Citizen Led Healthcare - Learning from the Millom experience: An NHS North West Leadership Academy Project

Abstract

Introduction: The most difficult place to recruit in Cumbria is the small town of Millom. After the retirement of senior partners 3 years ago the General Practice lost 50% capacity. For over a year it placed advert after advert without a single response. In April 2014 it gave notice that it could no longer cover the community hospital which closed temporarily. The community felt this was the final straw. Within a week the Millom Action Group was formed and organised a protest march with over 2000 people. At the follow up meeting health leaders invited the Millom Action Group in as full and equal partners and we formed the Millom Alliance. The action group now run all our communications and are fully integrated into our local leadership structures. Working together we have created a powerful social movement around health and wellbeing. The group produced a GP recruitment video https://www.youtube.com/watch?v=8rky8n7Co5U led by local schoolchildren, spread by social media with 5000 views in the first week. They even sent it to President Obama. It helped recruit 3 doctors. Together we have created an innovative population health system in which integrated health teams (the two local Foundation trusts have joined the GP practice as partners to create a multidisciplinary, multispecialty practice) have worked with a community mobilised at scale for health and wellbeing. Results have been impressive with a 23% reduction in non-elective admissions and 16% reduction in elective admission since the march plus community led initiatives to improve health including a programme in schools to teach 700 children how to use health services, and an initiative to become an autism-friendly town. Method: The NHS North West Leadership Academy (NHS NWLA) is a member organisation supporting effective leadership interventions across the North West of England. The NHS NWLA became involved when the Millom Alliance in partnership with Cumbria Leadership and Improvement Collaborative (CLIC) applied for a Systems Leadership Grant to study and spread the leadership behaviours behind the Millom success. The dragons den style pitch for the grant was health and community leaders standing together. The study looked at formal and informal leadership within health providers and local communities. Results: The first piece of learning was around context – never waste a crisis. The second was that social movements and asset based approaches can solve seemingly intractable complex problems. A critical moment was inviting the protest group to join us in the leadership team of the new Alliance taking a lead on communications. Health leaders led from the ‘edge’ of their organisations across boundaries, sharing success. The leaders were visible, displayed authenticity, an ability to move between strategic and tactical and built trust. Traditional power structures were dismantled. Conclusion: As the leader of the community action group said recently ‘I used to think you were really important. I now realise that we are the most important’. We are traditionally accountable upwards through layers of governance to regulators. We have effectively rebalanced our accountability back to the communities we serve.