The Secret Community Leader is an anonymous column sharing the highs and lows of community leadership. It provides an open and honest forum for community leaders to get nagging challenges and worries off their chests. It also aims to share some of the most rewarding moments of community leadership, in the hope of both relating to, and inspiring, other leaders and communities...
Community Leadership: making the case and making it land
COVID has given us a mammoth opportunity to press the reset button in the way we think about health. A light is being shone on health inequalities like never before. It’s our role to keep it shining and articulate the changes we need to see. This could be the most significant opportunity for a generation to showcase the importance and ability of real community leadership and let people determine for themselves what’s good for them, not have it prescribed for them. I hope this pandemic forces us to finally value and properly invest the role of community in addressing health inequality. To release the shackles, change the rules, and remove the barriers for those of us who’ve been doing this all along.
Several weeks ago I was on a call with representatives from across my local Health and Social Care System. I listened as everyone talked about how important this was too, how they had to seize the moment, how we will likely never see an opportunity like this again in our careers. Yet, we still couldn’t identify how to make any practical difference, instead moving on to discuss business as usual. The opportunity is right now – and it feels like it’s slipping through our fingers! It’s been ten years since the Marmot Review in 2010, where it’s become widely accepted that the main challenges to health and well-being are social not physical. It’s widely accepted – but with little discernible changes in the way we invest. Health care budgets are still linked to how people’s physical needs are addressed after they’ve entered the system, rather than linked to aspirational goals to prevent people entering that system in the first place.
What little investment there has been in community response has centred around social prescribing.
This is a term which inherently suggests people need a ‘prescription’ and are told what to do; a concept that means multiple things to different people so is never consistently applied. It’s a response which is still rooted in health care targets designed by (largely) suits in central London not responsive to what people actually want, and an idea which suggests there is something ‘social’ to actually prescribe people to (the years of austerity and the effects of the current pandemic make that increasingly less likely it seems to me).
As the leader of a local community organisation that works primarily with people that have some history of substance misuse, I feel like the work we do and most importantly the way we approach that work – by building relationships of mutual respect and trust, recognising people for what strengths they bring not what needs they have – has never been more vital. In many ways over the past few weeks it has also never been more appreciated. Yet I’m still full of frustration because unless we make a 180 degree shift we’ll be sat here in another ten years saying the same thing, only it’ll be even worse after what I fear will be an unimaginable impact of a further five years or more of austerity. It feels like the health system is talking the talk, but not able to walk the walk. There are glimmers of hope, then it’s back to business as usual. The last few months have clearly demonstrated a willingness and ability to behave differently, but organisations and systems have short memories. Health in particular is being pushed back to business as usual at the expense of genuine system opportunities to reflect and reset.
We need to conceptualise all of our health care budget as a health inequalities budget.
An emphasis on wellness not illness, that spend on community organisations and life – free from defined targets so local people can define for themselves what’s important – is not a cost but a long-term investment. If we don’t make that shift we are perpetuating a sense of helplessness, fuelled by widening income inequality and by often moral judgements on people’s capability and capacity – ‘benefit scroungers', ‘junkies’, ‘charity cases’. Tell someone often enough they aren’t able and rob them of the basic means to prove you wrong and eventually they won’t try – it’s a self-fulfilling prophecy. So, for me community leadership right now is about holding hard to our principles, stepping up to make our case whenever and whoever you can, holding everyone to account for what they say and promise. This much I believe is true whatever community you work with and for, when our broken systems have never been more starkly highlighted, and the value of community has never been more obvious.
We are tired; tired of this focus on what we have known and experienced all along, tired of delivering simultaneously in COVID and also planning for post COVID, tired of talking the talk and the nodding heads but lack of walk – but right now is the time to make our case and make it land. We won’t get this opportunity again.
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