The power of relationships

It is hard to take in, but I have now been the Chief Executive of Healthwatch Warwickshire (HWW) for 10 years. We have recently been successful in gaining a contract to continue for a further 5 years at least.

The success of HWW has been built on relationships. Over time we have developed strong relationships with commissioners and providers of health and social care services, with voluntary sector organisations and community groups, patient groups, Public Health colleagues, the Care Quality Commission, the Integrated Care System bodies, and many others.

Building effective relationships does however take a lot of time and commitment from all sides. Our relationships are built on trust and credibility. They must be seen to be respectful and constructive. We have few statutory powers and the effectiveness of a local Healthwatch and our ability to influence is heavily dependent on these relationships.

HWW has adopted several guiding principles which both direct what we do and how we do it. The principles are also very transparent and well known to those organisations we work with. The principles we have applied consistently for a number of years are:

• HWW do not simply give opinions, we communicate what the evidence tells us.
• HWW has no interest in trying to catch anyone out. Our objective is one that we share with providers and commissioners – to improve services for the people who need them.
• Our focus is on relationships not structures.
• HWW take our support and challenge, the critical friend, role very seriously.
• HWW uses a Workplan, an Engagement Plan and a Communications Framework
• HWW are committed to the idea of continuous engagement.

This last principle around continuous engagement is vital. Perhaps the most important relationship HWW has is with the people and communities in Warwickshire.

Over the last 10 years it has become clear that the traditional models of limited time engagement about significant service changes carry with them serious constraints. It does not allow the time needed to develop the relationship, the time needed to build credibility and trust. The results of an engagement exercise carried out in this way are inevitably compromised – they can give the impression of box ticking or asking questions when the answers have already been decided.

A better approach is surely to invest time in building relationships, especially for those groups who are frequently ignored, to build up that trust and understanding. There are community and voluntary groups who can assist in this.

The outcomes of engagement carried out in this way are more likely to be authentic and genuinely reflective of local sentiment and aspiration. We can build in cultural reference points that will be immediately recognisable to many groups. It can also be a form of “early warning”, picking up and amplifying the “noise” around the system about emergent issues.

None of this is easy of course, culture change never is, but it does make it far more likely that changes will land with local people and communities and bring about the real changes we all want to see.

HWW will continue to work and develop these ideas, we will continuously assess their effectiveness, we will try to bring key partners with us on the journey, above all we will continue to sense check how it’s going with local people. If we can come up with a strong workable model of continuous engagement – I would be content with that as legacy.