Wild Card - Whose Shoes?

59. Kim Shutler – VCSE’s vital role in transforming health care

• Gill Phillips @WhoseShoes

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And so we continue our mini series of podcasts on universal healthcare, in collaboration with London South Bank University and the Universal Healthcare Network!

Kim Shutler shares insights on the role of the voluntary sector in healthcare, with a focus on community-based solutions.

With the NHS experiencing overwhelming demand, we need radical transformation with more power and resources within communities.

Lemon lightbulbs 🍋💡🍋
🍋 Let’s maximise voluntary sector potential in health care

🍋 Create the conditions for VCSEs to thrive and transform healthcare by shifting power and resources closer to communities. 

🍋 Old system HAS bitten back post-pandemic, due to governance structures and statutory provisions – but we KNOW we can do things more imaginatively!

🍋 Success comes from relationships, passionate individuals, a local knowledge

🍋 We need a bottom-up approach to healthcare transformation

🍋 Value and build trust with communities and local organisations

🍋 Collaborate across boundaries to maximise innovation and resources

🍋 Make decisions WITH people to avoid unintended consequences

🍋 Use imaginative, inclusive ideas like participatory budgeting

🍋 Enable small organisations to focus on work, rather than bidding for work

🍋 Cut the jargon and hoops to jump through!

🍋 Open doors - find out what local voluntary organisations are doing and find opportunities to collaborate

🍋 VCSEs should approach local practices and primary care networks to explore partnership opportunities

🍋 Primary care can run clinics and health checks in voluntary sector buildings to engage communities 

🍋 Different localities require unique solutions, but key principles save you re-inventing the wheel

🍋 Decision-making power shift can be uncomfortable for those used to traditional distribution of money

🍋 Social prescribing is important to address social needs and reduce medicalisation

🍋 Social prescribing is great … but not if there are lots of travel agents and no holidays!!

🍋 Practice-based peer support workers with lived experience of mental health problems can provide community-based support, funded by the GP practice

🍋 Invest in communities and hand over power to drive change

🍋 Start small. Start somewhere!
 

Links:
Becky Malby – Universal Healthcare - podcast
Universal HealthCare National Inquiry
Easy Read Executive Summary
10 Leaps Forward - Innovation in the pandemic
Gill's Universal Healthcare work with MPFT

The Art of the possible  Gill's poem inspired by the conversation with Kim

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Please recommend 'Wild Card - Whose Shoes' to others who enjoy hearing passionate people talk about their experiences of improving health care.

 SUMMARY KEYWORDS

people, nhs, work, west yorkshire, bit, charities, community, brilliant, primary care, bradford, terms, organizations, talking, social, deliver, great, shoes, big, kim, prescribing

SPEAKERS

Kim Shutler, Gill Phillips 

Gill Phillips  00:11
My name is Gill Phillips and I'm the creator of Whose Shoes?: A popular approach to coproduction. I was named as an HSJ 100 Wild Card, and want to help give a voice to others talking about their experiences and ideas. I love chatting with people from all sorts of different perspectives, walking in their shoes. If you are interested in the future of healthcare, and like to hear what other people think, or perhaps even contribute at some point, Wild Card: Whose Shoes? is for you.

 Gill Phillips  00:46
I am really enjoying recording this mini-series of podcasts around universal healthcare, and I hope you are enjoying listening.  It is an exciting collaboration with London South Bank University and the Universal Healthcare Network.  We are seeking to raise awareness of the Universal Healthcare National Inquiry report - you can find a link in the show notes- and the exciting opportunities that it offers to design health care in a different way, and a far more person-centered way.  So far, we have had Professor Becky Malby setting the scene and telling you what we are talking about. We’ve had consultant paediatrician, Tom Holliday, telling us about the exciting work they are doing in London to offer more joined-up care to children and families. And we’ve had Dr George Winder, a very forward -thinking GP in Leeds, reminding us that poverty is not something to be medicalised and giving wonderful examples of reaching out and working with the local community, co-designing solutions.  But how does all this feel from a community point of view?  What’s happening there?  What does it mean to have a ‘neighbourhood-based solution’, which is an example of the jargon that is sometimes used in healthcare?  Today’s guest is Kim Shutler, Chief Executive of the Cellar Trust Mental Health charity in Bradford. As a vibrant member of the Universal Healthcare Network in West Yorkshire, Kim is ideally placed to tell us more about the role played by the voluntary sector, and why it is so important.  So welcome, Kim. Can you tell us a little bit more about yourself and introduce us to this topic.  

Kim Shutler  02:30
Thanks Gill, great to be here today. So, so yes, I'm the Chief Exec of a brilliant mental health charity in Bradford, that's been going for over 30 years, established in, in the cellar of a house in Bradford. And I've also got another hat: I am the lead for the voluntary community and social enterprise sector on West Yorkshire Integrated Care Board. So perhaps I'll cover a bit of both today. 

Gill Phillips  02:54
Brilliant  

Kim Shutler  02:55
In terms of the topic today, it's an exciting one. It's something I'm really passionate about. And it's about how do we maximize the potential of the voluntary community and social enterprise sector in Health and Care, and today, we'll particularly focus on primary care and...the voluntary community and social enterprise sector, it's not a proxy for communities, and it sometimes is thought to be, but actually we work so closely alongside communities, so we're a brilliant vehicle and enabler, and you just have to create the right conditions to allow that to thrive. 

 Gill Phillips  03:24
Yeah. And I think that's such an overlap with my Whose Shoes? work. You know, creating the conditions is what people don't always get, isn't it, that you can't just have a tick list of things to do and it will all be fine. It really is about nurturing people and valuing them and building trust.

 Kim Shutler  03:40
Absolutely. And I think that's the key, isn't it, in terms of working with communities, and it's a big lesson that I, and we've, learned as an organization, and I think it's a big lesson that's still to be learned by a lot of the health and care sector, and it's not something easy that you can put into numbers, and that's something that we struggle with, isn't it, as a system, when we're driven by and performance managed in terms of metrics and numbers. This work can feel quite intangible, but the evidence is very, very clear, and actually, it's the only thing that we can do to transform health and care. We have to work differently and better alongside communities themselves.

 Gill Phillips  04:19
Yeah, and that's, that's really powerful. It's the only thing we can do. And I've got excited about this work. You know, reading the Universal Healthcare National Inquiry, and it's a very different, isn't it, way of working, compared with the 'everybody must come to the hospital, everybody must come to the GP, that is how we deliver healthcare, and always have done' - taking things out and reaching out to communities is a different thing, and now you're saying it's the only way of doing it. So, that's quite a jump for people to come to but I think it's actually at the core of what we're talking about.  

Kim Shutler  04:54
I mean, we know, don't we, that our health and care system feels pretty wobbly at the moment. We're experiencing huge levels of demand and overwhelm, I think I would say, and that, you know, there is no sign of that stopping. Of course, we're also experiencing massive pressures in terms of the funding. So, you know, you have to think pretty fundamentally about, what do we need to do differently? And we talk about it being radical transformation. It shouldn't really be, yeah, seen as hugely radical to think about shifting power and resource as close to people where they live as possible, but in terms of how the NHS has always been set up, it is pretty transformational and radical, and it will take quite a lot of bravery and some real leadership to transform how we work. 

Gill Phillips  05:50
Yeah, if somebody didn't know anything about this, I mean in terms of  - so VCSE, what do we mean? And 'working in partnership with primary care', what do we mean?

Kim Shutler  06:01
Sure, sure. So the VCSE is the Voluntary, Community and Social Enterprise sector, and often charities, sometimes social enterprises. You know, the one that I run is a charity, and in West Yorkshire, for example, we've got some 14,000 organizations. And it's amazing, like our strength is the rich diversity and the breadth of everything that we deliver. 95%-ish of those organizations -regionally, locally and nationally, it's pretty much the same - are small or micro. So you teeny, tiny organizations that, they run on a wing and a prayer, but the work that they deliver is absolute gold dust. The organization I work for is a bit different. We deliver services that are quite big they're, you know, they're mental health contracts that are often quite close to what would have historically been delivered by the NHS or local authorities themselves. But they're non clinical services, they're a non clinical alternative provision. In terms of how those charities and similar organizations can work with primary care, well, if we think about primary care in the context of this podcast, as thinking about our GP practices, about the, the general practice where we live in our community, close to our home. Often those charities operate in that space, those little ones, they either work in a specific neighborhood or a locality, or they might work with a specific group of people. And so it's bringing those two things together. It's saying, 'actually, we've got our amazing general practice in our local community, and we've got all these fantastic, vibrant, voluntary, community and social enterprise organizations. How do we get the power of both? How do we create that really great offer of support and also ability for, or to embolden communities close to where people live?'

 Gill Phillips  07:58
Yeah, I think the power of both is such a great phrase there. And I think you've explained what I alluded to in the introduction, the neighborhood based solution, and people getting the idea that if something's working brilliantly in one place, it's probably something that you can take some ideas from. But I think what you've touched upon there, Kim, is how different different localities are, and to find the solutions with your own local people. So much of it is around individuals, isn't it, as well. If you've got an absolutely great little local organization, then the person who's running that can't just be cloned and put somewhere else. A different area will come up with their own version of that, but not the same, never the same, probably.

 Kim Shutler  08:44
No, it's never the same. You know, you're absolutely right that it's in everything, I think. Our success is so reliant on relationships and individuals, passionate individuals who want to change the world, to make things better. And you know, we see that so much in the sector that I work in - people give, you know, hundreds and hundreds, thousands even, of hours of their time and their lives to give back to causes and communities that they're really passionate about. We can't underestimate the power of that. So, yeah, you can't lift and shift models. But some of my frustration, though, is that we do know key elements or models that do work in terms of bringing together the power of general practice with the work of the VCSE, and we just don't use that so we too often reinvent the wheel. There are some key sort of things that are part of the, like, the recipe book, I guess. And if we could just share those things a little bit more, and just, you know, frankly just crack on and do them, we'd make more impact in a shorter amount of time.

 Gill Phillips  09:48
Yeah, and that was something I picked up from the report: start somewhere. And I think that's such a powerful little phrase that you can, you know, overthink, and you can have you commitees and you can have your meetings, and you can have your...everything, that kind of tells you why things are difficult and what barriers there are. But to start somewhere and start to see some progress, and then get excited about it, and then draw more people in, is a much more exciting model, really. 

Kim Shutler  10:17
Yeah, and if you think about, you know, if we're trying to transform health and care, the NHS, etc. It's a huge, like, big beast, big tanker or whatever, to try and turn around in our experience, where, you know, you start with a little pilot. You know, when it comes to working with our sector, let's be frank, there's quite often some perceptions of the VCSE as this soft, cuddly, nice to have activity and a bit of a wariness or a lack of trust in terms of our ability to deal with risk, with complexity, whereas actually that's, you know, a complete fallacy, because we operate in those spaces all the time. But if you start with a little pilot, working really, really closely with NHS or other statutory colleagues, you can start to build up that trust again. People can start to see the magic of what can happen when you bring those things together. You build the relationships, and then you what I've noticed is then other parts of the NHS or whatever, or other teams go, whoa. I'll have a bit of that, that looks nice, that looks shiny. I like the impact of that, and then it grows and it snowballs. So you go where the energy is to start off with. 

Gill Phillips  11:27
Yeah, and that's so... I'm excited at the moment, I'm doing a wonderful, I think it is, project with Midlands Partnership Foundation Trust, where we're trying to join things up more for children and families. And you think, these other organizations need to be involved. So that's the NHS Trust, but Staffordshire County Council is absolutely key. And do those organizations work together? Well, perhaps they do. I'm sure they do. But in this particular topic, how well do they work together? And then suddenly you get a spark between two individuals, and it's just caught fire, and it's drawn other people in, and then it becomes almost a bit unstoppable, and everybody's excited about it, rather than this 'project' (in inverted commas) that we're trying to 'deliver' (in inverted commas), and it's just the language and the feel of it just becomes so different, and people want to be part of it, and that's how change happens, I think. 

Gill Phillips  12:24
I've got, so this is a bit naughty for me, so I use a lot of poems in Whose Shoes?, and I've already got the seeds of an idea. It's got a bit of alliteration in it. It's already got bureaucratic barriers, policy positions and mandated models. What do you think? 

Kim Shutler  12:24
And that's the, I guess, that's the real bottom-up approach, rather than being told what to do. And it's difficult, isn't it, in the, the environment that we operate, particularly in the NHS and local authority as well, is there are policy positions, there are mandated models that we're expected to implement lately, and when they come down in that way, understandably, they're there about like, trying to implement best practice, but they can often hinder that really organic way of working from the bottom-up and over my time, it's been hugely frustrating where there have been specific models that have been mandated, or policy positions mandated that really gets in the way of local innovation, or some of the stuff that we would really love to drive forward, either locally or even at a West Yorkshire level, 

Kim Shutler  13:28
I like it. Yeah, you know, it's, it's hard getting the right balance, isn't it, because we'd, we don't want a postcode lottery. We don't want some areas to choose, oh, well, I'm not going to do this'. And that's, I suppose, that's why they mandate certain ways of working, so it's, it is tricky, but sometimes I think, 'oh if we could just...'. Like, like, during covid, if I'm honest, like, if we could get rid of some of those bits of red tape and just get on with stuff, bring together the right people to make things happen and stop with the barriers. Yeah, we could, we could make a real difference. And I feel a bit sad actually, that there are a lot of things that we learned from covid in terms of ways of working, that that we've lost. 

Gill Phillips  14:09
And I think there's a big part of our shared connection with Becky Malby, and during the pandemic, I absolutely loved her 10 Leaps Report, because it was practical, and it came out very early, and it was sort of spot on in terms of some of these things that cut through the red tape. And I know she was talking all the way through about, let's not let the old system bite back, and let's try and keep these things that we've proved actually people can do. You can trust them. You know, it does work, give people more autonomy. And then now we are, you know, couple of years post pandemic, how much of that have we really managed to learn from and hang on to, I guess. 

Kim Shutler  14:54
I think the old system has bitten back. And I think sometimes that's because of how we set up our governance structures and in terms of statutory provisions. So, NHS people often start talking to NHS people, local authorities start with talking to local authority people, education people talking to education people, etc. So some of the brilliant stuff in covid was when, you know, for example, the VSE came together with the police, with the private sector, with education, with health was, you know, with the neighborhood teams, you've got amazing ways of working coming out of that. But when we retrench back into our traditional governance structures, we don't get that opportunity for cross collaboration and bringing together different minds to to innovate and and also bring together the different bits of resource that we all have, because resource might being incredibly tight - of course it is, it's terrible - but actually, I'm a big fan of the putting together, like the bits of the jigsaw. Yeah, you have to be very good at that if you work in the VCSE. So yeah, I'd love to see more of that. I mean, in West Yorkshire, we have got our West Yorkshire partnership, where we bring the NHS together, and of course, I've got a place on the Integrated Care Board in West Yorkshire, which is a great mark in the sand. There's not very many integrated care systems that have the, the role that I have and the program that I have the opportunity to lead. So we're really privileged in West Yorkshire that we're we are quite ahead of the game in terms of really integrating the VCSE in terms of that partnership working. 

Gill Phillips  16:26
Yes, it feels like it. And I think you've touched Kim, there on resources. And I mean, I suppose one of my big beefs from my experience with voluntary sector and so on and great charities, is funding and sustainable funding. And I think when we spoke before, let me find it, it was a brilliant quote that you came up with. What have I done with my brilliant quote? 

Kim Shutler  16:51
Was it 'The road to hell was paved with good intentions?'

 Gill Phillips  16:55
Well, we'll have that one as well.

 Kim Shutler  16:56
That's that one belongs to Bill Graham, who you, you interviewed. Or it might have been 'The road to hell was paved with small grants'.

 Gill Phillips  17:05
Oh, I like that one. So that was a Bill Graham, was it?

 Kim Shutler  17:08
The good intentions one was, was Bill

 Gill Phillips  17:11
So you came up with a quote that I really like: 'Focus on the work and not bidding for the work'.  

Kim Shutler  17:18
Yeah, if you look at all our small organizations in particular, go out and see them, and you know, they run on, like I say, a wing and a prayer. But then, you know, for a very scrappy little bit of money, they spend all their time writing bids. They don't necessarily have the skills to do that, so the success rate is often not great. And then, of course, then they're doing all the monitoring, and each of the funders want something different. If they could just spend that time on doing the work, making the impact, they'd make a lot more impact. So we have to think through, what can we do to to remove that bureaucracy? I mean, the NHS can't be the answer to funding everything in charities, it's just impossible. No, but there are things that we can do to unblock, make it as easy as possible, and those are some of the things that we're working on at the moment. To think about, like, what are the things within our gift, within our control to make it easier? And let's, let's, really try and unblock some of those things. 

Gill Phillips  18:21
And that's got to be a win/win, hasn't it, for any organization to be able to plan a bit longer term, to be able to attract better people, because you're not offering a six month contract, you're offering a little bit of, you know, something you can get your teeth stuck into, and a bit of job security as well. It reminds me, Kim, it was a long time ago, but some work we did around dementia care, and there was somebody in Kent who just had brilliant ideas, and she would have written the bid, and to me, it was in English, and it would have looked brilliant, but perhaps it wouldn't have ticked the boxes and the jargon that was needed to be a successful bid. So they had somebody else who was very skilled in management speak, who'd take that idea and turn it into the tick-box type. And it just made me sad, because the original idea was just brilliant and plain and English. And do you think that's changed at all in terms of funding and...? 

Kim Shutler  19:18
No! 

Gill Phillips  19:21
And I'm talking like 12 years ago, with this! 

Kim Shutler  19:23
Not in terms of statutory funding. So, you know, the service which I run, it's, you know, we're, we're a reasonably big charity and - but not one of the big, like, national/ regional, you know, we're still a charity -  but it's, it's an art writing those statutory bids. And, you know, I'm quite decent at writing. You know, I did an English degree and all of that, but I can't write bids that tick the right boxes, that hit the right scoring. So we have to pay someone, a specialist, to do that as well, and we're of a size... but we still need to do that. So if you think of we're in the 5% of the larger charities in the country, right, the 95% have absolutely no chance. Some of the grant funders, the charitable trusts and foundations, they're a lot better. They, they're working harder. Some of them are working really, really hard to try and make that much more accessible for for organizations. But even then, there's lots that are, you know, behind the curve. 

Gill Phillips  19:23
It's interesting, I think, an awful lot of wisdoms coming out through this, bits and pieces that we're touching upon as we go along. Where should we go next, Kim? 

Kim Shutler  20:38
I suppose, I mean, we could talk a little bit more about specifically in terms of primary care, general practice, and how the voluntary community sector can really, really help. So, you know, we're in a place at the moment where our general practice is pretty overwhelmed. You know, we're hearing in the press a lot about people waiting a long time for appointments. Some of your other guests have talked, haven't they about actually, a lot of the time the people that are coming into primary care are coming for reasons that are not, are not to do with physical health symptoms, they might be to do with other things, such as loneliness and isolation or or actually, do you know what? Fundamentally, we can't meet their wider social needs that are going on, and that might be driving why they've they've come there, and I think that's where, where our sector can come in. Now, those charities will have existed in those localities, in those neighborhoods forever. You know that's the, that's the beauty of them. But it's relatively new in terms of general practice opening its doors, I think, in terms of real, true, integrated ways of working. So being one team, essentially. Charities don't want to lose their independence. But actually often, when I speak to small charities, they do still want to create those links, and they just don't know where to start in terms of broaching their, their local practice, or, you know, or their primary care network. They're very, very hard to navigate. So we have to think of ways to make that possible. Now, the rules, the mandated models, etc, necessarily lend themselves to making that really easy. So you again, you're really reliant on innovative individuals to open the door and say, you know, look, you know what, what can we do together? We've got some common challenges and some fantastic opportunities. So guess what I would say is, if you're listening and you're from primary care, open your door out, you know, go and talk to go and find out what's in your local area and have the conversations with with the charity leaders that are around. We're very, very, very good at solutions, but we don't always understand the problems that are going on in the NHS and, in this case, primary care. So once we can understand what are the things that are causing the problems, we're very, very, very good at thinking through, how do we work together to make a difference? 

Gill Phillips  23:08
That's brilliant, and I like that. That's a really strong call to action: 'open your door out and find out'. Find out what's happening just outside your door, isn't it? Really, rather than the traditional focus on everybody coming to the building, within the building. Everything happens within the building.

 Kim Shutler  23:24
Well, and also in a very practical front, there's no room in the buildings! There's no room in the building! Primary Care estates are one of the biggest challenges that we've got in the NHS. So, so I've got a couple of peer support workers, mental health and specialist workers who've got their own lived experience of mental health problems, and they work into a primary care network, Modality, who, I know that you're interviewing soon and, but they are community based, so the referrals come that, you know, it's funded by the practice, and they work as part of the team in the practice. The referrals come from the practice, but really they're community based. They're meeting people, maybe in their home or very, very close to their home, in a community venue that feels non-clinical. Often people don't want to go somewhere that feels clinical to have their needs met. So you just need to think a little bit outside the box. Um, yeah, and think about the art of the possible. Other, you know, other things are possible, like charities often have estates where primary care can reach into so, so we've got a building which has got, not primary care reaching to into it at the moment, but mental health services are based in there. Those integrated teams, co-location work really, really well. And actually we're, we're refurbishing our building at the moment, and we, you know, when we're talking to local GPs about whether they can run health checks in our building, or do different types of clinics that don't require a clinical space in our setting, which will feel very, very non stigmatized and really holistic in terms of services that will be in there.  

Gill Phillips  24:59
Yeah. Yeah. And I think those are the kind of practical examples that Bill Graham was going to be talking about in the next episode. So that is a really great link, Kim, I think people are understanding how the model works, really.

 Kim Shutler  25:14
It's going to where people are, isn't it? And even as a charity, we've learned some lessons about that. You know, a few years ago, you know, five or six years ago, everybody would have come into our head office building to see their work one to one, and we've made a decision to completely change that, because actually, it wasn't that easy to get to our head office. If you lived on the other side of Bradford, you might have to get two buses. So almost everything we deliver now is out and about in the community, whether it's, you know, going for a walk with somebody, in their home, in a library, in a job center, or in another health setting. We speak to people a lot in different parts of Bradford who will tell us, really, they only want to access services in that postcode. They're not going to go beyond that. So, if we're really, really serious about tackling health inequalities, that's what I mean earlier, is that this is the only way. 

 Gill Phillips  26:08
Yeah, so what about this might be a thorny topic, and I got very excited about social prescribing. What's happening now with social prescribing? Do you think because that seemed to be a way of doctors GP is being able to prescribe something that wasn't medication and was, for example, something more around social needs, and to actually have a little bit of money or a little bit of support for that, and to help people not be medicalized with all these problems, like you say, loneliness and social isolation and things that really are not medical needs as such.

 Kim Shutler  26:42
So social prescribing, in itself, is a great thing, but unfortunately, you know, a few years ago, it, it was like, like the NHS had, you know, invented electricity or something like it. You know, it's not a surprise, like VCSE has been doing social prescribing in one form or another, forever.

 Gill Phillips  27:06
That is the role isn't it?

 Kim Shutler  27:09
So, you know, so in a way, it's good. It's been recognized, and it's been recognized as fundamental and really, really important. There are two problems, though. One is, you know, to quote one of my brilliant VCSE colleagues, Vicky Beere, like, there's too many travel agents and no holidays. We've got all these social prescribers, community connectors, whatever you call them. And at the same time, because the funding isn't there for the VCSE, there's the assumption that they'll always be there, that they're being prescribed to places that aren't sustainable, haven't got the capacity to cope with the number of people. So from an NHS perspective: it's brilliant, get all these people off our caseloads, out of our door and into the VCSE, and at the same time, the funding gets cut from the VCSE, or the level of funding isn't proportionate to the demand that there is. The second really big risk and problem that we see at the moment is historically, to take Bradford, for example, social prescribing would have been something that the VCSE was commissioned to deliver. So it would have been funded directly from the - then - Clinical Commissioning Groups. Because we've seen a policy change, so the introduction of the the ARRS workers in primary care, GPs have been able to directly employ their own social prescriber. So therefore, often the VCSE then gets decommissioned because that role is provided in-house, in general practice. You know, and there's some benefits for them being in general practice, of course, but often there's some big disadvantages of that. So actually, it's, in a way, it's had a, it has had a, quite a negative impact on a lot of the sector.

 Gill Phillips  28:51
So things are set off with the very best intentions and that we're all excited about. It's how it then gets managed from there, isn't it, to make sure that.... it is seeing that whole system, isn't it, and the knock on effect somewhere else of doing the latest shiny thing. I mean, I liked your analogy with the NHS implementing electricity.

 Kim Shutler  29:10
Yeah, there's a lot of unintended consequences of decisions that get made in all parts of the system, not just in the NHS and local authorities. Yeah. Yeah. Same in our sector as well, but thinking it through when things are being decided. And that's why, if you make decisions as close as possible to the people or in the local area, then we've got the best chance. The further away the decision gets made, the more, more chance there is of these unintended consequences. And you know, we're seeing some of that happen now because of the financial pressures, decisions having to be made - really, really unpalatable decisions that no one wants to make - but actually, some of those decisions are being made speedily without really, really thinking through that the impact of that decision might last forever, and we might only realize the impact in a few years to come, where we think, 'oh, what happened to that organization or or that service?'.

 Gill Phillips  30:09
Yeah, I mean, as you were talking then, I mean, I was thinking, Yes, co-production is all about co-production, and then you don't get the unintended consequences nearly so much, because you've got people there saying, 'whoa, what about this?' or 'whoa, you know, but that would mean that such-and-such happens'. So that's that's very much on the same page. The other thing that went from my mind was you were talking about, when we spoke before, participatory budgeting, and like, giving people the power to make some of those difficult decisions. 

 Kim Shutler  30:39
Yeah, I mean this. I was talking to some brilliant colleagues, Sam Keithley and Elaine Appleby in Bradford, and they've been doing participatory budgeting for years in Bradford, like maybe 20-odd years ago. And it was, you know, giving relatively small pots of money to, to people in that area and essentially saying, we want to solve this. We want to do this. This is the outcome we want to achieve. You tell us, you tell us your ideas. And people essentially bid for it. I guess it's a little bit like a bit Dragon's Den-y. They get supported to pitch their ideas, and then it's that room of people who also get to decide which are the ones that get picked. And there's a little bit of bartering going on in there to try and make a difference. But, you know, I haven't been part of it directly, but I've been so happy to see that that again, number of years later, it's, it's starting to be brought back as a as a concept. Ultimately, though, it's scary for people who are used to working in a specific way, in terms of distribution of money, it really is giving over power in a way that will make a lot of people feel really uncomfortable. So it's whether we're prepared to do that, you know, really, really prepared to do that and also invest in communities in the long term, because you know the change isn't going to happen within six months. You give people a six month contract and expect to see big outcomes. Well, that's ridiculous. 

Gill Phillips  32:11
So, do you think that's a really good note to end on? I mean, I don't know if you've got any other key messages, but I was hearing there that the key to this is to hand over the power and to invest in communities. What do you think? 

 Kim Shutler  32:23
Yeah, yeah. I think, I think the key is to invest in communities and hand over the power. The key is to be prepared to do something differently, even if that's uncomfortable, and we really, really need leaders from all areas to be prepared to drive this forward. Otherwise it will. It just won't happen. 

Kim Shutler  32:46
Well, thank you so much. Kim, I mean, I go through the podcast. As part of the description, I pick out some of the lemon lightbulbs from our conversation. I think you'll have plenty of lemon lightbulbs.

 Kim Shutler  32:57
The one about the NHS inventing electricity?!

Gill Phillips  33:03
That definitely needs to be one of them! 

Kim Shutler  33:06
Okay, thanks.  

Gill Phillips  33:07
So thank you, Kim, that was brilliant, and we look forward to talking to Bill Graham and finding some of these more practical examples. 

 Kim Shutler  33:16

Brilliant. All right, that's great. Thanks so much. Gill, 

Gill Phillips  33:19
Thank you so much for listening. If you enjoyed this episode, it would be fantastic if you would leave a review and a rating, as well as recommending the Wild Card: Whose Shoes? podcast series to anyone who you think might find it interesting, and please subscribe - that way you get to hear when new episodes are available. I have lots more wonderful podcast guests in the pipeline. And don't forget to explore and share previous episodes - so many conversations with amazing people,  who are courageously sharing their stories and experiences across a very wide range of topics. I tweet as Whose Shoes?. Thank you for being on this journey with me, and let's hope that together, we can make a difference. See you next time.