Public health. Until a couple of years ago, the average person in the street thought it meant doctors, nurses or maybe being nagged about smoking less. Then Covid-19 happened. Now, 145,000 deaths and more than 700,000 long covid cases later, directors of public health like Wakefield’s Anna Hartley have a much higher profile.
Despite the massive pressure this has placed on a group of previously anonymous professionals, Hartley is determined that something good might come out of the pandemic. To this end, she is about to launch WMDC’s ‘big conversation’, a paradigm shift in the provision of public health services in the Wakefield district.
The Covid-19 pandemic produced unexpected benefits
Hartley’s determination to bring about this sea-change came from two main areas: the pandemic and listening to people’s real-life stories. She told me:
“Whilst covid has been an incredibly difficult and challenging time, one of the interesting things that came out of it was that sense of community participation, where people were taking the initiative and doing things really quickly and sensibly by focusing on things that really matter. It became apparent there were lots of fascinating things that could be done to embed far more meaningful, ‘people-powered’ measures.
“However, it wasn’t until I actually sat down and listened to first-hand accounts of peoples’ struggles within the social care system that I really understood the realities of their lives. For instance, one family told me how much their caring for one child (a teenager with additional needs), impacted on the other siblings. That conversation really stuck with me to the extent where I can almost remember the moment; how they felt, how difficult it was for them, their fears about the future for their child and so on.
“Listening to people’s stories has changed the way I operate. In even the most carefully-constructed survey or focus-group, that conversation would have been led by me and what I wanted to talk about. However, if you sit down with someone and have a chat with them on an equal level, people can share what they want to share. The things I learned in such conversations I find myself sharing now on an almost daily basis. I wouldn’t have got that from four million surveys.”
It’s clear that this empathetic response to families’ experiences has given her work a different focus. It’s also significant that this initiative in Wakefield is part of a much wider exploration of new ideas in local governments all over the UK, in an environment of austerity and budget cuts.
Community wealth building, the Preston model and the Wigan deal
The best-known of these is the Preston model, where a council links up with large local employers known as ‘anchor institutions’ to purchase services locally as part of community wealth building. Instead of taxpayers’ cash going to multinationals, it goes instead to locally based providers. The logic runs like this: give the contract to SERCO or similar and they give it to their shareholders, none of whom live or shop or eat out in your town; give it to a local firm owned by and employing local people, and the whole town gets a boost.
Then there’s the Wigan deal, a set of commitments undertaken by Wigan Council to underpin their decision-making and practice. It is into this context that Hartley is trying to operate differently in the Wakefield district.
“Currently, what we do is, we have a service and then ask people what they think about it, sort of tinkering around the edges. We never really start from listening to people and then building things from that. I’ve been heavily influenced by the work of Hilary Cottam and her book Radical Help. She talks about listening to older people meaningfully: If someone needs a lightbulb changing, it’s no good setting up complicated systems when what they really need is a good, reliable handy person and some social contact.
“When you read about the stuff that works, it always comes from listening to people and hearing their stories then coming up with simple solutions.”
How will the big conversation work?
“We’re starting a process where we’re training about 100 of our Wakefield district staff, local councillors, young people and community champions, in appreciative inquiry, which is all about finding the positive things people want rather than prompting them to tell you what’s bad in their lives. By doing that, we think we can create a sense of hope and opportunity rather than just this-is-rubbish type dialogues than don’t really go anywhere.
“We want to create conversation rather than consultation; a more open-ended dialogue where our people are trained to listen rather than lead. We then bring back the content of those conversations and create themes out of them to use in three ways:
- To build long-term strategy for the district
- To develop local responses to local demand, eg if people in Hemsworth turn out to be really keen on climate change, then we might prioritise our response in that area
- To respond immediately to needs where we can.”
How will the big conversation benefit people in Wakefield?
“The main benefits are, firstly that it helps in developing citizen skills within the district by giving people the chance to become more actively involved in the decision-making process. Secondly, the information we gather can be used by the council and other agencies to improve how we work across the board.
“We can see this, for example in the example of Future Generations work in Wales where an infrastructure project like extending the M4 was measured against the principles established via listening to citizens. Once they did that and saw it didn’t meet their requirements, they abandoned it and diverted funding instead to active travel and public transport.
“Our plan is to send out our community researchers between April and July (longer if more people want to engage), before we form our 5–10 year plan depending on what they tell us. Interestingly, in New Zealand they’ve stopped running pilot schemes; if something’s worth doing, they just go out and do it. This gets round the problem of having to apply for funding after a really successful pilot and then having to wait, or worse, not being able to secure funding at all.”
“We want to know what works”
Hartley says that here in Wakefield, they’re looking to build on what’s already working rather than trying to continually think up something new. “Working with existing good practice is better than bright and shiny new ideas.”
In an environment where the phrase ‘build back better’ is borrowed or stolen by interests across the political spectrum, the residents of Wakefield district will soon be able to judge whether or not their council’s attempts to bring about change have the desired impact.
With some of the bigger beasts (Burnham, Jarvis et al) appearing to have already decided that local and regional politics holds out more possibility of affecting positive change, it will be fascinating to see what impact schemes like the big conversation have in the post-austerity, post-Brexit landscape.