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People not systems

How Innovation Unit’s approach to power and relationships has transformed adult community mental health in three pilot sites.


Over the past four years of the Living Well UK programme, Innovation Unit is proud to have supported nearly 6,500 people with their mental health and unlocked more than £10 million in new investment.


Our pioneering partners in Tameside & Glossop, Salford and Edinburgh have marked new territory in mental health provision, with Innovation Unit helping people and practitioners take the journey together by:

  • forging a powerful shared vision for change

  • facilitating co-design and co-production

  • testing and scaling of new integrated teams

  • supporting practice development and leadership

  • coaching leaders and building collaborative leadership.

At the release of our evaluation report, we asked partners what has been unique and inspiring about the Living Well approach. We asked particularly about their new teams, the people they help and their path to transforming services.


Three core themes have emerged: firstly, how Living Well systems transform relationships; secondly, how co-production embodies power and involvement; and finally, a focus on people, not systems.


Transforming relationships


Our leaders identified relationships - between practitioners in and across services, those coming to them in need of support, and between the Living Well sites - as critical.


Judd Skelton, Assistant Director for Integrated Commissioning, from Salford, acknowledges "existing good relationships in Salford" but describes the stand-out achievement for their site as "the strengthening of local relationships across people and systems.”


For Judd, the co-creation process of service design, testing, and feedback between those using the service and practitioners is "a true partnership approach, with providers, primary care, people with lived experiences and commissioners all working together to explore solutions.”


For Linda Irvine Fitzpatrick, Strategic Programme Manager from Thrive Edinburgh, true partnership is about multi-disciplinary and multi-skilled teams across the statutory and voluntary sector “respecting one another’s skills and strengths to support people and hold shared values.”


All sites commented on the importance of shared values in 'holding' the work's success. Lynzi Shepherd, Living Life Well's Head of Mental Health, Learning Disabilities and Ageing Well (Tameside & Glossop), said: "staff tell us the approach, vision, and values of the offer are conducive to a positive working environment."


As a result, our evaluation report, covering May 2019 to March 2022, finds "statistically significant improvements in people's satisfaction with relationships with friends and family.” Also, staff employed in the core Living Well delivery team experience high satisfaction levels through sharing skills and expertise across agencies: “... peer workers and third sector staff were pleased to be part of a professional network with the NHS and statutory sector staff."


So what is it about co-creation that enhances relationships and, therefore, the effectiveness of the services?


Co-creation and power


Living Well UK systems focus on meeting people's needs. All the sites talked about the importance of storytelling and co-creation in anchoring their work - especially in how it transformed power relationships and enhanced empowerment.


Lynzi says: “It was empowering for staff and people who have lived experience. Usually, they don't get to be part of the process or have their say in a meaningful way."


Judd and Linda also talk about equal empowerment. Linda said Innovation Unit's unique approach was "inspiring people to collaborate and be involved, treating everybody equally and listening to our local needs and context.” Judd added that "the co-creation process has embedded the flattening of hierarchies across all partners and people with lived experience.”


Anchoring service design in stories is another unique feature of Innovation Unit’s approach. Says Judd: “The most inspiring element was to centralise the ethnographic research in the programme. This approach to lived experience and understanding someone's journey has revolutionised our approach to co-design and co-production. It has created a ripple effect, with influence being felt in wider programmes of work relating to mental health."


People not systems


As our evaluation report outlines, each project dedicated time and space to allow an iterative process between lived experience, prototyping and developing a service model.


A system of 'collaboratives' involving all stakeholders was held every one to three months to diagnose progress, set a vision, hold the broader system to account, and centre the person at the core of the work.


In talking about dedicated time and spaces, Judd says: “The framework for co-design focused our approach and provided an opportunity to build prototyping/testing/learning spaces which could then support innovation and testing. The ‘critical friend’ challenge provided by Innovation Unit was extremely helpful in developing alternative approaches to existing challenges.”


Lynzi talks about the power of story across the design process, noting how they were “bringing real stories of experience to life in every session and using this evidence to appropriately challenge the traditional systems/services and ways of thinking."


Linda recognises that the Innovation Unit approach taught “the value of deep listening, sharing experiences, bringing alive adaptive leadership.”


Judd talked about how the IU's approach – co-creation, co-production, testing and being a 'critical friend' – meant that practitioners felt empowered to innovate:


"Holding a safe space around the vision challenged Living Well Salford partners to think outside of the traditional service approaches and to consider how people's strengths and needs could be approached differently."


This upending of traditional ‘top-down’ approaches is valued by our site respondents, with Linda commenting: “We are opening conversations with people that begin with ‘how can we help you?’”


Looking at the person not the system to create an authentic person-centred approach was critical to the success of Living Well.


Why does it matter?


Demand for mental health support is increasing, particularly after Covid and the rising cost of living. According to the Royal College of Psychiatrists, there were a record 4.3 million referrals to specialist mental health services in 2021. The Care Quality Commission has estimated that up to 10 million people, including 1.5 million children, will likely need additional mental health support due to the pandemic.


Services are characterised by long waiting times, poor collaboration, confusing and inconsistent thresholds leading to people falling between the gaps, ineffective discharge processes, no way to share best practice and an inability to harness the strengths of those seeking support. Reform has focused on improvements to aspects of the service rather than the system as a whole.


Judd, for example, talks of around 4,500 to 5,000 Salford adults who previously fell between the gaps in provision and who would "bounce" around the system and "not get their needs met".


Our evaluation report, covering May 2019 to March 2022, shows that Living Well helps people get the support they need much sooner - with first conversations being offered between 14 and 25 days after referral.


The success of our four-year programme, funded by the National Lottery and evaluated by Cordis Bright, continues to influence our approach. We currently support adult community mental health transformation across Derbyshire County, Greater Manchester and York, in line with the 2019 NHS England Community Mental Health Framework for Adults and Older Adults.


 

In the New Year, Innovation Unit will publish a learning report so that everyone can benefit from what has been a remarkable programme.


Contact us if you are looking for new solutions to improve community mental health and wellbeing in your area.

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