ICBs working with people and communities
In October 2023, NHS England commissioned the Better Way to act as a learning partner for 16 Integrated Care Boards (ICBs) across England who were taking action to improve their community engagement.
Learning report
This learning report describes what they did, what they learned, and sets out ideas for what can be done to achieve more:
“A key insight is that it is simply not enough to develop the narrative about the value of community engagement (that is already well known in broad policy terms), nor to produce even more generic toolkits and guidance (there are plenty of those already). Rather, to really move forward, there also needs to be a willingness to change within, a fresh look internally at the ways that ICBs themselves operate, and how, inadvertently, they may be making it harder than need be to bring about the closer collaboration with communities that they know is required, in the face of the accumulating crisis of increased demand and overstretched services.”
The learning report is accompanies by the following videos and blogs, which provide a taste of the insights and energy that emerged from the ICB engagement leads and their partners during this project:
Engaging local communities, to produce a rural health strategy
NHS Shropshire, Telford and Wrekin Integrated Care Board (ICB) has embarked upon the production of a rural health strategy. This was building on the Shropshire, Telford and Wrekin Big Health and Wellbeing Conversations, and Joint Strategic Needs Assessment that informed the NHS STW Five Year Forward Plan.
The rural areas the engagement focussed are within Shropshire. However, they acknowledge Telford and Wrekin do have rural areas and the Rural Health and Wellbeing Strategy will consider the needs of all rural areas across Shropshire, Telford and Wrekin.
To get things started, the ICB matched a small grant from NHS England and commissioned an external organisation, the Good Governance Improvement, to facilitate the process. A workshop took place in February 2024, drawing together a spectrum of community stakeholders, to take stock of what was already known, to gather further insights, and to start to identify strategic priorities.
In addition, a discussion guide and toolkit has been designed, with an easy-to-use method to upload feedback, to help local leaders, from the community and voluntary sector, local councillors, and others, undertake further community engagement themselves, on behalf of the ICB.
This isn’t a tick-box exercise. Importantly, the decision to produce a rural health strategy didn’t come from the ICB, it came from strong voices from within the community. Throughout the process, the ICB has taken care not to predetermine the content of the strategy, framing the discussion through open questions, allowing space for the insights and ideas of community members to emerge. And there is senior buy-in for this exercise within the ICB.
It is hoped that the strategy will be in place by July, and become a living document, capable of evolving over time, and one which will help to shape how the integrated neighbourhood teams, and other parts of the system, operate.
In this video, Jackie Robinson, Associate Director for Communications and Engagement for the ICB, describes the aims, and the journey so far. As she says, ‘it can’t all be on the shoulders of the NHS or of the council’, and this is a way to ‘bring a wider partnership together to improve the situation, to enhance connectivity, and help local people help each other’. And her top tip for other ICBs is a straightforward one: ‘look at what local people are saying, listen, and be seen to proactively respond’.
Watch the full video here: https://youtu.be/WXEW4jm0JLc.
If information is power, what would happen if local communities were able to generate and control the data about their health and well-being?
In this blog, Claire Teeling and Rachel Smith share some early learning from work in progress with the Derby and Derbyshire Integrated Care Board (ICB).
Claire: I lead a social enterprise called Grow Outside CIC, working to increase environmental awareness and protection by delivering nature-based wellbeing and community horticultural projects. I’m passionate about inequalities, our loss of land sovereignty and the associated disconnection from nature. Grow Outside was established to address some of this by working with communities to change this experience and story.
I am also part of Green Spring, a cross-sector green social prescribing programme, set up in 2020, as part of a national pilot. When we started out, I had assumed that the key challenge to supporting health and wellbeing in communities would be a lack of financial resources but being part of Green Spring, I started to understand that the siloed and fragmented way that health, community and public sector services were working together would be a huge challenge for us.
Our work seemed to demand more time speaking truth to power than being able to actually deliver activity that could be of benefit to people. This felt really counterproductive and unintuitive, and we have found it really hard to get around this.
From a community perspective the system feels impenetrable; small groups and organisations feel excluded and isolated. Speaking up is tough and can feel futile or counterproductive. So, when our ICB shared their work on developing a Community Insight Framework and asked for input I was hesitant but hoped it might be an opportunity to contribute in a meaningful way. Our thoughts and constructive criticism were listened to, and we were invited to get involved in a local learning network, convened by the Engagement Team in the ICB. The network was made up of people working in or in support of communities and began to meet regularly. This then opened up the chance to represent Derby and Derbyshire as part of this national group of ICBs, and to interact and share learning on the work we were doing.
Rachel: I lead Make/Shift, a growing collective of people, groups and organisations who believe in the creative power of communities to make positive change in the places they live. We’re rooted in Amber Valley, Derbyshire with networks reaching out beyond. Our approach is based on an Asset-Based Community Development model, where neighbourhoods are seen as “pivotal units of social change”. A big part of our work is testing new ways of working and learning together, which shift more power and resources to communities to make decisions, take action, and make change together on their doorstep. We’re one of 39 Creative People and Places projects, an Arts Council England-funded programme which aims to engage new people in shaping arts, culture and creativity where they live.
We’re still at an early stage of the project, asking questions, listening and finding our place. During our first year we got involved in a pilot project testing a new digital platform called Understory, which helps communities map social action and infrastructure together in their place. It was a really fascinating process, and it kick-started a lot of conversations about relationships, power and health. As part of these conversations, we met Claire who was involved in the ICB work and we started to think together about what might shift if we put communities, rather than professionals, at the heart of gathering, generating, owning and using community data.
We wanted to work with communities in Heanor to start building a collective understanding of their town, testing different ways for qualitative and quantitative data and insights to be generated by, owned by and useful to the community first, on their terms - before being shared with relevant professional sectors. Lots of different professional sectors - from health to education, housing to culture - want to use community insights to improve what they’re doing. But when data is extracted and decontextualized from a place, segmented into sector specific silos and only accessible to professionals it tells a very fragmented story, that can be really disempowering for communities. We wanted to start from a different place, putting communities at the centre of the process and working at a hyperlocal neighbourhood scale that makes sense to people.
We’re currently collaborating with two community hubs in Heanor and we’ve started to develop some really strong and meaningful relationships with and between people and groups. We’re building trust with people who live in this community, especially for them to understand what we are hoping to achieve and what capacity and power this could create in their community. The former is quick to start but needs to be given time and nurtured carefully, and the latter is full of possibility but fragile and easy to lose.
We have learned that the speed and expectations of the wider system, however well-meaning the individuals in roles might be, are at odds with the need for trust-building and the time required for communities to be in a position of understanding their intrinsic value and potential power.
Being involved in the Understory pilot has sparked our imagination about how communities might be able to generate, access, break down and play with their own data.
We’re thinking a lot about power, responsibility and accountability. We’re starting to understand how much richer and more meaningful community insights would be if they were rooted in context and stewarded by the people they are supposed to benefit, rather than being extracted and processed in siloed professions outside the community.
So, what next?
More of the same; more time, care, and patience.
Finding opportunities to talk to people in the system who have the capacity and bravery to challenge received wisdom and negative public sector cultures and hierarchies.
We’re building on our relationship with Understory and will be one of four places working together over the next four years to explore community-led ways of generating, collecting and sharing warm data.
We’re also nurturing peer support opportunities in communities, to create space for peers to share experiences, stories and talk openly together.
Some key take aways that other ICBs and their partners might be able to learn from:
- Be honest, even if it’s to say you can’t do something.
- Find ways to show up as a human rather than a professional.
- Don’t over promise or say things you don’t mean or can’t deliver, it’s worse than not trying at all.
- Avoid transferring the pressures and demands of your job onto the community; they may well have the answers but not necessarily to the question you think you need answering.
- If you want to tap into the capacity and insights of communities, you have to be prepared to shift power and resources too.
Partnerships with overlooked communities
NHS West Yorkshire Integrated Care Board (ICB) is seeking to address a perceived gap – a lack of dedicated practical resources to support engagement with under-served or overlooked communities.
As Colin Hurst, Involvement, Insight and Consultation Lead for the ICB, explains, there is no shortage of toolkits about patient/public involvement – a new one is being published every few days, it seems. But there also seems to be far fewer specific resources for engaging with certain ‘high priority’ groups - people with learning disability and their families, people from the LGBTQ community, those from particular religious or minoritised ethnic groups, for example.
So, in alliance with South Yorkshire ICB, Humber and North Yorkshire ICB, and North East and North Cumbria ICB, they have undertaken a review a range of involvement toolkits, and they are doing this with small groups of people from those under-served communities, where good relationships already exist.
The intention is to produce useful guidance on getting involvement exercises with such communities off to the best possible start. Colin explains that they are not planning to produce yet another toolkit, and want to avoid a tick-box approach. Rather, they are hoping to provide a set of ‘considerations’, allowing flexibility for particular local circumstances, and which can be added to in the light of further experience.
And, as Colin points out, ICBs should not be wary of engagement with their communities. In his experience it can be very rewarding: ‘members of the public are nearly always reasonable, understand the pressures faced by the NHS, and simply want to give something back’, he says.
And his top tip for others: ‘be values-based rather than process-driven’ – values can adapt to the particular circumstances in the real world far more quickly than processes. And sometimes it is best not to rush things. This kind of work requires time, says Colin, if we want to produce benefit, rather than simply complete a project.
Watch the full video here: https://youtu.be/8A-VdYlgT3E