Impact Hub Yorkshire celebrates five years of success at Bradford Live

“Stop Fixing, Start Listening!” Meet the people training healthcare workers to hand power over to patients - and transforming lives in the process. It all began with curiosity. Twenty-five years ago, a physiotherapist asked a simple question: why do some stroke patients manage to find their way to a fulfilling life more speedily and completely than others? Obviously, the severity of the stroke plays a big part but even those with similar neurological and physiological impacts had very different experiences. Determined to find the answer, Fiona Jones decided to speak to stroke patients in depth. What she found was surprising: the key was the nature of their relationships. And the relationships that mattered were not just those between the patient and family and friends but, crucially, that between the patient and the healthcare workers trying to help them. Too often stroke patients felt disempowered by the way professionals interacted with them. Out of the very best of intentions, those professionals wanted to ‘fix’ their patients by taking control of their recovery, failing to fully acknowledge the complexity and diversity of their lives. The stroke patients that did better were those that helped to play a bigger role in their own care by managing their medication, rehabilitation regimes and pace of recovery independently of their clinicians – what is often termed ‘self-management’ A Bigger Story But extensive further research revealed something deeper. The secret to a truly fulfilling change in a stroke patient’s life was self-efficacy. Those who felt more in control of every aspect of their recovery also began to feel more in control of the lives that had been so disrupted by a severe medical condition. That meant moving beyond self-management’s focus on medicines, exercise and training and instead allowing the patient to shape the underlying methods, goals and style of recovery. This was radical stuff. As Fiona puts it: while self-management requires the patient to change their behaviours, an approach based on self-efficacy and empowerment requires the healthcare professional to change theirs. It means shifting mindset and practices away from any sense that the health worker knows best with ready-made solutions at hand. Instead, they need to act as expert collaborators led by the expectations, hopes and challenges identified by the patient themselves. It’s an ethos that originates with the heartfelt recognition that when it comes to their own lives, the person in front of you is the world-leading expert. Fast forward to 2013 and, after further research, Fiona founded Bridges Self-Management (with the support of City St. Georges and Kingston Universities) - a social enterprise designed to help health workers play that empowering role. This is far from easy. Health workers sometimes feel they are abdicating their responsibility by not coming up with quick solutions, not being in the lead. And when they do recognise the need for self-efficacy, the skills, strategies and language to enable that are often undeveloped. In addition, what they see around them is countless colleagues - often very highly regarded ones - doing things to rather than with their patients. Breaking down these personal and cultural norms requires lots of self-reflection, self-questioning and gradual, careful introduction of new approaches. But the impacts speak for themselves. Bridges’s work training staff who support people with Long-Covid was recently the subject of a randomised control trial. Called, appropriately enough, ‘Listen’, the project was found to have improved patients’ ability and confidence in managing their symptoms and doing everyday tasks. It also improved their sense of self-efficacy and emotional well-being. Most significantly, that greater sense of self-efficacy was directly related to the improvements in patients’ recovery. It is research that endorsed the findings of Fiona’s own initial enquiries all those years ago and the knowledge the Bridges team has accumulated through research and experience since it started work. Workers’ Liberation The impact of this way of working extends beyond the patients. Call it ironic, call it counter-intuitive, but it seems that by stepping back, listening and empowering the patient, the health worker actually ends up feeling more empowered themselves. Liberated from the strictures of routinised interventions and the pressure of taking sole responsibility for fixing their patients, health workers report being able to build much more fulfilling human relationships focused on helping people build a self-defined, decent life for themselves rather than achieve a set of externally set, medicalised milestones. It gives them more time. And most importantly, of course, they can see that working in this “Bridgey” way is better for the patients and their recovery. Again, the data speaks for itself. Of over 250 NHS staff trained by Bridges in the last 6 months alone, 84% said they are now listening more and ‘fixing less’. 94% said that Bridges was having a positive impact on their day-to-day work and 60% said working in the Bridges way had already increased their job satisfaction. Ultimately, the ethos of Bridges is a challenge not just to the professionals they work with but to a whole healthcare and public service system that is still built around doing to rather than doing with. Of course, there are many occasions when the enormous expertise of health workers must operate unhindered with little immediate regard for co-designing a solution - no-one undergoing cardiac arrest or a major trauma wants anything other than to be fixed by experts as rapidly as possible. But too much of this acute mentality has leached into every other aspect of healthcare - often reinforced by time pressures and lack of empowering skill sets. So, the question now is how we can make the training Bridges provides utterly normal across healthcare rather than something so out-of-the-ordinary that it can almost feel like a process of deprogramming for those seeking a better way of working. Given the theme, the final word should go to Jeremy - a patient with Long Covid. His testimony shows what happens when a health worker takes the time to really listen and co-design ways forward. His words speak with far greater eloquence of the power of patient empowerment than anything written here. Do find the time to listen! By Adam Lent This case study forms part of a series we are producing together with the healthcare consultancy Baxendale and think tank King’s Fund, to demonstrate the innovation shown by social enterprises delivering health and social care.

For impact to work, it can’t exist in a silo. Most profit-focused businesses are beholden to their shareholders and owners to generate as much revenue as they can, with no real obligation to give back. That is not the focus of social enterprise. Our business model centres purpose, and the best way to purposely serve your community is to work with the community. Cooperation is the name of the game. A strong role model of purpose-led community activity can be found in Ashford, named a Social Enterprise Place thanks to its collaborative ecosystem. “Collaboration throughout the social enterprise sector in Kent is really important,” said Rebecca Smith, Chief Executive Officer of Social Enterprise Kent (SEK). “We find through networking and bringing people together at conferences, events and training sessions, it creates a touchpoint to spark ideas and raise issues. It’s about bringing people together as a team and not working in silos is what makes the voluntary, community and social enterprise sector stronger.” Our member SEK have nurtured this impact community as they have done for the past 40 years. To find out more, we visited them at their new, volunteer-run SE Kitchen, now their second social supermarket in the county after Ramsgate. Ashford MP Sojan Joseph visiting the SE Kitchen They transformed this former art supply shop into a real community space, providing affordable and healthy grocery options from food charity FareShare as well as other suppliers working closely with local farmers (it is the garden of England after all). Of course, this work wouldn’t be possible without vital partnerships. In fact, they work with more than 100 partners, consistently delivering at least £1 millon a year in funding, allowing them to support great projects like the Social Impact Gateway or Thanet Social Enterprise Boost. From working with East Kent Health Care Partnership to highlight health inequalities to partnering with corporate organisations such as Amey for their Elevate programme creating apprenticeship opportunities for care leavers, they demonstrate how these conversations across organisations form a lynchpin of positive influence. After a delicious lunch provided by Lily’s Social Kitchen, we visited more of the local social enterprises which make up the rich network of organisations in our Places programme. These were some of the businesses championing the movement: Chatting with the volunteers at The Beehive Ashford The Beehive Ashford - a shop which not only sells second-hand clothes, but also provides skills workshops, a volunteer-run café, and hosts several clubs including knitting and a book club. It also offers women referred by local services a place to access free clothing. Made in Ashford - a vibrant and popular gift shop which started its life as a pop-up ten years ago. It houses the handmade craftworks of more than 70 artists from across Kent in-store and online. The Coachworks - a trendy, repurposed multi-use space by the train station hosting street food, live music and entertainment events, and workspaces. Going back to the central theme of collaboration, it shows there’s a concerted effort for social entrepreneurs in the area to pool their resources, doing much more for the community, local economy and environment than they could on their own. A spirit of camaraderie which helps deliver a better, holistic service. As a Social Enterprise Place, Ashford proves its status as a hot spot for social impact activity thanks to this ethos. Browsing the crafts at Made in Ashford Rebecca added: “It’s been fantastic having Social Enterprise UK down here to see our work. The theme has really been about collaboration across the board with other social enterprises and charities, the wider business community and our public sector partners. It makes our programmes better, allowing our entrepreneurs to be given the right tools and funding to solve the specific problems they are facing in their local community.” As our flagship data shows, there are more than 131,000 social enterprise businesses in the UK, all working towards benefitting people and planet in their own ways. Imagine the possibilities of replicating the collaborative efforts of the impact community we’ve seen here in Ashford across the whole country? This is why we do what we do, and we’re proud to see it going from strength to strength.

If the government was in any doubt about the challenges facing those starting social enterprises, a mixed group of stakeholders presented it with a vivid picture this week.   It was the most recent evidence delivered to the second roundtable of the All-Party Parliamentary Group (APPG) on the Social, Cooperative and Community as part of their ongoing inquiry into growing diverse business models.   The highs and lows of social enterprise  Give Your Best (pictured above) was a side hustle that grew into a business for founder Sol Escobar and was supported by ‘tech for good’ grants from organisations such as Innovate UK. Escobar told the inquiry she didn’t know what a social enterprise was as her initiative first began to flourish and described how vital the support ecosystem was.   “I did every single incubator and accelerator I could possibly find, because … I didn't know how to grow this organisation, and they really have just taken me from step to step and taught me how to run this organisation and scale it to become revenue-generating,” Escobar said.  Now 800 to 2000 items of donated clothing are chosen by people in clothing poverty every week through the social enterprise, helping to tackle the £140m worth of clothing that is thrown away annually.   Starting a social enterprise might be an option if you have certain advantages, but what if you don’t? The financial implications for those in this situation were made stark by Bayo Adelaja, founder and CEO of Do it Now Now, which annually supports approximately 150 Black leaders of organisations with business training and grant funding. "Most of the people in our community are earning under £18,000 a year and 27% of them didn't attend university, but they remain pillars of their society and are leaders and changemakers within their community," Adelaja said. "The income they're receiving each year is approximately £32,000 and around 40% of that comes from the salary sacrifice of the directors themselves. The vast majority of them are working full-time jobs and about 40% of them have never received grant funding.”  Adelaja asked the APPG to consider how the government could put in places systems and processes that empower people who don't have the access, schooling or business training of others, but are creating social enterprises in response to communities that need services delivered annually. In particular, she recommended that funding not be project-based, with multi-year funding schemes introduced instead.   “We’ve limped our way through”  Escobar had earlier credited School for Social Entrepreneurs (SSE) as being instrumental in her development as a business founder. Whilst acknowledging that the “nudge economics” of SSE’s match trading grants and bringing social entrepreneurs together in supportive cohorts to bolster confidence had both worked well, SSE CEO Alistair Wilson was less optimistic about the support ecosystem in general.  "It is interesting to reflect that second-tier support organisations in this country are hanging by a thread. We've limped our way through the last 15 years, and many organisations have gone bust. If the government wants to see this sector thrive, they've got to get behind it in a more serious way," Wilson told the inquiry.  He went on to say that he thought the UK had slipped from being world-leading in social enterprise to “being in tenth place, if you’re lucky” and that he hoped the government would consider how to get the UK’s leading status back. Wilson was backed by Louise Cannon, Director of Social Entrepreneur Support at UnLtd, who also asked that long-term ecosystem building be considered by the government.   Matt Smith, CEO of social investor Key Fund made the point that support organisations like SSE were crucial for equipping passionate social entrepreneurs with the skills and experience to run a business. Like Wilson, he expressed concern at the lack of support organisations that existed now compared to 15 years ago.   Smith also thought that more grant funding could level the playing field in areas of unequal opportunity such as those described earlier in the session by Adelaja. “There's a gap where grants should be playing the role that friends and family would in more affluent communities,” he said.  Fellow social investor Seb Elsworth, CEO of Access called for more mainstream providers to participate in social investment, particularly the state-owned British Business Bank, which manages loan guarantee schemes aimed at SMEs and targets a rate of return of 1.5% for its overall portfolio. “We know most social enterprises are looking for relatively small-scale, flexible, patient, unsecured lending. Providing that kind of finance is difficult to do on a purely commercial basis,” said Elsworth.  Two further evidence-gathering sessions will be conducted before the APPG delivers a report to the government later this year.