Talking leadership: Mark Doughty on delivering a vision of real collaboration

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Mark Doughty joined The King's Fund just over a year ago to lead on work with patients and communities. He has lived all his adult life with a number of chronic long-term conditions that have required regular contact with primary, acute and community services. He tells us why he is thrilled by the vision in the NHS five year forward view but thinks it's critical that there is a new relationship between those in the health care system and patients and local communities.

You chaired a session at The King’s Fund’s seventh leadership summit a few weeks ago on working collaboratively with patients – what did you take away from the event?

I came away from the summit energised by the discussions around engaging with communities and citizens in new ways, shifting power to patients and involving them directly in decisions about their own care and the future of health and care services. I was also reminded of the daily challenge for clinicians to be present for their patients, treating them as a person and not just a problem or symptom to be diagnosed and fixed. The system must enable them to do this and not work against them, which includes giving them time and space to be present in that way. I would hope then that more patients could experience what I felt when my rheumatologist asked me: ‘What would it be like to for you to live a well and fulfilling life with your arthritis, Mark?’ – that I was being properly seen and heard, and felt empowered and at ease.

What examples have you seen of this relationship developing?

At The King’s Fund we have been working with groups of health care professionals, patients and community members who are keen to explore what the new relationship might look like and how can it be developed and embedded within the system. Examples have included supporting Patients as partners for improvement, a project being led by Pauline Smith Senior Improvement Manager, Patient Safety Collaborative and involving the Leadership Academy; Kent, Surrey, Sussex Academic Health Science Network (AHSN); Healthwatch East Sussex and Surrey in a collaborative venture. The purpose is to support AHSN improvement managers and clinical leads and patient and public volunteers to collaborate and work in partnership on improvement and quality work streams.

Another project, commissioned by Nottingham City CCG and led by Alison Kirk, Engagement Manager, has involved working with a group of patient leaders and stakeholders from the CCG (including commissioners and clinicians). The purpose has been to support local residents, patients and members of the voluntary and community sector to work collaboratively and in partnership with CCG staff, clinicians and other health care professionals to improve local health services. Collaborative ventures have included working with commissioners to support the integrated personalised commissioning agenda, working with complaints and on the diabetic eye screening project, and being lay evaluators on procurement panels.

Why isn’t this sort of relationship widespread already? What are the blocks?

It can be hard to translate the good things that happen on an individual basis with patients and communities into ‘common practice’. Leaders are leading in a system where they are dealing with the pressure of meeting strict financial and regulatory requirements within very demanding timescales. They are also being asked to find the time, space and energy to build these new types of relationships.

NHS England has recently published their delivery plan for the Forward View – Next steps for the five year forward view. While in the original document there was a whole chapter devoted to the importance of the new relationship with patients and communities, in this document the focus is on performance, re-working of services and the reassertion of the importance of financial measures. It feels as if just as we have got closer to fostering new ways of thinking and new relationships that support the development of person and community-centred approaches to health and care, the priorities have changed.

What can health and social care professionals do now?

Given the pressures on them to deliver, and the embedded mindset associated with a traditional model of delivering health and social care, I think it’s important for health and social care professionals to consciously reflect on how they are as leaders. From my experience this means finding the time and space to ask challenging questions, both of themselves and of others. It requires engaging with people with an open mind, acknowledging any pre-judgements and biases, and being prepared to have their beliefs challenged. It also means accepting that sometimes insights, wisdom and potential solutions might come from members of the workforce or parts of our local communities that have not traditionally been listened to. I find that structured forums such as Schwartz rounds, action learning sets, process consulting and peer coaching can help to support the change in thinking that’s needed.

What work are you and The King’s Fund doing to support them?

We are continuing to run our Leading collaboratively with patients and communities programme, which is a key part of our work in enabling the types of working relationships that create change. As well as running it as an open programme, we are offering it as a specific programme tailored to the needs of individual organisations or local systems. We are hoping to run an action learning group for senior leaders from the third sector who are seeking to build collaborative and partnership relationships across the health and care system. We are also supporting patient and community leaders through leadership development programmes, action learning and one-to-one coaching. As well as this, we are supporting service users and health care professionals from mental health trusts to work in partnership to design and deliver services that meet the needs of their local communities.