That moment. When you say something and someone just scoffs.
That happened to me a few weeks back. I was delivering a talk to a group of leaders of health care and social services who’d come together to explore cross-sector collaboration. I was sharing a case study of a newly formed health care provider seeking to ‘stabilise’ people with multiple challenges in their lives, including drug addiction and homelessness. The provider’s initial aim was to find and stabilise these people “within six months”.
The scoff was friendly, not malicious, but it was heart-felt. I stopped my talk and asked the scoffer what it meant. Her answer was that the idea of ‘stabilising’ people in such difficult circumstances within six months was unrealistic to the point of being ridiculous.
She knew what she was talking about. She’d been leading a community-based organisation for years and had seen it all. It’s easy to see people as a set of problems that need solutions. It’s even easier when you can atomise the problems into those that you have solutions for. Drug addiction? We have a programme for that. Homelessness? We have a programme for that. But providing programmes, the scoffer had seen, is never enough.
Last week, I published an interview with Maff Potts, the founder and leader of Camerados. When it comes to programmes, Maff has led his fair share, including homeless shelters, hostels, rehabilitation centres, and domestic violence refuges. During the economic crash of 2008, a TV crew asked him what he was doing for people whose lives were falling apart. He realised that he had nothing for them – until they’d lost everything.
Where do we go when our lives begin to unravel? Maff spent years asking people this and he consistently heard two answers – the doctor’s office and Starbucks.
My clinical colleagues know all too well about the former. I recall spending a morning with a general practitioner (primary care physician) to observe how she accessed and used clinical information as part of her practice only to find that none of her patients had clinical issues. Most needed help to navigate the welfare system. Others just wanted someone to talk to. Either way, all the practitioner could do was refer and listen – knowing full well that neither was enough.
Doctors are trained to fix people. But sometimes fixing is not what people want. What they want, Maff believes, is company, a friend. In search of that, they head to a local coffee shop. And so, those are our options in the public realm: “a place that tries to fix you and a place that tries to sell you something”, as Maff puts it. There are fewer and fewer places where we can just ‘be’; places where we might be able to make friends.
‘Fixing’ social issues with programmes is all the rage in health care right now. But, as one leader of a community-based organisation told me this week, health care is acting like it’s made some new discovery: social circumstances matter to health! they need to be fixed! we better get on with the fixing! The one thing that too few leaders in health care are doing is listening to those folks that have spent their lives mired in these circumstances.
In the UK, the Dartington Social Research Institute (DSRI) did just that. Over two years, their researchers spoke with a hundred or so young people facing severe and multiple disadvantage and those who seek to help them. They published a small and enlightening book called Bringing Everything I Am Into One Place (project described here, PDF of the book here). One of its many insights was just how poorly programmes reach those that need them.
According to DSRI, we’re really good at designing services for the majority, especially when their needs are predictable. We’re not so good at designing for the minority whose needs are “messy and multiple”. Indeed, what the researchers found was that even when services are provided (for the messy and multiple) they fail to reach those in need largely because they’re provided to the wrong people. That’s not to say that those people don’t benefit from the services, only that they’re taking slots that could potentially be allocated to people with even greater need.
Ridiculous aims. Atomised solutions. And not really reaching those in need. All that in a scoff. So, what is health care’s role in working with people enduring difficult social circumstances? If it’s not just about providing programmes, what else is it?
According to Maff, after 20 years of providing services he’s realised that two things are fundamental to people turning their lives around – having friends and a sense of purpose. And that’s why he started Camerados. It’s less a programme and more a movement. A movement of people “who get through tough times by looking out for each other”. And there’s nothing quite like looking out for someone, as Maff says, to give you a sense of purpose.
So, if you’re in a community health meeting this week ask yourself if you’ve really listened to the folks mired in the social circumstances you’re seeking to fix, and, even if you have, ask yourself repeatedly whether providing a programme is the whole of the answer. Perhaps what people really need is a space in the public realm where they can just ‘be’.
A place where they – we – can look out for each other.
- My conversation with Maff Potts is called Halfway Between a Stranger and a Friend and what I did not cover above is how when Camerados was introduced to a hospital it was the staff that needed the space more than the patients and their families
- When you open the PDF of Bringing Everything I Am Into One Place scroll to page 51 to see the compelling diagram for how poorly services reach those in need – and then go back to the beginning to read the whole thing because it’s fascinating
- If you’re looking for models for how to better engage with the folks you’re seeking to serve, consider this one from Nottingham, UK, designed to ensure the research aims of a dermatology unit were aligned to people’s real world priorities
- If you’re looking for insights into how to make social care more amenable to local control, read this fascinating interview with the CEO of Cornerstone, a Scotland-based charity that delivers care and support
- And if you want to explore how Maff Potts’ insights might play out in your setting, do consider trying Camerados’ ‘public living room in a box’, their idea for providing anyone and everyone with the tools they need to join the movement
Previous Issues of Community & Health
- Sectors, Partnering and Place: How cross-sector partnering demands thinking about place, and why thinking about place means thinking about people’s choices and freedom
- On Absurdity, Collusion and Silence: How our failure to effectively respond to non-communicable diseases may be because our science needs updating – if only our politics would get out of the way
- The Politics of Measurement: How eliciting social definitions of value may make emerging partnerships between health care and CBOs more effective
- The Social Determinants of Relationships: How other sectors are learning that the key to responding to social circumstances is deeper relationships with the citizens they serve
- The Fallacy of Behaviour Change: How a flawed idea got traction and what you can do to fight back
- Lessons from the Frontline of Cross-Sector Partnering: A conversation with David Relph, formerly of Bristol Health Partners, on why collaboration has to be the core purpose of institutions concerned with health
- The Need for Human Learning Systems: A conversation with Toby Lowe on his journey from baffled Chief Executive to a key figure in the movement to find more effective ways to work in complex social environments
- The Challenge of Going Beyond the Usual Metrics: A conversation with Andrew Harrison of Revaluation and The Learning Studio on the promise and complexity of surfacing new types of value
- Effective Housing Goes Beyond a Home: A conversation with Paul Taylor, Innovation Coach at Bromford, a housing association in the UK, on why building homes is not enough
The photo behind the title is by Ev on Unsplash.