How to change our failing systems

How to change our failing systems
New Start, by Clare Goff


As the human and financial costs of the failures of our public services add up, it’s time to create human-centred systems that are truly transformative, says Clare Goff.


The flagship Tory borough of Wandsworth in south London is not where you would expect to find a thriving voluntary sector that is challenging and changing the health system to greater support the needs of its BME community.


The Wandsworth Community Empowerment Network – the only surviving CEN from former prime minister Tony Blair’s 2001 policy – has created six community networks, which train local leaders in family therapy. Through the Black Pastors Network and the Dementia Network, those with mental health issues are gaining help and support from an early stage.


Malik Gul, who formed the CEN in 2001, was scandalised by the over-representation of black and ethnic minority people at the acute end of mental health provision. According to data from the Department of Health’s DRE report, black communities are 44% more likely to be sectioned under the mental health act and 14% more likely than white people to be turned away when they ask for help from mental health services.


‘The local mental health trust called these people “hard to reach”’, says Gul. ‘I said, “I see these people every day, they’re not “hard to reach”.’


The health system was failing a large proportion of its population; Gul’s answer was not to attempt to improve the local health institutions with better targets and processes but instead to tap into the latent ‘social capital’ in the local community.


Through holding local conversations and building trust and capacity over many years Wandsworth CEN has changed the system for the better. And by focusing on a problem in its early stages the networks are expected to save millions for the local mental health trust.


Starting from ‘year zero’


Rarely a week goes by without new evidence that our public services are ‘broken’, that people have been failed by the ‘system’. The stories in the press focus on targets not being met, reforms not working and adequate care not being provided. Often the response is for even greater reform to further improve targets and efficiency. The evidence however is pointing in a different direction, away from ‘system’ improvements towards a more human-centred approach.


Gul changed his local health system through local collaborations, conversations and relationship building over many years. He understood the need for a response that is embedded within the community rather than created by building a new layer of administration.


Interestingly – and perhaps controversially – he attributes his success at least in part to the fact that there wasn’t a strong community sector in place when he began his work. ‘It was ‘year zero’, he says. ‘Wandsworth had not been corrupted by the voluntary sector culture which, towards the end of the Blair regime, was being co-opted into a delivery arm of the state.’


Clare Hyde had the same ‘blank page’ feeling when she became the first manager of a small women’s health organisation, WomenCentre, in Calderdale. She joined from a large local authority and was given free rein as manager. ‘It was an absolute joy to work in such an unfettered way,’ she recalls.


She set about asking questions and creating her own, intuitive, solutions to helping women suffering multiple problems, from domestic violence to substance abuse, mental health issues and insecure housing. She questioned the statutory silo approach that bounced women from service to service without actually solving their problems, and instead created a one stop shop based around the woman and beginning with empathy and care.


‘We were there to be a good mother to women dealing with multiple problems, to hold their hand for as long as it takes without creating dependency.’


Over a period of 20 years, Hyde turned the WomenCentre from a tiny local organisation focused on women’s health to an exemplar institution serving the needs of women suffering multiple disadvantage from across the country. Her starting point was compassion and her organisation flowed from the women who walked through the door seeking help, rather than attempting to fit those women into existing organisational processes.


While Clare Hyde and Malik Gul have created human-centred, collaborative organisations building social change they did it largely by going against the current grain. At a time of complex social, economic and environmental problems our social systems and structures are unable to provide the necessary solutions. Despite huge sums of money spent on reform, public services are struggling and it is becoming clear that further reform is not the answer.