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"Health is fundamentally the product of an experience of place"

15 June 2018

David Relph, who has been Director of Bristol Health Partners since 2014, left the role in April 2018. Here he pays tribute to the people he's worked with, as well as the power of the partnership and the Health Integration Team model. He also describes the profound change in his attitude to health, brought about by his time working with the partnership. This blog was originally published in our 2017-18 annual review.

As I leave the partnership I would like to say a heartfelt thank you to all those people with whom I have worked over the last four years. I think Bristol Health Partners is in very good place - a successful partnership with a national profile that can demonstrate real impact and has funding in place for the next three years. We also have that most precious thing - a model that we know works.

I have worked with a huge range of people across the city and I hope that I have helped bridge the gaps that can exist between large, often internally focussed, systems and organisations like the NHS, and the communities that they work within and for. Organisations cannot be islands or fortresses: they exist in a geographic and a social context and the ones that will thrive in the next 20 years will be those that recognise this. Bluntly, the last four years have taught me that organisational success is irrelevant unless the city that we all share is somehow being made better as a result.

Achieving change at city, place or societal level, and not simply within organisations, is the crucial skill that we collectively need to develop. It is what is most lacking in our collective capacity and its absence is the reason we find it so hard to address, rather than just identify, societal or ‘system’ problems. So much of the work we do is actually just commentary on the world and the problems we can see. We often lack the ability to actually change things.

Bristol Health Partners is part of a wider story about how we are starting to address these thorny issues. In the long term, organisational objectives and even survival matter little. What makes a difference to people is the quality of the places they inhabit and the societies they experience. My most helpful and profound personal shift in thinking has been to move from seeing health as in some sense a technical challenge or outcome, to seeing it as fundamentally the product of an experience of place. In basic terms this is an acknowledgement of the simple truth long recognised by public health: that health has a fundamentally social context. The corollary is that if we want to address health issues then we must address societal ones.

Bristol Health Partners does this through an approach that is population focussed but also flexible enough to allow a laser focus on specific chronic conditions, and a methodology that is applicable at any scale. I am talking about the Health Integration Team (HIT) model that sits at the heart of the partnership.

We all owe a debt to the people that set Bristol Health Partners up back in 2012, many of whom are still actively involved in the partnership today. The principles that they established are still at the core of what we do: a commitment to collaboration, the link between evidence and research and service change, and a focus on population health - all brought together in the Health Integration Team (HIT) model.

During my time as Director I have begun to understand what a powerful and important model the HIT approach is. It sounds straightforward: to help people work better together to create positive change based on the evidence. But this is complex and pioneering work that requires commitment, patience and passion. The HITs have been running, in some cases, for six years and we are now starting to see the profound impacts of their work, in terms of patient outcomes, commissioning decisions and research funding. This success is due to the myriad people involved in HITs at all levels. The HIT Directors in particular are doing work that is helping to transform the health and care system from the bottom up. Long may they continue.

I’ve been very lucky to work with an excellent Board, and I’d like to thank Andrea Young in particular for her support, guidance and friendship as the Chair of the partnership. I’d also like to highlight just how lucky we have been with the quality of the Bristol Health Partners Executive Group. This group is the operational heart of the partnership and has helped drive it forward - and to change it when needed. David Wynick has done an outstanding job as its Chair and I have enjoyed working with him immensely.

I have also been extremely lucky to work with a truly great core team in the partnership. They are one of the best teams I have worked with in 25 years and I shall miss them all.

Overall though, I am very happy to have been involved in the story of Bristol Health Partners in some way and very proud of the work we have done. I shall always be a friend of the partnership and will do what I can, in whatever capacity, to help it succeed. I look forward to seeing the partnership develop and flourish and - I feel sure - working with my friends and colleagues in Bristol again in the future.
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