System change in Merseyside
Today I was at the Liaison and Diversion Development Day hosted by Mersey Care NHS Trust at the Indigo Centre in the grounds of Ashworth Hospital just outside Liverpool. The event brought members of the criminal justice liaison and diversion team together with around 100 colleagues from a wide range of partner organisations from across the region.
It was an impressive gathering and, during the ‘World Cafe’ style discussions, I was interested to hear how the liaison and diversion service is now working with the Turnaround Women’s Centre, the Military Veterans Project, the Youth Offending Team, Learning Disability Services, Merseyside Police, the court service, Richmond Fellowship and substance misuse services among others.
Mark Sergeant and Gary Smith who lead the L&D service, explained the historical development of the service and how Mersey Care are taking forward the new operating model. Adele Maddocks from the YOT explained how the all age element is developing. Alongside it was good to hear from Peter from the Sunderland L&D service and from Jane Kennedy, the Police and Crime Commissioner. She shared her pride in how services are developing and working together in Merseyside and the difference that this is making for vulnerable people in the criminal justice system.
Reflecting on my Metro journey back towards Lime Street Station, I felt that the day was a great case study on the ideas I wrote about in my last blog where I set out some of the themes on system change that have emerged from our recent work with local authorities and other partners. I mentioned some key ingredients as I see it including working through complexity, focusing on the experience of service users, creating collaborative learning spaces and the importance of leadership. All of these elements were in evidence today, but I want to particularly consider the role of leadership in helping drive systemic change.
First though I should mention a little about what the day was all about. Mersey Care NHS Trust has been commissioned by NHS England to be one of the 10 ‘first wave’ liaison and diversion (L&D) trial sites. These sites are part of the government’s wider health and justice programme and follow on from the care minister’s announcement in January of the intention to roll out a new national L&D operating model to police stations and courts across the country. This was one of the key recommendations of the Bradley Report and has been a core goal for Revolving Doors since we were established two decades ago. Now, as part of the Offender Health Collaborative, we are providing support to a number of the sites on behalf of NHS England.
Over the past five years we have worked with the Department of Health, the Ministry of Justice, Home Office, government ministers, the Bradley Report Group, the Care not Custody campaign and many others to secure the commitment to the programme. Crucially, we wanted to make sure that the model that was rolled out considered a wide range of vulnerabilities as well as severe mental illness and learning disability including ADHD, Acquired Brain Injury, and substance misuse.
It was great to hear today how this recognition of people’s multiple and complex needs is now being put into effect across Merseyside as the new L&D model is bedded in. Alongside recognising a wider range of needs, the national L&D operating model has other features that are now in place here including an all-age appropriate response (youth and adult), extended hours, working across the criminal justice pathway and the core and extended team approach. The last of these creates opportunities to bring in additional expertise from partners to ensure that there are effective pathways to treatment, care and support.
In Merseyside there was already a strong platform for the new model given the long experience of delivering diversion services and some of the strong partnerships already in place. Despite this it was clear listening to the different speakers and delegates at the event today that mobilising and hardwiring these new ways of working into the local system demands considerable effort. As I pointed out in my last blog, changing the system requires focused leadership across a wide range of partnerships.
I wondered what do we mean by leadership in this context? It could be a vague ‘catch all’ term that doesn’t necessarily help us think about how change comes about.
But thinking about the people we have worked with over the past months and years in Sutton, Hertfordshire, Wandsworth and now in Merseyside, to name a few, I can see a number of common core activities that are defining features of the sort of leadership I mean. I am tentatively suggesting the following list as a starting point for debate:
Elements of leadership in local system change
Leaders who are engaged in system change in order to secure improved services for people experiencing multiple and complex needs seem to:
- Start with and maintain a focus on the experience of the service user
- Combine whole-system and person-centred perspectives
- Recognise the diversity of people and needs
- Involve people with direct experience of the problem in developing the solution
- Establish and communicate a clear vision and shared goals
- Clarify the business case and strengthen the evidence base to support change
- Challenge established ways of working
- Are open to ideas and learning from others
- Build relationships outside of traditional networks and collaborate across existing boundaries
- Be tenacious in overcoming barriers (and not just IT issues!)
These are certainly some of the core elements that I saw and heard about from the speakers and among the delegates in the room today.
When we were helping to develop the new operating model with the Department of Health and NHS England a year ago or so ago we recognised that it would be essential to make strong leadership a central feature. Managing a new service would only be part of the task. Providers would need to be able to develop strategic-level support and engagement in order to establish the wide network of services that clients would need.
The new L&D model is a national model and there is significant funding being made available to make it happen. But ensuring that the model delivers real change requires leadership that can change the system.
Today underlined for me just how important that leadership is.
Thanks to Mark, Gary, Beatrice and all the team for an interesting and encouraging day.
