PPL are pleased to be nominated for this year’s ‘Transformation and Change in the Public Sector’ Award from the Management Consultancies Association for our work in Fareham and Gosport. Vish Valivety, a Principal Consultant at PPL, shares his reflections on the project and the key lessons he has picked up from his time in Hamsphire.
Statements such as the following have been parroted throughout the health and care sector for years:
- ‘Organisations need to work more collaboratively’
- ‘We should look towards innovative ways of working’
- ‘The system should empower our front-line staff’’
They are invariably the basis of a number of transformation projects undertaken across the country every year. They are by no means wrong or misguided, but they also generally are followed by a lack of detail and clarity.
When we were asked to support Fareham and Gosport’s work towards more effective integrated care in the community, we also had a similar set of goals in mind: collaboration, innovation and staff empowerment. However, what set our approach apart was our understanding of what each of these three things mean on a practical and granular level. We made tangible changes that resulted in meaningful improvements for both the system and the people within it.
Collaboration starts with acknowledging what you can and can’t do
As consultants, we often tell our clients they should be collaborating with other organisations to provide the best outcomes. It’s a lesson that holds for us too!
We realised that to make the biggest impact for Fareham and Gosport, we needed to rely on other companies’ strengths to bolster our own and work as a partnership. This enabled us to provide a strong and effective package of support that went far beyond what we would have been able to provide on our own. We did this through a consortium consisting of PPL, Optimedis COBIC, NEL CSU, Imperial College Health Partners and Social Finance. While it was a challenge to work as a single unit at first, we were quickly able to rely on each other to provide targeted expertise and share thoughts and ideas.
Our own journey of collaboration was reflected in how we helped the different provider organisations come together. We started with enabling people to be open and honest about their concerns and struggles but also showcase what they were good at and how they could support each other. The result: an agreed integrated governance arrangement between commissioners and providers and a CJV for a home visiting service that fundamentally changed how those in need received care.
Innovation does not only mean doing something new – it can mean doing something better
One of the key problems surrounding the development of innovative ideas is the tendency to shut out the world around you and create something seemingly new in isolation. Inevitably, this creates the risk of ignoring good work already being done and repeating the same mistakes in the name of doing something ‘new’.
Luckily in Hampshire, we were not starting from scratch and we had a pretty impressive model to build up from. Given the success of the Gesundes Kinzigtal model in Hamburg, it would be foolish to pass up the opportunity to test whether adapting a similar approach would provide the same benefits and outcomes. We were able to shift our focus from performing something that had never been seen before to something far more practical: the innovation around adapting a model that was proven in another country to the unique challenges of the UK health and care system.
And we showed that it does in fact work. We proved to both commissioners and practitioners that this was a worthwhile experiment as it radically changed the way local care was provided. It established a network of primary care practices supporting a population health approach through assessing and addressing needs. Since Fareham and Gosport is an Accelerator site within a Vanguard location this approach was shared with NHS England and informed the new Long Term Plan pushing the innovation across the country.
Empowering staff needs to occur on both ends of the spectrum
In our year in Hampshire, we talked with a lot of people, from GPs who knew their individual patients by name to executives of multiple CCGs. What we realised was that to truly move the area to the new way of working we were espousing, we had to move beyond grand strategies and plans. We had to actually work with individuals to help them understand on a practical level what the changes meant for their role and the way they operated.
Working with organisation leads and executives, we brokered difficult questions around risk and benefits sharing, what each organisation had to commit to for this to truly be a partnership, and how leaders could give agency to their managers and staff to provide more efficient care.
This would all be wasted, however, if we did not spend a similar amount of time with the staff to help them understand what working collaboratively and innovatively mean. Our 10-week process allowed them to develop the right frame of mind around identifying opportunities for improvement, mapping their current processes, and testing and refining new approaches as a network.
This year of working alongside brilliant partner organisations and for a group of clients who truly wanted to embrace change has been an amazing opportunity. I will definitely take my greater understanding of what really makes innovation work into the future and I’m really excited to see what comes next in Hampshire and across the country.