who stay together and help guide each other in the right direction.
I had a very nasty RTA, then followed by a complete mental breakdown, and there was no support for me. And I needed that support.
Dr Sarah Raistrick
So the men's support group has been a really positive thing from my experience. So many of the men who go to the group happen to be patients at my surgery, so I've known them in that capacity.
And seeing them really flourish by taking leadership roles, by having this new community that they've got as the men's support group, has been really positive. There are some amazing community initiatives happening, but often they're not seen as legitimate because in some ways they're not validated, they're not tested, but they're there.
We know that they're having transformational effects on individual people's lives, but some of the really good things we've got in our community, like the Waka Waka Fitness Group, actually because they're not a statutory service, me referring to those doesn't get recognised. We know that really good friendships are formed there, a lot of energy, a lot more social connection that will last beyond the few weeks of a traditional weight management course.
And yet, sadly, that wouldn't be recognised.
In order to shift power, you need to both build and strengthen community leadership.
Being a community leader is someone who brings people together. And that's what we are trying to create. Like most of them, I never knew them before, but because of this, Waka Waka, I've come to know them.
And there are times that I call each other just to check on how they are doing, which is really good, and it's good for our mental health, you know, some people are so isolated.
Waka Waka attendee
Coming here, first, I made new friends, which is very important for me as a stay at home mum.
Usually, evening, I just used to sleep. But, we have this amazing opportunity to be here in community, and this great time you can just enjoy doing some exercise, and there's nothing more than that.
Valerie De Souza
It's crucial and urgent that we prioritise working with communities, because in Coventry we have got what we call a 'gap' in healthy life expectancy between our most deprived and our most affluent areas.
So unless you understand communities, where they're coming from, what their stresses in daily life are, we have no way of reversing those inequalities and reducing them.
There's lots of people on long waiting lists to be seen, and all the time that they're not being seen by statutory services, they can be coming, you know, not well, but I think that's the urgency from the person side of things.
I think there's an urgency on the side of the system. We need to start to understand each other better so that we can work together, but I'm sure there's some financial imperatives, but we never really stress those either.
If you're fed up with business as usual, if you're fed up with crisis after crisis and having to deal with emergency, then make some space to come and talk to healthy communities in Coventry about how we can get upstream, how we can tackle the real causes of those emergencies, and that is about community, it's about connectedness, it's about what we can do for each other.
This isn't about the one, this is about the many. And the needs of the many will outweigh the needs of the one a million times over.
- In their own words: what the partnership in Coventry said at the start of the project
‘The two problems we want to un-stick are health inequalities, which are persistent where we are, and the relationships between our sectors.
‘We want to bring the whole system together – starting from individuals and moving out to their families, friends, neighbours, local voluntary sector groups and services, and then up to secondary and primary care – through a series of large, place-based conversations to hear and understand the story of lived experience, to explore together what an improved story would look like, and to plan how to create it together.
‘In the first nine months we’re going to do that with people experiencing mental health issues who are going in and out of formal mental health services. The practical outcome that we want is to have a really well-tested and refined model, that we can apply across the health and care system for other issues or cohorts of concern over the following three years.’
- Video transcript
Dr Neil Goulbourne
We've always felt that the way in which health and care is traditionally delivered just isn't fit for purpose, it's not going to give us what we need for the future. One of the really exciting ways to change that is to move away from the traditional statutory services delivering and instead, to work with local people, particularly through the voluntary sector, to make the most of the assets that people have in their lives.
We've got three work streams which we set up. The first one is about funding and commissioning. It's about trying to shift funding to the voluntary sector. The second one is about empowering and engaging local communities. And the third one is all about representation of local people and of the voluntary sector.
Voluntary organisations are in the business of providing for local people and their essential needs. In the way that previously local government or the NHS would have done. But they're doing it differently. And they're doing it in a way which promotes independence. And communities are vast, sometimes they're not at all collective.
But local people do have connections in the places where they live and often where they work. And it's by... developing those connections that they can quite often find the support that they just don't get if they were to go to the GPs or into the council.
During the pandemic, voluntary activities formed the Local Community Partnerships (LCPs) with charities and institutions working together to aid housebound individuals. LCPs promote community cohesion, involving local people in decision-making for neighbourhood services.
One of the most exciting things about the work of the local community partnerships is a different way of funding opportunities being provided in Croydon. Over the next two years, it's been agreed that a certain amount of funding will be given to each local community partnership and it's the members of the local community partnership who will link the use of those funds to the community plan.
The local community partnerships, I think, are one of the best things that's come out of the HCT programme. We were really, really, really clear that we wanted to put the resource and the power and the money essentially into those local community partnerships for them to commission the services that they wanted at a very local level.
Brigstock Road Community Hub is a community space run in partnership with Asian Resource Centre Croydon and Age UK Croydon, one of the first voluntary sector partners to join the HCT project.
You're here at the Brickstock Road Community Hub. It's in Scratchley Hall.
We have been providing community support activities all around for many, many years. And Hub came as a logical extension for us to provide those services, primarily because it helped us to not only bring partners into the service, but also statutory bodies like housing from the Croydon Council.
So many people walking through the doors to kind of have empowering conversations with our community facilitators and then be able to see a service provider which is a bonus. It's a genuine piece of co-production in their community which is accessible to them.
Along with paid practitioners, our volunteers talk to residents in confidence, who aim to support and work with them at the Community Hub. One resident, who has sought help through the Hub, has become a valued and trusted volunteer.
I was basically going to ask for help with counselling but then I thought to myself 'probably what I need is to take a voluntary work'. It's a commitment that will take me out of the house and also I will help people, they will help me.
Quite often we see this with clients who come in with problems to resolve themselves, but actually they really want to help others in similar situation because I think they have that empathy, they have a lived experience.
It's like my second home. Some of the visitors that they come to see us, it's a regular thing. Just like it becomes a bigger and bigger friendship and family doing the voluntary work. I wish more people would do that.
Any kind of change programme, I think, requires a huge amount of tenacity, a heavy dose of optimism, and to a certain extent, some blind faith, it requires us all to make a bit of a leap, really, in terms of what we want to achieve. And I think that's what we've been really successful in doing as partners in the Healthy Communities Together programme.
I think it's really important to recognise that we cannot carry on doing the same. Something has to change. We need to give agency to communities and the only way to do that is to work with community groups to make sure that we're all working collaboratively together and creating an ecosystem that we can all help each other, support each other and we recognise the strengths of different sectors and this system gives us an incredible opportunity to create a better future and healthier people.
- In their own words: what One Croydon Alliance said at the start of the project
‘We’ve got a vision to transform how we deliver care and our One Croydon Alliance has been working hard to do this – moving power to local people and communities, focusing on the wider determinants of health and being proactive in preventing ill-health – but we know we need to do more to help reduce local health inequalities.
‘We believe that the strong voluntary and community sector in Croydon is best placed to empower people to improve their wellbeing, and we have seen this in action in the collective local response to the Covid-19 pandemic. We want to build on and develop an even better quality of partnership for our borough. We want One Croydon to be part of a much broader coalition, connected to all sections of our community.
‘We have huge differences in financial inequality and health inequality, so we really need programmes that are locality based to meet the needs of people in different parts of the borough and we are starting to put these in place. Our focus over the first nine months, as we develop our locality approach, will be to hear from people locally and act on what they tell us; to develop a new way of commissioning that brings our budgets together across health and the care; and develop leadership that fully involves the voluntary and community sector as well as the statutory bodies.’
- Video transcript
So today's our monthly meeting for the Healthy Communities Together Gloucestershire Stewardship Group. So there's a group of nine of us drawn from the voluntary sector and the public sector.
Gloucestershire is a county that has a population of just over 660,000 within it and it is generally a pretty healthy county but within the county there are differences for our communities as well. So, we know that the average life expectancy for males is 80 years old and for females is 84. But then when we look at the differences in that life expectancy between the wealthiest and the poorest areas, we know that there's considerable difference.
We also know that whilst that's our life expectancy, that actually the healthy life expectancy is considerably lower than that. And again, we've got differences for our populations in terms of that healthy life expectancy.
HCT Gloucestershire is trying to create the conditions for good partnership, good collaboration, in a complex world.
And I think the thing that really stands out for me is that 'how' matters for us infinitely more than 'what'. So deliberately setting out to learn how do we behave, how do we relate to each other rather than taking what is more traditional kind of project driven, task driven approach.
Contribution not attribution.
For many years we've always wanted attribution, you know, 'we've got some money so, um, we've got to decide what we're going to do with that and we want to make that line to that attribution so we can say that was us. We can tell our funders that's what we've done. We can tell the population that's what we've done'.
But in that environment where the people are getting multiple funding for example, or things have become emergent and people have started doing stuff without funding and they want to scale that up, you can't attribute that down to us because we've suddenly decided that we've either been asked for support, or offered support, and provided support, and often or not we make a contribution into that system rather than attribution, so it makes it very difficult and sometimes we have to frame that about what we're putting into the system not what's coming out as a result of what we're putting in.
I think discomfort is a really good way of defining it, and more than anything, it's my own discomfort. 'Contribution, not attribution, the conversation is the work' aren't concepts that I'm particularly comfortable with. You know, in fact, two years ago, I'd have rolled my eyes at those concepts entirely.
Making sure that I fully understand them and embrace them has been really difficult and at times, it's been obscure, and it's been quite a journey for me. But I can honestly say that I think HCT, for me, has been the best bit of learning I've done in my professional life.
I think partnering differently requires leaving your power at the door and treating everybody as equals. And leaving, you know, and giving them space to contribute and actively listening to different perspectives and different ideas.
Gloucestershire HCT have been using Open Spaces as a tool to support their work with partners and the community.
So the event on the 29th, is called, titled 'Structures of Togetherness'. It's a gathering to bring a whole range of different people together from across the system in Gloucestershire to diagnose the health, really, of our structures of togetherness in Gloucestershire. Because... if we're trying to collaborate to tackle some of the big issues that we're facing, whether that's health inequalities or the environmental crisis, we know that radical collaboration, deep collaboration based on trust, is going to be vital to in any way tackling those issues.
So we're just asking the question, 'how good, how strong, how effective are our structures of togetherness?'. And implicit in that question is 'how might we not be working well together? Where might be the weak points? Where might we not be really, really strong together? And how and what can we do about that?'.
We want to see equality of opportunity and people given a fair chance to live their very best life and live a healthy, happy life. You know, what we see coming through in terms of the data and those health outcomes, it shows us that actually opportunity isn't equal, which just feels fundamentally unfair in a wealthy modern country such as the one we live in.
You know, and a county like Gloucestershire, which is an amazing county, you would have thought everyone would have that equal opportunity. My call to action would be anyone that feels there is a change needed to create fairness and equity and feels passionate about that should play their part. And you know, come and be involved with us, help shape this system change to a fairer Gloucestershire with us.
But absolutely play your own individual part as well.
- In their own words: what Gloucestershire Enabling Active Communities said at the start of the project
‘We want to create sustainable, transformative change and rip up the rule book about how we work in partnership across the whole county.
‘First, we want to widen the discussion that we’re having, deepen our understanding of people’s priorities, and be present in communities without an agenda or something set in our minds to work on together – genuinely be in communities listening to people and understanding their priorities. At the moment we would accept that we’re not reaching everyone, we’d like to create a partnership where everyone has an equal seat at the table and reach out to all of the voluntary and community sector organisations in Gloucestershire, all of our communities, allowing everyone to have their voice heard. It’s about “together we are greater than the sum of our parts”. So how can we, through real collaboration, find new and different ways to improve lives?
‘What can we achieve through this? We aim for the stars in Gloucestershire, it’s kind of limitless really. We just want to completely change the way we’re doing things in the system, underpinned by the development of a culture and way of doing things, our “Gloucestershire way”, that allows us to really “do with” instead of “do to”.’
- Video transcript
This is a short film about a partnership in Leeds that is working with marginalised groups untethered from 'place-based' assumptions about community.
Sex workers, asylum seekers and refugees, Trans communities and Gypsy and Traveller communities are at the sharp end of health inequity and disadvantage, but in Leeds their lived expertise and ideas are re-shaping how health services are commissioned.
We recognise that Gypsies and Travellers, asylum seekers and refugees, trans folk and sex workers have similarities of experience that are kind of beyond place. They are often shut out of place-based services.
So we decided to come together as a group to basically see how we could share our resources and support each other.
The idea isn't that all of these groups are the same or experience the same thing, but that the mechanisms that exclude them are the same, because they're about stigma and they're about discrimination. So I just wanted to welcome you all to this fantastic event for Gypsy Traveller History Month where we're celebrating the culture of Gypsies and Travellers across West Yorkshire.
I've been doing this job for eight years and it still shocks me, the things that people think it's okay to say about Gypsies and Travellers. So if you imagine, you know, the people that deliver our services are not detached from society, are you? And if generally, in society, people think it's okay to have those opinions and say those things openly, people that work in our services also think that.
I think the catalyst was putting people with lived experience at the heart of our approach. Because the organisations have got trust in their communities, they're able to talk to them about the projects, they're able to make them feel comfortable to be able to share their voice.
If somebody would have told me, Mags, you're going to be working in Leeds GATE , you're going to be doing this job, I would have said, 'no way'. Do you know what I mean? And I just absolutely love it. And I hope I encourage other Gypsy women to be doing the same work that I'm doing.
We work with people who are less likely to be thought of when systems are set up.
And our commissioning from the margins kind of approach recognises that if we can get things right for these communities, as well as the very valuable and valid thing of making things better for these people, we can also change systems for everybody.
Myself and the project are a catalyst. We're not necessarily fixed features in the system.
We're part of a programme that is looking to create lasting change. And if that happens, I hopefully won't be necessary anymore.
Adaptive Action is an experimental methodology that is trying to encourage the system to foster equitable spaces.
So we would bring participants into a room which are from all facets of the landscape. So from our experts by lived experience right through to senior leaders in the council. One of the first things we ask is that you don't introduce yourself by title. There's nothing indicative of the job or role that you're in. It is purely a listening space. And the things we get out of those sessions are brilliant.
Roads, Bridges and Tunnels is a piece of work created by Leeds GATE members that came up with three ways they think people access services.
The first is a road. And services imagine that everybody can travel down that road smoothly, no issues, got everything they need to participate in that service. However, we know for lots of communities that is not the case. And that might be a barrier that's set up through racism or discrimination or stigma that mean that some people find it a lot easier to travel down that road than other people do.
So bridges were the efforts that services make to include those people. So often with Gypsies and Travellers , that looks like a specialist service or an outreach service. And whilst that is good in the short term, it's not the long term goal. The bridge shouldn't exist forever, people should just be included within services.
The other way in which people navigate those services are tunnels. So they're people's self navigation. So often that's a way in which people find to access something based on the networks and assets and skills that they have available to them. So it might be things like sharing an address, or it might be things like finding a friendly GP and everybody sharing that information within the community.
The final idea that our members came up with was that rather than this sort of straight road, they'd like a multi- laned motorway with lots of slipways on and off, where people could come and go at their own pace, and there was lots of different ways in which people could access.
We have to think of that power dynamic between organisations and people and services and the people who commission them.
I think the important thing is to think is we're all equal partners. One of the key things is we haven't got all the answers individually.
I think if I could give one thing to encourage this work to be effective, is be brave. And in order to effect actual change in these systems, we have to be the willing parties to stand up and say, 'no, I'm not going to do it like it's always been done. I am going to be different and I will model that difference in every part of me.' Every day that I get up, I think about the fact that I have to be brave, I have to be challenging, I have to be disruptive. And not necessarily disruptive in the way that people like to think about disruption. We talk about productive disruption all the time. You know, we want sustainability in this work. We really, really do. And our communities need to see stability.
- In their own words: what the Solidarity Network said at the start of the project
‘Systems that work better for marginalised communities work better for all communities. We want to work on what “commissioning from the margins” looks like, to create a model that could work for a range of marginalised groups. And to make a paradigm shift to support it, from transactional to mutual relationships between our local authority, NHS and voluntary and community sector.
‘We’re looking to ensure real participation and real ownership with our experts by lived experience and our communities. We haven’t pinned down the detail yet because we want to be taken there by our communities. But in the first nine months we’re looking to develop a learning partnership of organisations that can be ready to approach the challenge of systems change in Leeds. We’ll bring together a steering group including the Solidarity Network, NHS and public health and most importantly experts by lived experience. We’re going to resource that properly and ensure it is meaningful interaction with our communities that can translate their stories into actions.
‘In the first nine months a lot of the focus will be on system mapping: across all the different structures we’ll be looking at where marginalised communities appear, how they appear, how that has led to change, whether it supports collaborative and mutual relationship-building, whether participation is real. We’ll also map out who are the leaders at those points of the system, where is their power and what is their passion, so that we can understand the levers and the points where we can make real change happen.’
- Video transcript
HCT in Plymouth is a partnership between the health sector, the local authority and the voluntary sector. Its focus is on tackling loneliness and social isolation and creating a city where everybody feels like they belong.
We haven't got a specific project that we've started and that we're going to work through and finish in a traditional way. It's a kind of social movement, so we're building a kind of movement in the city, tackling loneliness and social isolation in lots of different ways. The key aspect of it really is about listening to the community and how can we address it as a whole.
I think there's something that happens to people when you say the word 'community', there's like almost a little blink and I don't know what that is. I don't know whether that's like, 'oh, crikey, it's gonna take longer', or 'oh, I dunno what they're gonna expect of me or ask me'. When actually they can speed up a process because you can get the right people in the room, you can have conversations.
Having said that, I think that people, they have lots of work to do, timescales to meet, and sometimes engaging with the community can be the thing that you haven't got the time to go and do. And therefore decisions can be taken that don't have people right at the heart of those decisions.
Young people are at the heart of the community listening work happening in Plymouth.
Do you feel like you belong in Plymouth? If you don't or there's negativity around there. What things, as young voices, can you help support or improve there?
More support for mental health, definitely. I feel like adults don't really understand young people's mental health, or they don't make enough time for it. Like, they're very focused on education.
The most annoying thing about being a young person in Plymouth is how undermined we are and how much our opinion is belittled due to our age.
I think we lock out our young people quite a lot, don't we? And I think it's really important they are the future. They are amazing, young, flourishing human beings, aren't they?
And they've got a lovely take on the world that we do need to listen to and accommodate and incorporate in everything that we do.
But listening requires good relationships, and relationships need hard work to build trust.
As human beings, we muddle along in relationship. We're very rarely conscious and intentional. That's why it's beginning to feel like hard stuff. One of the threads that's been a mantra of mine was to slow down in order to be able to move faster. And that's a significant piece for me as far as this project work is concerned.
So we started with Myron's maxim 'the process you use to get to the future is the future you get'. That for me is the heart of everything that we are doing. So if we want people to be heard in community, we want people to feel like they belong, we want people to be able to exchange views that are different, be able to work through the conflicts that are arising.
If we want all of that... the way that we go about delivering that has to be entirely consistent with that.
So initially, one of the real seeds of the project was the Community Researcher strand. So our Community Researcher strand means training people to conduct community conversations with the people they knew or people they got to know.
There's kind of a principle behind that, that you can access different kinds of people, you can access different kinds of stories, and you can access different kinds of narratives by speaking to people in that way in the community.
So we've been working hard over the last 18 months or so to develop ways that we can come together to tackle social...
So today we're going to be hosting a sense-making workshop where we will be feeding in some of the community conversations that have been processed so far into that.
What we've had is a disparate group of people bringing lots and lots of perspectives, most of whom don't know each other. We've each been given, little fragments of conversations that have been lifted from the community and tried to bring our perspectives together to make sense of those narratives.
It's really brilliant in the sense that it, the whole aim of the HCT programme is to create understanding between the different sectors and I think that's really working and I think that the voluntary sector becoming much more an equal player at the table so that we're actually listening to the community and voluntary sector.
That's a really great outcome for the programme. I think that was probably one of the core aims of it in the beginning.
My call to action for Belong in Plymouth is that social isolation and belonging is not something that the system can fix for you. It's such a personalised human experience. Don't be afraid to accept that you do have the power to both make yourself feel like you belong more, but also to make other people feel like they belong more, and are acknowledged, and are seen, and are celebrated, or just a welcome part of the community.
We have that, and quite often when we choose to do it for others, we do it for ourselves.
- In their own words: what the Plymouth partnership said at the start of the project
‘We know social connection and isolation are strongly linked to health inequalities so our aim is to build connected communities, but the question really is “How?”, because there’s not a single approach to building social connection and there’s not a single approach to building communities. The only way that we’re going to understand is by talking to people about what social connection means in their lives. And if we can have that conversation in a participatory, open way we enable more to come out of it.
‘If you’re having a conversation with someone about their social connections they’re not going to talk just about services, they might talk about their gardener coming in, or their neighbour – so what would it look like if we had a conversation with a bunch of gardeners across Plymouth about the social good they provide by the act of just taking care of somebody’s garden and having that cup of tea when they do so?
‘We’ve had a history in Plymouth of conversations that developed into community hubs, the complex lives alliance… big developments that joined services up to people. What we’re hoping we can do is not just transform the system through changes to services but actually transform the city in terms of the movement-building we want to see.’