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Only together can we help rewrite the future of urgent care

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William Lilley is new ventures manager for Bromford, chiefly tasked with developing new relationships in health and wellbeing that can enable our customers to be their best. 

Some years ago, I was huddled together with strangers around a sharp cornered table and I will never forget the haunted stare of an urgent care commissioner as she described in atomic detail the many challenges facing our local A & E departments. A room packed with local people, we shone a collective gaze at the lonely and somewhat stranded commissioner, as she set about listing all the potential reasons for the shocking rates of unplanned admissions.

Slide after slide nervously followed each other, gigantic statistics blurring together, until the room quietly broke out into a collective confusion, humming like a trapped fly repeatedly hitting a window pane.

As a human being, I felt sorry for the commissioner before me. The size of the task before her and her team seemed to me one that could never be completed, with every valid attempt scuppered by influences often outside of her team’s control.

The event I attended a few years ago was assembled by a clinical commissioning group (CCG) to bring people together in an effort to sure up support for proposals and also invite suggestions from the assembled audience. Although a distant memory, I’m reminded of that day and the commissioners stare, by the many current headlines that blurt out from my phone, informing me of hospitals around the country grappling with missed targets and increased admissions.

At that event, I was struck by two things which, for me, are still relevant and have influenced my own thinking about today’s headlines.

Firstly it felt unfair and unnecessary to locate so much responsibility on a handful of individuals when the scale of the challenge rests in so many hands, and requires a collective effort across all sectors, communities and households. After the end of the event my first impulse was to hug the commissioner, although I restricted myself in the end to an English pat on the back.

The second thing that has continued to influence my thinking and epitomises this first point was represented in a single anonymous slide midway through the presentation. It told a deeply personal story that touches on reasons and issues that are so much bigger than any commissioning strategy you may care to read.

It showed a map of the geographic area and pinpointed to where admissions were arriving from. Although there were some in the audience that later remarked on the significance of the map, few others seem to be fascinated by what it told. For me, I knew the red marks well from other maps I had seen of the area.

The single message of the map was that the majority of the admissions were emerging from two particular wards, which are among what some describe as the most ‘disadvantaged’ in society. I did not know these areas well, but one thing I have learned in years of community development, is that the answers to the challenges in these communities lay in these communities. It was startling to see this map, but with such little reference to the story it may tell.

It felt to me as a call to action, inviting us to visit those communities and understand from the people that live there why admissions are so high and how we, with their help, could collectively reduce them.

Time moved on, and so did I. I have not visited this CCG since, but the thinking and the slide have stayed with me, influencing many of the projects we have developed at Bromford to this day. We exist in the heart of communities, housing the many real people that live in these maps that are often drawn up.

Over the past 12 months we have engaged a number of CCG’s, and in the spirit of participation have developed a number of pilots that support local attempts at reducing unplanned admissions.

It has, of course, not been easy but by collectivising our efforts we have been able to localise the solutions to a neighbourhood level, inviting local people to step outside of their homes and engage in this broader effort.

One such scheme is Winter Buddies, designed in partnership with local urgent care commissioners. It encourages neighbours to be more mindful during the winter of the frail and elderly in the streets where they live. Another scheme called Youth Connector, has a youth worker based in an Emergency Decision Unit at a local hospital, enabling young people between 16-25 to retell their story beyond the healthcare reasons that have lead them there. We do this in the hope that they will help point out the characters, plot lines and potential solutions to help to tell a different story: one where they won’t return to hospital.

These are modest attempts at collaborating with urgent care commissioners and A & E departments, to reduce the pressure they - and we - are all faced with at this time. They both point towards the potential that exists within patients and communities to solve their problems collectively, through harnessing the strengths that often exist outside the system. We are also doing this, because as a large social enterprise we recognise that we are part of a wider family of sectors and agencies that can only really help if we start thinking and acting together.

There is an urgency in a society, and that’s the urgency to reconnect community to the institutions that were founded to help them.  

Read William Lilley's guide ‘Leading by stepping back - building community and citizen led services’ here.