Only collaboration can deliver the change our health and care system needs

In this blog post, originally published as the foreword of our 2016-17 annual review, Bristol Health Partners Director David Relph reflects on what the partnership has achieved not just in the last year, but over the last five years since its inception in 2012. He discusses the value, financial and otherwise, that the partnership has brought to the Bristol city region. This is part of a series of blogs, where key players in Bristol’s health sector write about a health related subject of their choice. If you want to contribute, email [email protected].

As Andrea Young sets out in her welcome to this year’s annual review, it’s been an interesting and challenging year for Bristol Health Partners. As we move beyond our fifth anniversary in April 2017, there is much to celebrate about the partnership and the work we have enabled and supported. There is also much that has changed that we need to respond to.

The question we have to answer is ‘where do we go next’?

Bristol Health Partners has always been unusual. It’s not the result of a national mandate or licence, and is accountable only to the partners who support it. As a result, we can focus the partnership wherever we wish, and shape its activity to address the challenges that matter most to us and the people who live here in Bristol.

This discussion has been going on for some time, and will crystallise over the summer. The Bristol Health Partners Board have decided to extend the current collaboration agreement to April 2018. We will work over the summer to draft and sign a new one, setting out the scope, purpose and direction of the partnership to 2020.

I won’t second guess the conclusions the Board will reach, but I would like to share my thoughts on the partnership and where it might go next.

Our impact over the last five years

First, the impact of Bristol Health Partners is real and backed by evidence, but we are still in the early stages of understanding just how powerful partnership working can be.

Over the last five years, our Health Integration Teams (HITs) have been responsible for bringing nearly £19.5 million of investment into our local health and care system. During that time, they’ve attracted more than £3 million in new investment in services, and nearly £16.5 million in research funding that has flowed into Bristol as a result of the partnership. They have also delivered £1.27 million of savings to front line providers.

What is more intangible – but in the long-term may be more important – is the way we are learning together about what collaboration means in practice, and developing the skills and confidence to do it well. You cannot coach these things: you have to learn by doing. If someone else had written the book on this, we’d be reading it, but they haven’t.

I think this point is important because it’s very easy to forget just how innovative Bristol Health Partners is. Our Health Integration Team model is unique and there isn’t another health network with our diversity of partners, except those inspired by our Bristol model in places like Leeds.

We are breaking new ground here, and learning as we do it. We won’t always get things right and we won’t always know what’s possible until we actually begin. This emergent, flexible and collaborative way of working is culturally very different to the structured bureaucracies in which we all traditionally work. But it is through this new approach that we will address the challenges we face, here in Bristol and elsewhere.

Our collective ambition

It’s easy to feel beaten down by the weight of the ever tightening financial constraints in which we operate. My biggest worry is that we’ll react to this pressure by retrenching, finding ourselves moving in ever decreasing circles, clinging to the aim of simply continuing what we do but with ever reducing budgets. This only ends in failure.

Our challenge is to walk the walk as well as talk the talk on collaboration. The discourse we often hear in our health and care sector is that we believe in collaboration and making the most of the capabilities that we have here in Bristol, whether clinical, academic, third sector, public or civic. We are also able to demonstrate the financial value of this type of approach.

In this situation, there is a case to be made that the best response to a tightening budget is not to do the same with less. It is to invest more of our effort in an approach that works.

The new core business

My view is that we need to hold our collective nerve. We know that collaboration is how we’ll address challenges that don’t respect the structures we have created. It would be a mistake to stop working in this way just because we haven’t become amazing at it straight away.

Collaboration is not a ‘nice to have’ any more, it’s not a marginal activity that is fitted in as an extra to ‘core’ organisational activity. Collaboration is the new core business, and the more we can work in this way, the better we will become.

We tell each other that the issues we face only have system, not organisational, solutions. This is, in my view, the single most important feature of the environment in which we now operate. Its logic is clear and ruthless. Working together and calling on all the skills and evidence we can share is the best way to operate – and we will get better at it. Organisations will always be important, but it is the networks that they are part of that will, increasingly, drive change.

Focussing on immediate challenges and longer term prizes

That said, focus is key. Resources, financial or otherwise, are finite. We need to ensure that the work we do together is what’s likely to have the most impact. The challenge will be to understand that impact in both the short and long-term.

The immediate challenges we face are important and occupy much of our collective time and brain power. Clearly as a partnership we need to make a difference here. This is precisely why we have done so much work in the last 12 months to align our activity with the emerging aims of the Sustainability and Transformation Plan (STP).

But there are longer term prizes that should be on our agenda. Our work with the Elizabeth Blackwell Institute on data is a great example of this. We have developed a data asset register that will be the foundation of projects that we haven’t even thought of yet.

The link between the built environment and health is another example. We know that poor housing is a key health issue, but it’s not something you are likely to see in any of the STPs that emerge around the UK.

The longer term is where the transformational change we all want to see lies. We must retain the will and means to support this long-term work, as well as respond to immediate challenges.

What’s next?

Over the coming months we will develop a vision and a model for Bristol Health Partners for the next few years. The Health Integration Teams will continue to be central to Bristol Health Partners. But the partnership won’t look exactly like it does now. It will be more focussed and lean, and inevitably this means there is work we are doing now that won’t continue.

But we shouldn’t fear this. The last five years have been an exercise (deliberate or otherwise) in collective learning – and when we learn we must also change. I think this change will be inspiring, allowing us to build on, retain and deepen what is best about our partnership. It will also allow us to lift our eyes, to recognise what will genuinely transform Bristol, and to work together to achieve it.

As ever, I look forward to working with everyone as our journey continues.

– David Relph, Director of Bristol Health Partners