One of my favourite stories comes from Richard Nixon’s visit to Beijing in 1972.
The story goes that Chinese Premier Zhou Enlai was asked at the time about the impact of the French Revolution, two centuries on.
His response? It is “too early to say”.
I like the story despite the fact it’s almost certainly not true. Most likely it was a misunderstanding, that became a handy – if clichéd – way of describing different historical perspectives. However, stories that endure tend to speak to something real.
Today, the more radical the change, the more likely we are to conclude – after considering all the available evidence – that it is “too early to say” if it might work.
We then tell ourselves other stories: that our current practice is based on solid evidence; that the status quo may be unsustainable, but it must be sustained; and that things never change, or if they do, they change for the worse.
These stories endure because they also speak to something real – real experiences, and real frustrations. But if we listen carefully, new stories are emerging all the time that point to a different, and potentially better, future.
We started looking at person and community-centred care in 2012. At that time, we built on work NEF and Nesta had undertaken on co-production in public services, trying to apply the findings to the management of long-term physical and mental health conditions.
The question we heard most often was “This sounds like the right thing to do, but where is the evidence?”.
In fact, we found there was more evidence than we expected; in many cases, better evidence than for existing practice. But we also had the chance to meet and work with some amazing individuals who weren’t waiting around – who were getting on and making change happen.
The Lambeth “Living Well” Collaborative was one such group. They were determined to improve outcomes for local people with severe and enduring mental health problems. Bringing together all parts of the NHS, the local authority and voluntary & community sector, they started small – a regular get-together over breakfast at a local café – but were thinking big.
In 2017, I was lucky enough to meet the mother of someone who had been helped by the Collaborative. She told their story – of a son, sectioned, confined, unable to communicate; today living independently, his mum’s biggest worry now the suitability of his latest girlfriend!
We all understand how long and difficult that journey was. But it had to start somewhere.
We started PPL 10 years ago, and if nothing else, that has brought us a degree of perspective. When we studied the projects and programmes which had created the most value, we found they shared 3 key features:
- Starting today – not worrying about finding the “right” or “best” thing to do, just something everyone agreed needed to be improved, and that couldn’t improve without people coming together differently.
- Describing tomorrow – being able to articulate how things will look and feel different, for all the managers, staff, individuals and communities involved.
- Creating a different future – implementing real change at the frontline, even if in the first instance it means helping just one extra person.
Around the same time as we met the Collaborative, we met Peter Colclough, a key part of the early integrated care services in Torbay.
Peter was explaining that improving care for “Mrs Smith” had been a 10-year journey – much to the alarm of many of those present, who felt they needed more immediate solutions. Peter’s answer? “If you don’t start today, it will take 10 years and one day”.
And to those who had asked, back at the start, to see the evidence it would work?
“I told them we were the ones creating the evidence”.
Image source: Wikimedia Commons / Richard Nixon Presidential Library and Museum