This week we publish the learning from the first chapter of Circle – our membership service for people 50 and over. Circles are thriving in Nottingham and Rochdale but very sadly London Circle was forced to close in March this year.
What have we learnt? Circle has learned how to build robust and diverse communities that can really support each other – leading to happier lives and savings to the public purse. This is something everyone involved has been very proud of.
Less tangibly we have learnt that it is not just what you offer – in Circle’s case practical support and a rich social calendar – it is how you offer it. Relationships were at the heart of Circle: how we talked, what we did and how we did it. And members responded – they felt that this was something different and they joined in their several thousands, made new friendships and helped others in very concrete
Relationships were at the heart of Circle – how we talked, what we did and how we did it – and members responded.
But it was not enough. To thrive Circles need to be part of a strong local vision which marbles statutory and community approaches – something in which Nottingham Circle are starting to really progress, but is very hard to make happen. And they do need some recurrent funding – very little, but too much for most to contemplate.
In this context the London business model was wrong – it was an attempt to build too much too fast, but the Circle model still has much to offer as those who thronged to Rochdale Circle’s birthday party (picture above) were keen to celebrate.
If you want to build a public service that works, it is vitally important to get frontline workers on your side. We’re interested in building services that help people to boost their abilities, connect with others and basically live life to the fullest. Frontline workers are the people who help us make that happen on the ground. In the case of our Wellogram service, which helps people take control of their health, our allies are our co-workers in the GP clinics: doctors, nurses, administrators, dieticians, counsellors and healthcare assistants.
We talk a lot about the experience of people who use our services, but not as much about how we work with service workers, so we thought we would share a some bits from a flyer we created to help people working in the clinic understand Wellogram.
1. Get to the point.
The first thing you needs to understand about people working in a GP clinic is that like most frontline workers, they are insanely busy. You’ve got to get right to the point and explain how your service will help them get their job done. Doctors, for example, only have 10 minutes with each patient. However, we’ve found this also means they sit up and take notice when you offer a service that spends 30-60 minutes with each patient. They know some patients need more one-on-one time, and they’re happy to do what they can to help them to get it.
2. Make it easier to think differently.
Perhaps logically, doctors and nurses tend to be “clinically focussed”. Their effectiveness is being measured by metrics like “BMI reduced” or “smokes X less cigarettes per week” rather than “feels in control of their health” or a patient’s overall wellbeing, despite the fact that they want all those things to happen. This combined with their busy schedule means that when told about a service like Wellogram, they might focus in on the fact it works well for older patients with long term conditions and forget about what else it might be able to do. They’re very good at prioritising! So we included a variety of example users for them to look at on the flyer, from lots of different backgrounds. The medical info is bolded, so they when they immediately scan for that, it’s easy to find. But there are also some boxes at the bottom which might remind them of conversations they’ve had with patients: “I want to exercise more.” “I want to eat better” “I want to smoke less.”
3. Don’t forget they have to feed the beast: paperwork
Finally, people working in clinics have to work with their own special set of paperwork and computer systems. These require them to reference thousands of “read codes” for everything from the programmes to which they refer patients, to symptoms, diagnoses, or even the patient’s occupation. Including the read code for Wellogram on the flyer helps make the data input process a little easier for them.
4. Stories matter, and people matter most.
No matter what you say yourself, the best way to persuade is a good patient story. One of the doctors we work with had decided after our first visit that Wellogram was good for helping people manage their blood pressure, and from then on in her mind we were “the blood pressure guys”.
The Wellogram Guide who works in that clinic ran into her in the tea room often, and mentioned regularly that it was good for all sorts of patients with all sorts of concerns. One day, the Guide received a note from that doctor in her mailbox. It explained that she’d been seeing real improvement in many of patients that had signed onto Wellogram, but just that afternoon she’d spoken with a lady who struggled with obesity. The patient had told the doctor her story of visiting the Guide each month and starting to feel happier and more in control of her choices, as well as losing weight. “Just thought you’d like to hear the good feedback,” the doctor told the Guide. From then on, we’ve received a flood of referrals from that doctor, from a wide variety of people who want to manage their eating habits, smoking and long-term conditions. It goes to show that no matter how good your messaging is, nothing beats the power of real human connection for making change happen.
Have you ever had that quintessential dentist’s office experience, where they ask you to open wide, cram your mouth with tools, and then start asking you questions? Going to jobs skills sessions can sometimes be a bit like that. You show up, are asked to open your mind to their way of doing things, are given a load of top ten lists and techniques, and then you’re expected to be able to translate them to your job search right away.
Not that I don’t sympathise with the people running these sessions- in fact, over the past four weeks I’ve been hanging out in local cafes and pubs in South London, delivering a four part series of sessions sharing practical information on job seeking. This is part of our Backr service, which helps people find hidden jobs through word-of-mouth.
I have to admit, our sessions do ask people to try a new way of thinking about their job search, and we share tips and tricks. The important difference is that we aren’t interested in forcing information at people. We’d rather hear what they have to say first, and help them come to solutions themselves. More wide open than “open wide!”
Once people at the sessions open up, they’re the ones offering tips and suggestions to each other, rather than waiting for us to tell them what to do
The people we meet have packed schedules, full of drop-in support, skills sessions and job search plans. So how do we keep their attention and rally up the motivation to try what looks on the outset like yet another skills session?
For one, we’re not teachers, trainers, or instructors. We’re just people who are on a journey, fellow travellers who are happy to share some useful recommendations. It’s important for us to work with people rather than megaphoning prescriptive instructions ‘at’ them. We facilitate Backr members to support one another, providing a safe space to practice building real world relationships.
Being truly “present’ at a session is vital, but what does that mean? Releasing your attention to the past or the future and investing your full attention to what’s happening among your group. This enables us to be flexible in our sessions, to fit with people’s needs and adjust to an appropriate pace for them.
We often hear ‘no one ever told me how to do that’ in regard to trying ‘this networking approach’. In our sessions we’re not handing over kryptonite, we’ve simply developed a few tips and tricks that we do in every day life, such as asking a friend about a baby sitter recommendation, finding out about the best nursing course to go on, to stepping in last minute to help someone out. This is common sense for a lot of people; it’s just sometimes we forget to apply the same qualities and processes to finding work and need a friendly nudge in the right direction. More often than not, once people at the sessions open up, they’re the ones offering tips and suggestions to each other, rather than waiting for us to tell them what to do. The best moment is hearing, “Hey Dave, you want to get into security right? My cousin works for a security company, I’ll give you his details’. Our sessions are a safe place to step back, think about where you’re at and what you want to do differently to make progress. It’s a chance to reflect and put plans into action.
Recently I’ve talked about the coverage of the Nuffield report on women who’ve had multiple children taken into care. Many of the lessons learned there really chimed with what we’ve found over the course of running Life Programmes. However, I did think there was one key thing left unmentioned. Interestingly, it’s a problem for both the families in need of help and the programmes trying to help them.
When children are removed from a family, services often stop working with parents, seemingly on the assumption that by removing the child the problem is resolved. As this report clearly shows, the parent’s difficulties usually continue, now exacerbated by the pain of losing a child – and the cycle of chronic crisis all too often starts again.
The way we’ve tried to break this cycle is by working with the whole family, including wider social networks, for longer periods of time. Life Programmes can work with everyone that matters for a family, from ex-partners to grandparents and neighbours and are able to work between and across service thresholds, offering families continuity in relationships and support that is rarely mirrored in the system. Statutory services might be able to make a positive impact on a family’s life for a brief period but long-term support around families experiencing difficulties parenting their children is rarely the goal.
Frontline workers are as tied up in knots as the families they’re helping. We require brave decisions, listening and long-term commitments to support change.
In a strange parallel, the programmes that help these families to thrive are lacking in long term support themselves. These initiatives are still largely one-offs, despite being lauded as pioneering and innovative. This dilemma is something we can certainly identify with. Life Programmes were designed to work in a different way with a small number of families in a corner of the system, but with the intention of catalysing wider culture and system change as the only way to realise the potential of this approach at scale. Grasping this nettle takes long-term political leadership, significant allocation of integrated multi-agency resource and a shared vision across services. We have worked with some brave local authorities towards this goal but realising this vision is tough, even more so in this time of drastically reduced budgets and rising demand.
There is a poem called ‘Trouble is not my middle name‘ by Liz Lochead that resonates strongly with me when I think about Life Programmes and their work with some of the most troubled families across the UK; ‘Hard to unfankle this. But you can help me. Loosen all these knots and really listen‘. I think that this is a perfect metaphor for Life and is what comes across strongly from families when they share their experiences on the Life Programmes. The Life Team are able to ‘loosen all the knots and really listen’.
But it is also a metaphor for what needs to happen in the system – frontline workers are as tied up in knots as the families they’re helping. Listening to them is critical if we are to ‘unfankle’ this situation. It seems to me that business as usual is in no-one’s interest and there is a clamour for a different approach from all angles at the moment. I think this is really heartening, but it does require brave decisions, listening to the frontline and long-term commitments to support change. As Liz Lochead says in the last line of her poem; ‘I cannot plainly tell you this, but, if you care, then — beyond all harm and hurt – real hope is there‘.
Rachel James was Programme Manager at Participle and lead on the Life Programme . She wrote this on her last day in the office. We’ll miss you Rachel!