Rekindling Hope in Public Services

Chris Naylor writing at The King’s Fund –  In the late 1960s the psychologist Martin Seligman made a name for himself by exploring how animals respond to the experience of powerlessness. His research involved delivering electric shocks to dogs in a series of carefully constructed experiments. He found that when the dogs had no control over what happened to them, over time they became passive and stopped trying to avoid the shock. In subsequent tests they did not attempt to stop the electricity, even when given the power to do so.



Seligman coined the term ‘learned helplessness’ to describe their condition. Seligman believed that people, too, could have their sense of agency diminished through repeated exposure to negative outcomes seemingly beyond their control. Talking to people working in public services, I have sometimes heard the term ‘professional fatalism’ used to capture a similar idea – the notion that over time, confronted by complex or chronic problems that are not amenable to a simple solution, and working in systems that are often ill-equipped to support people with these kinds of challenges, it can be hard for staff to hold onto the belief that better outcomes are possible. A parallel process can take place for the people and communities they work with, who may experience similar feelings of powerlessness.

Public Servises

In the face of this challenge, it strikes me that several of the most compelling examples of public service reform we have examined in recent research at The King’s Fund share a focus on giving frontline professionals more control over their work and cultivating positive beliefs about the capacity of staff and service users to bring about change. Take this quote from a social care professional we interviewed as part of our research in Wigan:

Now we can actually do the things we came in service to do… We really wanted to make a difference to people’s lives but couldn’t do that previously and now we can. It is people’s attitudes and behaviours that have changed.

What impressed us most in Wigan was the sense of purpose and self-belief we encountered in staff working for the local authority and other organisations. People told us that this was new, and that the change had come about as a result of senior leaders giving staff greater flexibility to work with service users in a different way to understand what kind of support would work best for them. This was part of a major transformation known as the ‘Wigan Deal’. I was left with the feeling that if the Deal has achieved one thing, it has been rekindling hope among local professionals.

This resonates with what we have seen elsewhere. For example, in our report, Outcomes for mental health services, Ben Collins describes the work of the social enterprise Navigo, which delivers a wide range of services to people living with mental health problems in north-east Lincolnshire. Like Wigan, Navigo has placed considerable emphasis on recasting the relationship between professionals and service users, removing an unhelpful sense of hierarchy, and has achieved impressive results.

Standing back from these and other examples (including our research on the Buurtzorg model of community nursing), there are several distinctive shared features that give a glimpse of what may be needed to build hope both in the caring professions and in the communities they serve. These include:

None of these can be implemented overnight, but our research shows they are achievable ambitions provided organisations have sufficiently bold leadership and an ongoing commitment to challenging engrained ways of working.

In the latter half of his career, Martin Seligman turned away from studying the origins of mental distress and became one of the founders of ‘positive psychology’, which aims to understand the conditions under which people thrive. If public services are to help bring these conditions about, leaders will first need to put power in the hands of frontline staff and the people and communities they work with. Through this shift in power we can build hope, and hope is the fuel needed for improvement.



Saving lives, supporting communities: The role of volunteers in ambulance services

Helen Gilburt writing at The King’s Fund: At the frontline of NHS emergency care, the ambulance service is probably the last place you’d expect to see volunteers – but you’d be wrong. There are now over 10,000 people who volunteer in ambulance trusts across England.



There are two main areas of care that ambulance service volunteers contribute to – non-emergency patient transport services, where volunteers transport patients from hospital to home, and community first responder schemes. Community first responder schemes, which account for the majority of volunteers, comprise local people who are trained and despatched by the ambulance control centre to attend life-threatening medical emergencies in the area where they live and provide basic life support until the arrival of a professional ambulance crew.

Ambulance

Examples of community first response schemes can be found across the globe, and in the UK some community first responder schemes actually pre-date the ambulance trusts they now support. But being first on scene in a life or death scenario is not for everyone and ambulance services across England have been exploring how they can capitalise on different types of volunteer roles to improve the care and outcomes of the populations they serve. Commissioned by the Office of Civil Society, our new report Volunteering in ambulance services: developing and diversifying opportunities, captures this process and the emerging practice.

One of the key areas that ambulance services have focused on is building the current capacity and quality of the volunteering offer through the Investing in Volunteers accreditation. Satisfaction and retention of volunteers is associated with good volunteer management and through the accreditation process, ambulance trusts are hoping to strengthen their approach to volunteer management in line with good practice.

The ambition of ambulance services should be applauded, but it doesn’t come without real challenges.

Ambulance services have also focused on developing the volunteer roles themselves. For example, South Central Ambulance Service has built on the community first responder role – developing advanced training and investing in lifting equipment so community first responders can be deployed to people who have fallen in their homes who’ve not been injured, but need help getting back onto their feet. In contrast, North West Ambulance Service have developed a new role which enhances their existing response to people who make frequent or excessive calls to the ambulance service. In both cases, these roles aim to provide an improved response alongside professional ambulance staff and capitalise on the existing infrastructure of clinical governance, which supports community first responders to ensure that the care provided has appropriate oversight.

A final area of development is ambulance services connecting with communities through volunteering. The 999 Academy, developed by South West Ambulance Service, engages young people aged 16–19 in a cadet-like scheme, providing vital life skills and an introduction to the blue light services supported by staff from the ambulance, police and fire services. Other ambulance services have developed partnerships with local voluntary and community sector organisations to develop volunteer roles able to respond to and support the wider needs of people in the community. Ambulance services serve large populations across wide geographies and the ability to build relationships with communities and the organisations within those areas provides opportunities to influence current and future patterns of demand for health services and make a positive contribution to population health.

The ambition of ambulance services should be applauded, but it doesn’t come without real challenges. The current infrastructure to support volunteers has evolved in line with the clinical requirements of these roles but can constrain support required for volunteers engaged in other activities. In addition, volunteer managers often have oversight for large numbers of volunteers across a region and an overarching focus on operational delivery means that capacity to develop the volunteering offer and support more volunteers is often limited. What they have achieved therefore is a sure sign of their commitment. And there are early indications of the potential benefits from this work, from enhancing current processes to developing creative solutions to improve the response of the ambulance service – ensuring the public get the right resource, the right skills and at the right time.

If we fail to incorporate ambulance trusts within the bigger picture of volunteering, we risk them reinventing the wheel and developing competing demand for volunteers.

The NHS long-term plan sets out an ambition to double the number of volunteers in the NHS over the next three years and the long-awaited NHS ‘People plan’ – a plan for the NHS workforce – is expected to cover the role of volunteers. In order to achieve that ambition, NHS organisations will need to develop varied roles that are able to capitalise on the different needs and expectations of volunteers.

Legitimate concerns have been raised about how this is achieved: the safety of care provided by volunteers and role boundaries, as highlighted by in the charter drawn up between the Helpforce programme and NHS trade unions. The experience of ambulance services with frontline volunteers provides unique insight into how the balance of risk and benefit can be achieved. At the same time, if we fail to incorporate ambulance trusts within the bigger picture of volunteering, we risk them reinventing the wheel and developing competing demand for volunteers. Seizing the opportunity to share learning and take advantage of the different approaches that are emerging across NHS organisations must be the way forward to creating a new generation of volunteers.

Ensuring the focus of development is spread across different types of NHS organisation provides a vital opportunity to share learning and take advantage of the different approaches that are emerging in different settings to maximise impact on patient care.