Problems Worth Solving
Technology doesn’t transform services. People do.
Problems Worth Solving brings you conversations with the leaders, practitioners, and radical thinkers reshaping health, care and support services. It's hosted by Sam Menter, co-founder of Healthia (www.healthia.services).
From transformation and AI to prevention and human-centred design, each episode uncovers the ideas and experiences behind lasting change.
Guests include NHS directors, policy shapers, entrepreneurs, clinicians, and designers — all united by a drive to solve complex problems.
Listen if you would like to understand how health systems can evolve to meet today’s pressures and tomorrow’s possibilities.
Problems Worth Solving
Dr Neil Churchill OBE: What the NHS can learn from charities to unlock neighbourhood health
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Dr Neil Churchill OBE is Director for People and Communities at NHS England. He has spent much of his career working across the boundary between the NHS and voluntary sector. His argument is simple: the health service depends on charities far more than it often acknowledges - but those relationships are still too fragmented and transactional.
In this conversation, Neil introduces Diagnosis Connect - an initiative designed to connect people with specialist charities at the point of diagnosis, rather than leaving them to find support by chance. It raises a bigger question: as the NHS becomes increasingly digital, how do we make sure its real-world relationships with the voluntary sector exist in the digital world too?
We also explore what the shift towards neighbourhood health means for charities and communities - and why care closer to home can’t be delivered by the NHS alone.
Problems Worth Solving is brought to you by Healthia, the collaborative service design consultancy for transformation in health, care and public services.
Find out more about our work at healthia.services.
Why Diagnosis Connect Matters
SamDiagnosis Connect is a new initiative based on a simple concept. When someone receives a diagnosis, the NHS aims to connect them with specialist charities to support them practically and emotionally beyond treatment. It's a brilliant example of people from multiple organizations coming together to solve a problem that no individual organization can solve on its own. Today's guest argues that the real-world relationships that exist between the NHS and the voluntary sector also need to exist in the digital world. As care moves closer to home and into neighbourhoods, how can digital strengthen connections between NHS services, charities, and community organizations, rather than leaving people to navigate those boundaries on their own. I'm Sam Menter, founder and managing director at Healthier, the Collaborative Service Design Consultancy. If you enjoy listening, you can subscribe to this podcast and the accompanying newsletter at healthier.services. So our health system runs on a partnership it doesn't always acknowledge. Behind every hospital discharge and every long-term condition, every carer struggling to navigate the system, there are voluntary organisations and unpaid individuals holding things together, often with precarious funding and little say in how those services are designed. Today's guest is Dr. Neil Churchill,
Neil Churchill’s Mission And Mindset
SamDirector for People and Communities at NHS England. Neil joined the NHS in 2013 after 25 years in the voluntary sector. He now leads on patient experience, community engagement, and strengthening partnerships with unpaid carers and the voluntary sector. He's also an unpaid carer himself. Neil, welcome to Problems Worth Solving. How would you describe the big problem that you've been working to solve through your career?
SPEAKER_01I think the big problem I've been trying to solve is how do we value people's experience and bring that to bear in terms of change and improvement. And I think the challenge as that manifests itself at the NHS is how do we see from the outside in? Because the NHS is full of experts. It has tremendous technical expertise, people who really understand the system, understand their bit of the system, and can make it all work. And that can sometimes obscure what it's like to experience the NHS as a patient or to experience the NHS as a carer. It can make it harder to think outside of the box, to think about disruptive changes, which might work a lot better. And it can sometimes lead people to overlook how patients and carers and communities contribute themselves and the networks and the strengths and the assets that they have in those communities. So what we're trying to do, I think both in the voluntary sector and in the NHS, is to help decision makers see from the outside in and to approach decision making in a much more open, collaborative
The NHS And VCSE Interdependence
SPEAKER_01way with the communities that we're serving.
SamI think it's fair to say that the NHS couldn't actually function without the voluntary sector and unpaid carers. You've seen both sides of that relationship. How would you describe the dependency between the two? And do you think the system properly recognises it?
SPEAKER_01The relationship between the NHS and the voluntary sector is full of interdependencies, and they are often independencies that we take for granted. So the voluntary sector is involved in prevention, it's involved in well-being, it does important research which looks at what some of the risk factors are, how treatments can be developed, they support people when you're well and at times when you're recruiting the unwell, help to stratify risk, support people in recovery, and help people at end of life and support people with bereavement as well. So I think the NHS is so well embedded. And the boundaries do change, they're not static. So if you look back at the history of the NHS over time, there are ways in which the voluntary sector has got more involved. We've seen the development of social enterprises, for example, very different kind of provision in terms of mental health services. And I think with the 10-year plan, a real shift in focus in into the area that the voluntary sector has long prioritised. Yeah, but there's left shift. How do we keep people well? How do we treat people close to home? How do we really build on people's own skills and agency? So that it's not that they're not interdependent, but they are, I think, valued differently, they're remunerated differently on different timelines, and I think the voluntary sector is not well understood and can be taken for granted. And what we really need is a more strategic relationship, I think reflected in the government's civil society covenants, that that enables us to work better together and more strategically together and in a less transactional way.
SamSo it's part of your role to help the system recognise that codependency.
SPEAKER_01It is, and I think many people do, and there are many people in the NHS who who really do understand that, but it is very varied, and I think it varies according to health condition, it varies according to place, it varies according to where we are in terms of a policy and improvement cycle. So I think what what I think we have seen is a recognition in certain sectors that the voluntary sector is crucial. We might we see that in mental health, we see that in cancer, I think, but we don't see that as consistently elsewhere. And I think the diversity of the voluntary sector is not all that well understood. So people in the NHS might think about the role of the voluntary sector in relation to patient voice, for example, or in relation to service delivery, or in relation to research, but they don't necessarily see that organisations are doing a number of those, and actually the real strength might be in the connections between them and the fact that can lead to really rewarding perspectives
Unpaid Caring And Invisible Boundaries
SPEAKER_01and insights and occasionally disruptive change which can provide much better support for patients in the long run.
SamHow much has personal experience shaped how you approach the work? Because I know that you're also an unpaid carer yourself.
SPEAKER_01I think personal experience is a very powerful force for me and for others. And so I am an unpaid carer. One in one in three people who work for the NHS is also an unpaid carer, and most of us are going to be unpaid carers in in their lifetimes at some point. And I think it was interesting because when I set out at NHS England working with the carist charities, I wasn't really providing much care. It was some support for my mum and dad. But my father did have some very complex health conditions and ended up with a stroke and a fall and a brain injury and was sent home on an end-of-life pathway. And my mum is quite frail and housebound, and so it what I've needed to do has grown over time. And so what I have done is to sit with her in accident and emergency departments over time, or go with her on hospital visits, or try and help to settle her back at home after she's been in the hospital for a long period of time. And so you get to experience the system and you can see where it works and where it doesn't work, and realise that initiatives to improve care can make a big difference. But you can also see that things fall down at the boundaries. So I don't know when my mum was last uh a six-week hospital admission, there was clearly no connection between the support that the hospital was able to provide and what the local council was doing in relation to social care, and it resulted in two different sets of people coming round to make adaptations to the house because one could make adaptations on the inside and the other can make adaptations on the outside, for example. So you see some of the inefficiencies and you can see how things could be proved. So I I think one of the things that we need to do in experience is recognise that staff have this experience, but staff also do know how to work the system, and it is very different if you're walking into an emergency department and you're familiar with that environment compared to if you're walking in it and you're not. So we have to make extra special efforts, I think, to to understand that our own lived experience isn't everyone's lived experience. There will be people who are providing a lot more care, have a lot more pressures on them. I've met many carers in in that situation, and that uh the the the NHS needs to reach out to people who are getting the worst experience, the worst support, and understand their experiences, which will be different, I think, for mine or others. So there's a real focus now in how do we hear from those we most need to hear from? How do we use a variety of methods? We need to co-produce changes, but we also need to reach out to people who are less likely to be joining a working group, less likely to attend a meeting in daytime, who have other pressures on their lives to make sure we understand that and we're building on their experiences too.
SamIt's that irony that the people who we most need to hear from are the people we're least likely to hear from.
SPEAKER_01That is right. Although I do see around the country voluntary organisations and NHS organisations reaching out very well. There's been some fantastic work in West London, for example, so we we can do it, but we need to do it consistently.
A New VCSE Strategic Health Council
SamThinking a bit about how the system engages with the voluntary sector in the big picture. There's a formal route which historically the government and VCSE have communicated through, which has been the Health and Wellbeing Alliance. This is about to be replaced by the VCSE Council. Can you tell me a bit more about the problem this is designed to solve and how it's going to work?
SPEAKER_01The Health and Wellbear Alliance was the previous strategic partnership that existed between the voluntary sector and the Department of Health and Social Care, NHS England and UK Health Security Agency. And it was very successful. This was the vehicle that we had in place during the pandemic. We were able to share developments, make sure that policy and practice interventions were tested and the charities identified areas where things were falling short and further action was needed. And so when we were looking at things like the vaccination campaign, the health and well-being alliance was really fundamental to that and making it work. But I don't think it managed to really deliver the kind of strategic relationship that we needed. It was, I think, focused more on policy and practice decisions and embedding the voluntary sector in those. What we were missing was something at a higher level which was identifying where are the areas where the voluntary sector and the NHS have common mission, what are the problems that we're both seeking to challenge? How do we really create sector-wide, very strategic interventions at scale? The new arrangement is going to be called the VCSC Strategic Health Council. So we we're hoping that it will have the benefits of the older arrangements, but it will elevate that discussion and make sure that we will be able to identify and tackle challenges together in a more powerful way.
SamThat sounds really exciting.
SPEAKER_01I think it is, and I'm very pleased it's one of the things I've wanted to put in place for some time, and I think this should be a a way of seeing the relationship with the sector elevated across the board.
SamThis is an NHS initiative. Is there a financial commitment from the NHS into this?
SPEAKER_01There will be new funding arrangements associated with the Strategic Health Council, and uh we will be announcing that as the plans are confirmed and finalised.
Complementary Strengths And Better Commissioning
SamSomeone used the analogy at a round table recently that the NHS provides the warp, the fixed structure, while the community sector weaves the weft that brings the fabric to life. In practice, how do we ensure that VCSE organisations help shape that fabric rather than being squeezed into the commissioning frameworks designed around the NHS needs?
SPEAKER_01I think it is really important that we take a step back and understand how those sit together. So I would say that the NHS and the voluntary sector are often working at common purpose and they have complementary skills. And what we haven't been good enough at doing is recognising the complementary skills and building approaches alongside them. So for example, I would say the NHS is obviously very good at understanding clinical outcomes, what is going to work from a clinical perspective. It's very good at understanding cost effectiveness and what impact can be gained for what output. The voluntary sector is better at patient-centredness, particularly in a holistic way, so understanding people and their lives and how people are likely to behave. And I think the voluntary sector is also better at innovation and particularly patient-led innovation that can result in disruptive changes. And I think that what we suffered from in the NHS is that voluntary sector organisations are not well understood and they are either seen as being organisations that champion patient voice or organisations that deliver a particular service or organisations that focus on research. And as many voluntary sector leaders will point out, it's the connections between those things that have the most power quite often because it's through the patient-centredness that you really understand what leads to change, you have insights into behaviour, you have future research which is going to lead into some substantially big changes. So I think the what I do see is that a number of voluntary sector leaders have been able to marshal that in ways which are encouraging commissioners to re-engineer pathways and to think about doing things differently, starting small perhaps and building from that. I think Diagnosis Connect is an example where we've seen the recognition that specialist charities are better able to support people and to support self-care than the NHSs. And we need to see that happen more consistently. So uh I think you've touched on the crucial question, and I think the this is one of the conversations I think that the VCSE alliances locally are having, which is how do we get good commissioning and how do we get good frameworks for the voluntary organizations to be supported and invested in and to make their contribution over time? We've got some way to go.
Diagnosis Connect From Concept To Scale
SamYou've mentioned Diagnosis Connect. This is actually a very simple concept, but with huge potential for impact. And I'd like to talk in a bit more detail about this because I think it's really exciting. Can you tell me a bit more about what this is and what's the problem that you're trying to solve with this?
SPEAKER_01The problem we're trying to solve is that when you are diagnosed with a condition, then at the moment it's variable, whether or not and how quickly you might find a charity that can help you. And I think most specialist charities report that there is some considerable time lag between people getting a diagnosis and and then coming forward to ask for help. Um and um voluntary organisations tell me that by the time that people have come to ask for help, that they've gone through an awful lot that could have been easier if they'd been in touch with that charity. And I think the other side to it is that that charities do things that the NHS can't. They can put you into a community of other people who've got that condition, so you benefit from being part of that community, people who can help you to to know how to live with a condition, because that's again a difference of the NHS. The NHS is talking about how to treat something, it's not talking so much about how to live with it, and especially as charities are very good at helping you recognize the holistic nature of living with a condition and supporting it. So this is a proposal that came from the voluntary sector and the 10-year plan committed to introducing one, and we are working through that process at the moment. What we're looking to do is to start with conditions that would be diagnosed in primary care, to pick a small number of those, to look at how best you might connect somebody with a charity, to look at when is it best to do that, to look at what the differences are potentially between different conditions, and to to think about what some of the benefits from that would be. And I think what we would hope is that in time this is something that can be automated, it's something that can happen at scale, it will obviously put patients in control. I think it's in keeping with where the NHS is going, making sure that people have access to the information and advice, they have access to being part of the community, that there is some triage in place, which means that there is one-to-one support if that is needed. That that's the goal.
SamHow do you avoid overwhelm for the charities if they're suddenly connected with everyone who's got a certain condition? That must be something you've thought about.
SPEAKER_01Well, so this is a proposal that's come from the charities, so it's something that we need to work through. And there is funding available for charities to support additional arrangements that they might need to put in place. But it's a key point. The expectation overall is that this is a more efficient way of working, and therefore we should be able to route resources into it accordingly. So if you take myself as an asthma diagnosis, for example, I was diagnosed by a doctor with asthma and then given a prescription, and you go to the pharmacy to collect your inhaler, and then you go home and then you look at how to use it. And I didn't use it well, and so I had to go back a couple of times to the GP, and the GP's response at the time was to give me a stronger dose of inhaler. Whereas I think if I had been connected to asthma and lung health, for example, then they would have given me access to information videos about how to use the inhaler, or you can speak to a nurse about how to do it, and I would have been using it more effectively earlier, and I wouldn't have needed to go back to see the GP. And also I would have been part of a community that would tell me when, for example, winter comes around, some of your symptoms might get worse, and this is what you do about them. So I think if we are right that an earlier connection with a specialist charity means that we support self-care more effectively and that we have better use of NHS resources, then we should be able to find ways of funding this in in in the longer term, recognising that there'll be a small percentage of patients who will need more than that information device, they'll need more than the what you can get online, they'll need to be triaged and supported. But we can factor that in.
SamWe've been doing some work with Breast Cancer Now on looking at the way people access their support services. One of the things that became
Automation With Consent Using NHS Notify
Samreally clear is that even when those services are really effective, if the referral pathways are fragmented or the back-end processes are manual or people fall through those gaps. When you think about Diagnosis Connect plugging into organizations like Breast Cancer Now at that scale, what from your perspective does good look like operationally? And how do we make sure it becomes genuinely supportive?
SPEAKER_01I think one of the things that people talk to us about it is the value of making an automatic signpost. So is signposting more than a referral? Because if you are leaving it down to a clinician, if you're leaving it down to a practice manager, then there will be variation. There'll be some who have the capacity to do that, others who won't. And I think one of the one of the lessons that we are picking up from the existing schemes is that the the referral rates are lower than people had hoped for. So I think what we're hoping for from Diagnosis Connect is that by bringing in automation, now automation still with patients in control, but if we can draw on the data that we we have got around new diagnosis and then automate a response on that and then make sure that the connection is appropriate and wanted and effective, then we should be able to overcome some of those administrative challenges that people have been trying to do this up till now have experienced.
SamWhat do you see as the role of the NHS app in that process? And have you thought about the different mechanisms that this might work? Or is it still early doors?
SPEAKER_01Well, we're going to be exploring different mechanisms, and that's the the point of the discovery phase is that we've got some idea about the kind of ways we can do it, but we need to understand how patients would feel about that and what would work and what would work for whom. I think with NHS Notify, we have got a very powerful mechanism available to us that wasn't available a couple of years ago. So when we were starting to scope work on Diagnosis Connect, we were thinking about using text-based services which would cost money for each text that you sent and would not have the kind of adaptability that NHS Notify does, because NHS Notify enables you to communicate via a push notification from the NHS app. It enables you to communicate by email, you can communicate by letter. There's a whole range of ways you can do it depending on what the preferences of the individual that you're trying to communicate with. And elements of that are free. As the NHS app becomes something that more people use in their day-to-day interactions with the NHS, we have to think really about what does that mean for the voluntary sector and where is the digital world taking the voluntary sector and how do they fit together? Because we need to make sure that the interdependences that exist in real life between the voluntary sector and the NHS are maintained in the digital space too.
Digital Volunteering With A Single Front Door
SamThis year we've been invited to record an episode of Problems Worth Solving at HET in London at the end of September. Het's been a regular event in my calendar for a few years, and I always have interesting conversations and meet new people. This year there's a lot on the programme about neighbourhood health, joined up care, and how we use digital to deliver better services. If you're there, look out for us and do come and say hello. You've also been working recently on a digital volunteering scheme. This is something that came about through COVID and has evolved.
SPEAKER_01Yes, so we have a large number of volunteers in the NHS doing some fantastic things, and I think we often uh overlook many of the things that people are doing. So what we found during the pandemic and after the pandemic particularly, it was quite difficult to volunteer for an NHS organisation, in part because you had to research and apply to each one differently. So the portal was designed to be a single front door, a bit like the NHS jobs for volunteering, so that you can go into the portal and find out what are the volunteering opportunities. So it's also linked in with things like the volunteer passporting that people are trying to introduce, so that once you've been onboarded by one organisation, you don't have to go through the process of being onboarded by another. So it started off as that place where you can find out what's available and over time we'll we will grow that functionality so that um it makes the experience more more friendly and more efficient for both the volunteer and for people working for the NHS.
SamWhat's the role of third sector volunteering in this? Is there a possibility those will be combined or is this solely NHS?
SPEAKER_01You can be on the portal as a voluntary organization too, absolutely. And and the number are particularly voluntary organisations who are working closely with DNHS are using it, and lots of hospices are using it, for example.
SamSo through these platforms that work at a national scale, you can mobilise volunteers quickly and flexibly at kind of enormous scale. But how do we preserve those local relationships and that community knowledge that those VCSE organisations bring to the table?
SPEAKER_01The national initiatives that we are building, I think, are designed to reinforce local organisations and local knowledge and not to replace it. What we are trying to do is to, in a variety of ways, to re-inforce the infrastructure that is available to voluntary organisations and volunteers in those areas and to make it easier for people to recruit and for people to be used for local need. What we're trying to do is to support local decision making. So for example, we've got a program called Volunteering for Health, where we invested in 15 local areas in into strategies for volunteering that those areas determined. They are partnerships of voluntary organizations led by voluntary organizations, but involving NHS trusts, involving local commissioners, local authorities. So that's national money to support local initiative. So none of what we're doing at the moment, I think, gets in the way of those local priorities, and quite a lot is designed to make it easier, more cost-effective to improve the infrastructure around them.
SamIf we zoom
What Digital Maturity Looks Like For Charities
Samout from volunteering and from Diagnosis Connect, which you talked a bit about, what does a digitally mature voluntary sector look like from your perspective? What's the ambition?
SPEAKER_01What I would observe, I think, is two things. One is that as someone who continues to have a role in the voluntary sector as a chair of organisation and trustees, I think the world in which we can rely on helplines and websites is fading. And we need more sophisticated digital tools these days, both for beneficiaries and for professionals that we're working with. And we really need to see those interdependencies in the digital space that already exist in the physical world need to be in the digital world as well. And I would look at, we've been talking about the NHS app, but I think the NHS app is going to be a game changer in health and care. We are seeing it become a digital front door and a place that people will be able to do a lot of things that they need to do more efficiently. And I think this this has implications. And the voluntary sector, I think, you know, for for my own organisations and others, I know is witnessing some new challenges. So the use of AI, for example, means that people aren't finding their way to charity websites and the numbers that they were, because AI is providing limited answers, not making those connections in the way that it did. And that I think that the connections with the NHS aren't yet being made. And what we don't want to happen is for the NHS to do things that it's not best placed to do. It needs to recognise that the things that the voluntary sector is better placed to do and it needs to make connections. And that's one of the things we're trying to do, obviously, with Diagnosis Connect. So this is not substituting an NHS service, it's adding to the NHS services, but in a way that really recognises the things that the voluntary sector can do better than the NHS in terms of supporting self-care and then holistic needs of the individual. So the things that I look at, I think are very encouraging. There's a lot of, I think, really good work that we see happening. So I'm thinking about there's an organization in Bradford called Create Strength Group, which is about how they support people with a history of using cannabis, opiates, and prescription medicines. And they've got some really good digital tools, including one tool that allows people to report canister disposal, which helps the charity to target its interventions more effectively. There's another tool that they've got, it's a recovery app to help people putting all of the things that they need in one place, whether that's around meetings, it's around signposting to particular treatments. There's the work that Age UK Norwich is doing to link some of the health coaching work for people who are vulnerable to fools with smart technology, using an app to monitor physical health and risk. And so I think making those connections between what charities are doing with those kind of advanced digital tools, supported by some of the traditional things that they've done, and linking it in with the NHS, I think is going to be crucial. And again, what we see is some of those charities doing making these approaches in a way which is part of a wider strategy with commissioners designed to tackle some of those problems and link it in with some of those local pathways. And I think that's where we need to go.
Digital Support Pyramids And Smarter Triage
SamI sometimes think about the way the voluntary organizations support people as a kind of pyramid, a bit like Maslow's hierarchy of needs, where at the bottom you've got these health information and websites that reach many, many people at kind of low intensity, and then you have digital communities where people share lived experience and connect. And you mentioned the importance of that sharing of experiences earlier. And then you've got group support and kind of at the top one-to-one support for people who are most in need. Most organisations have built from the top down because that's where the need is most visible. But digital means that you can build from the bottom up and AI even more so, so fewer people reach the top. Does that model resonate with how you're thinking about these organizations operating?
SPEAKER_01Very much so. And yeah, and I think I know a number of charities who use those models. And I think the other thing about digital is it does expand your ability to help people in a one-to-one basis and in small groups as well. So I would say I'm chair of crew's breedment support. Before the pandemic, we were meeting a lot of people face to face. Now we're continuing to support people face to face, but we're supporting others online. We've got something called understanding your breathing online, where people in small groups will be supported by a volunteer to talk about their experiences and to understand grief better and some of the coping strategies. And again, with unpaid carers, for example, if you are an unpaid carer for someone with a drug or alcohol problem, for example, then you might want to be part of a group with other people with similar experiences. You might not want to go to a local carer service with people who are looking after someone with dementia, for example. So the ability of digital technology to connect you in the right ways is is very powerful. Part of what we need to understand is the triage processes that come into play in order to make sure that those who do need the support are getting the support. But I think there's something else that I see charities trying to do, which is just being part of data sharing locally, that will really help you to understand whether the people that you are helping are the people who are in greatest need. But what we will, I think, be able to do with better data sharing is understand how effectively are we targeting some of that need and where do we need to go further. So, for example, there will be areas where service is less available, perhaps because there are fewer volunteers or because the funding hasn't come through from those areas, and that might be because they're more poorer areas. So understanding where the hotspots are and how they match your Maslow's hierarchy under provision of those layers. And also thinking not just about the individuals but the people around them. So one of the things I think we're trying to do in the carers world is understand the carers who are in particular need, but also the patients and what support is being put around them. So if you're looking after someone with dementia, for example, then it helps to understand the carer circumstances and the patient's circumstances and to try and target more generally beyond the one individual charity. So I think data sharing and really thinking about those hotspots and thinking about how do we get into the areas that are underserved are going to be really crucial when we're talking about neighbourhood health. And neighbourhood health is certainly prompting those conversations. And I think it's going to significantly change the way that many charities organise the care they provide. It will also, I think, challenge us all in that to really step up to the potential of neighbourhood health. Charities on the whole won't have the capability of doing it across the patch that they're serving. So I think one of those folks as a chair of a county-wide charity for care is we're looking at how much capability will we have, where will we put that capability, and where are going to be the the areas where we won't be able to reach up and what are we going to do about it. So I think it it's really stimulating some important conversations.
Neighbourhood Health And Sharing What Works
SamHow much of that support do you think should come from the centre and how much should be locally driven?
SPEAKER_01I think it should primarily be locally driven. I think that the the centre can helpfully set out expectations about who should be around the table. So it's very important that the centre says that voluntary organisations need to be involved in neighbourhood health. It's been very important, for example, that the centre said that care and support services should be co-located with neighbourhood health services. So to get people to the table. But actually what it looks like in practice is best determined locally. But I think that there are areas where we can learn from others who've been there and done it. So if you look at data sharing, for example, a lot of I see a lot of areas struggling with how to do data sharing. But I also see other areas, parts of the country like Wigan, um, parts of Dorset, who have done it successfully. They've introduced it, they're using it, and it's working. So actually, one of the things I think the centre has an important role of doing is showcasing some of those approaches and saying for any particular problem like that, there are probably two or three ways you could do it. Here are the two or three ways. Look at what which of those is best placed to work for you and then work it through yourself locally. Don't have to you don't have to reinvent everything yourself.
SamDo you think this is an opportunity for more inclusion?
SPEAKER_01It certainly is. I think and I think the focus on neighbourhood is welcome. So where I live, then we are looking at parts of the county with the greatest need, and it might be poorer areas like Hastings, it might be older areas of the county too, it might be rural areas. And it's it's trying to encourage people to come round the table, and if we've got the right people around the table, that we've really got a shared sense around who i i is in that population, what their needs are, where the unmet need is and what we do about it. What it doesn't do by itself is to to meet that unmet need. And so there are conversations that need to be had about where do you prioritize and and what works. But I think in all of the cases I'm looking at, so far, it's a more inclusive way of working because it does really understand those communities and the differences in the communities.
SamAnd those community organizations are experienced at reaching people that perhaps digital services are never going to reach.
SPEAKER_01I think a lot of the organizations I see in this field are working with a mixture of digital and face-to-face. So I think there clearly is a role for digital-only organisations. And there's a role for organisations just doing face-to-face work. But I think a lot of the organizations I'm seeing are operating across that triangle that you described with the digital entry point and the digital connectivity in the community, but as well as the triad that leads you to the kind of the individual services and the one-to-one support. My sense is that to work effectively at local locality area, place-based area, you need to be able to do both of those.
Place-Based Digital That Reaches More People
SamWhat do you see as the role of digital in the sort of local and place-based work?
SPEAKER_01I think digital has a key part to play. So the examples I was giving earlier around, say, the group in Bradford who was supporting people with cannabis and other drug use, both in terms of an app that the community can use to help to highlight areas of need and some digital tools that users can use themselves to help to manage and organise their care. Or the example from AGK Norwich around the app that could be used to monitor people. Being able to deploy apps to support professionals making better decision making, to support volunteers in effective triad or risk identification, for example, to support beneficiaries in the things that they need to do are all really important. I think the digital connectivity in terms of community is really important. So we talked about unpaid carers who might have similar needs because they're looking after someone with a drug problem, for example, or an alcohol problem, but you've also got people who have limited mobility and might not be able to get out to a face-to-face meeting, but actually can sign up to something online. I think the digital tools really help you to reach out into those communities, and there will be people who are better served through a digital route, and it enables you therefore to target more carefully the limited face-to-face time that you have on the people who genuinely need it for whom it is the best intervention.
SamDo you think there's a specific role the voluntary sector needs to play in that shift, or is it different per condition or per region? What's the model in your mind about how this might work?
SPEAKER_01The 10-year plan, I think, in setting out that left shift towards care closer to home and more preventative personalised care is really articulating the something that the voluntary sector has been arguing for a very long time. And the voluntary sector is already doing in many instances and understands it very well. So the tenure plan can't be delivered by the NHS on its own. And I think one of the things that encourages me in the conversation around the tenure plan is that there was recognition that the NHS isn't best placed to do everything, that other people do things better than we do. And so that needs to be reflected in the delivery. And you see it in relation to many of the things that we've been discussing, whether that's care planning, whether that's neighbourhood health, whether that's more preventative care. I think that part of the challenge for the tenure plan is a tenure plan is a very long period of time. It feels like a vision rather than a plan. And that people have been under wanting to understand, well, what does it mean for us? And what does it mean for us is is going to be determined by local approaches and local circumstances. So the what what how neighbourhood health is unfolding, again we've touched on, but making sure that voluntary sector are seen as being key partners in that, and that the NHS needs to value the things that the communities bring to the table. Now the the NHS can I think act unhelpfully by parachuting into a community with a resource that is time limited, resource limited, and that then distracts from things that the community has already got in place that could have been strengthened in different ways by the NHS. So I think again, we've seen some really good DB initiatives that are focused on understanding that and trying to support the things that are in the community, and that's one of the things that again volunteering for health was designed to try and work in that way to try and strengthen things in the community that we can use. And then to think about how the NHS can fit around that. There is lots of scope for pop-ups and going into supermarkets and going into the high street and using all of those things. But the it is really important that um we're strengthening communities and particularly strengthening communities that that have the most fragile infrastructure, and on the whole, we know where those are and commissioners understand them, and we need to make sure that neighbourhood health particularly works in those areas.
SamYou've
Funding Timescales Carer Burden And Final Lessons
Sammentioned a few initiatives around kind of digital and community innovation in there. What are the some of the blockers that you see to scaling those initiatives?
SPEAKER_01One of the biggest blockers that we hear from constantly is just the funding timescales. So annual funding is really not conducive for partnership working or for strategic investments. So long-term funding for voluntary organisations that they can depend on that will encourage them to make their own investment and to really build on the achievements that they are achieving. I think that's probably one of the biggest things.
SamSo we need 10-year funding for a 10-year plan.
SPEAKER_01You certainly need longer-term funding. And if you want to work with the voluntary sector as a partner, you need to enable them to take a longer-term view and to be able to invest in the things that they need to do in order to realise the potential that they can bring to the table.
SamDo you think that the plan is going to put more of a burden on carers?
SPEAKER_01There is a danger, I think, that that in seeing carers as partners, that that we continue to expect that carers do things that they're not equipped to do. And I think there's a growing focus on carer breakdown and the burden of unpaid caring on physical and mental health. I think it is very important that we look at how we support carers as much as how we look at partnering with carers. But some of the things we're talking about, I think, will help. I think that the the NHS app has the potential to juice some of the administrative burden that carers have. And I think the involvement of carers in care planning is also really important because the carers obviously have a crucial perspective to bring to the table in relation to care planning. If you're planning someone towards the end of their life or their palliative care, for example, that that's crucial to hear. It will enable us to get that right more often, but also it must enable the carers' own needs to be considered and for us to be really clear about what the limits are to what the carer is able to do. And I think a reflection that we need to make sure that carers do get breaks and that we can't deliver better care at the expense of carers' own health.
SamHaving moved between third sector and NHS, is there something that you'd like people in third sector to understand more about the NHS and vice versa?
SPEAKER_01Yeah, I think it's a really interesting question. I think that it's important, I think, for people in the voluntary sector to understand the limits of policy, that it's very rare that anyone can pull a lever to make happen what people want to happen. There are times when it can happen, but it's rare. And that generally you achieve lasting change by really creating alignment between the different things that people do in a health service, whether that's the clinicians, whether that's the managers, whether that's the regulators, and just take time to build that alignment. And I think the other thing I think that I think it's important to remember is that the NHS is very rarely looking at an initiative on the basis of will it work or won't it work. Normally the NHS is deciding whether to back something based on whether this will work better than something else that also works. So the NHS is often making difficult decisions based on different initiatives that would all have a positive impact on people. And so thinking about the evidence about how this works and how this is more effective than other approaches is something to engage with. I think for the NHS's side, I think that really the understanding and valuing the voluntary sector for the range of things that it does, not looking at them as just as a source of patient voice, but as a source of expertise that comes from really understanding patients, particularly those at the margins, having services that really reach out to them, having research which is really relevant to them, and being able to marshal all of that to create insight and innovation. And the importance of involving voluntary organisations from the start in problem solving. So not once you've got a solution and consulting on that solution, but actually saying here is a problem, how do we collectively tackle that problem?
SamNeil, thank you so much for taking the time to speak to me today. It's been a really interesting conversation.