Anna Randle, Collaborate’s CEO, asks what did we learn from the pandemic and how can this help us build healthier communities now?
The pandemic is an experience of such magnitude that we will be making sense of it for years to come. As time passes, it’s useful to observe how narratives have evolved, partly in response to how the context has changed. This is to say, they are viewed through the lens of whatever is happening to us now.
At Collaborate, as elsewhere, we were excited by the rapid developments in place-based collaboration we saw during the pandemic. This narrative is well-established: people pulled together. Silos were overcome and organisations worked in partnership. Communities, mutual aid groups and the voluntary sector played a crucial role, reaching people no one else could. Services were redesigned overnight. People talked of culture change that would normally take decades happening in just weeks. Everyone was interested in the ‘new normal’. Collaboration was having a moment. But how would we sustain these ways of working once the crisis was over?
Is the ‘new normal’ just a worse normal?
Two years on, people are exhausted by what turned out to be a marathon, not a sprint. Some are leaving their jobs, creating new challenges of recruitment and retention in the public sector. The inequalities that existed before the pandemic have worsened. Despite rapid culture change, outcomes have gone backwards. The NHS faces huge backlogs and demand for social care is rocketing, but there’s no longer any significant injection of cash. The problems we face in mid-2022 are arguably worse than in early 2020.
In my work with public sector leaders across the country, I’m no longer hearing much positive talk about the ‘new normal’. Indeed, if there is a ‘new normal’, it seems to be a worse normal than before. And as these realities bite, the optimistic narrative from the early months of the pandemic is being re-written.
A group of senior health and care leaders I worked with in a London borough recently talked about how things were actually comparatively easy during the pandemic compared with now: it was clear what needed to be done and the methods that needed to be employed. While they acknowledged collaboration was key to working across boundaries, there was also a high degree of command and control that came with the urgent crisis response, and the authority and funding to get on with it. This is not to underestimate the huge pressure people were under — though, interestingly, this, too, is not such a big part of the story I hear now.
We must not forget what we learned. Those lessons can help us tackle complex challenges now.
We need to get some balance back into this debate and not lose sight of the positive lessons in our transition into the post-pandemic world. They are still with us, but at this point we need to work harder to remember them. (This blog from Matthew Taylor and Chris Ham is a helpful reminder, from the power of mutual aid to trusting local leaders.)
We need to be thoughtful about why things feel so challenging now, and work out how we can apply these lessons to the different, more complex kinds of challenges we will face in the (hopefully) post-pandemic world. Food parcels were a short term measure: how do we now enable people to have access to good food and decent income to buy it all the time? The vaccine programme was a great achievement, but how do we ensure everyone has the best chance of living healthy and happy lives?
Now, especially as Integrated Care Systems (ICS) to improve population health and tackle inequalities are being established, these questions should be in the front of our minds.
The solutions lie in the collaborative approaches which were adopted in the pandemic. But now they can, and must be, adapted for this very different context. Command and control is appropriate for some circumstances, but will not suffice when working in complexity, as David Snowden’s Cynefin framework helps us understand.
So, here are some thoughts about how lessons from the pandemic can inform how we tackle complex challenges today:
Understand the nature of the challenge now.
The pandemic was urgent, novel, all encompassing and it completely reordered our lives for some time. By contrast, addressing long term health inequalities might in fact be larger in magnitude and require even bigger changes in the ways we live because they are broad, interconnected and long term. Understanding this nature of the problem is critical. As new partnerships are formed, we will need time to explore local health needs and priorities, engage with a wide range of stakeholders to understand issues deeply, and to identify the factors that contribute to challenges in different communities.
Recreate shared purpose.
One thing people do remember about the pandemic is how easy it was to collaborate because of a shared purpose: protecting people from the virus. The purpose of an ICS is not as singular or simple, necessitating discussion, agreement and communication on the purpose of your local system. Clear shared purpose binds different leaders and organisations together, mobilises staff and guides investment. It taps into the intrinsic motivation of everyone in that system to work together to make a difference in people’s lives. For ICS and place leaders, tackling health inequalities would be a good place to start.
Work with community strengths.
The pandemic highlighted the strengths and resourcefulness of community groups and the VCSE, revealing that where investment had been made in strong, participatory neighbourhoods, the relationships and connections needed in crisis were already in place. We also know that people are healthier and happier in connected communities, and as this blog argues, communities are producers of health and wealth, not just consumers of services. All local partners will need to look for ways to invest in communities, connect and collaborate with community groups and leaders and be aware of and manage power dynamics to best support health creation.
Collaborate to achieve shared purpose.
Organisations and sectors specialise because they have different strengths and capabilities, however, some things can only be done together. To partner well, we must respect and trust the contributions of others, play to strengths, treat each other as humans, communicate well and take collective action. Creating space for learning together so you can adapt in response to what’s working is particularly important when tackling complex challenges such as health improvement and inequalities.
Create collaborative governance.
A great deal of energy has been invested in designing ICS and place-based governance arrangements in recent months, arguably often at the expense of action to address population health — and who had perfect governance arrangements during the first months of Covid?! In the context of complexity, traditional top down, highly structured governance approaches are unlikely to nurture the conditions we need: shared purpose, relationships and trust among leaders, collaboration, and learning and adaptation. Psst: Collaborate will be publishing more about governance in complexity soon.
Trust yourselves and step into your authority.
Local leaders rightly feel proud of the job they did during the pandemic. They knew their communities and didn’t second guess what they had the authority to do, so they saw what needed doing locally and they did it, sometimes despite what they were being told from above. What I see in many local health and care partnerships at the moment is a lot second-guessing what central government, NHS England or the ICS wants. Take your authority from your community and your place. Look out to that community and place, not up. Be brave together and get on with it.
Collaboration is for life, not just for pandemics.
Arguably, this is the work of transitioning from emergency response back to everyday public service, from protecting people from an immediate threat to enabling them to flourish by getting to the source of the complex challenges they face and collaborating with communities and across sectors to address them together. We can rise to the challenge. We can meet people’s needs. We can do things together that we can’t do alone. The roots of collaborative public services fit for 21st century challenges were planted. Let’s continue to nurture them.
So what did we learn from the pandemic anyway? This narrative will keep evolving, but let’s hold on to the things that stood out in those early days. Let’s focus on how those ways of working will help build public services fit for 21st century challenges, in a much changed but not yet much better world.