Published: 16/06/2005, Volume II5, No. 5960 Page 42
For many, the word 'networking' suggests IT infrastructure or what people do when conferences break for lunch. Andy Cowper says it is time to take another look
Networking - in the sense of making and maintaining an adaptive, interconnected and responsive system - is essential for an NHS that must balance patient-centred care and community engagement with payment by results, the Healthcare Commission's new 'health checks' and other challenges.
Equally, the successful spread of learning around the NHS has become an ever-higher priority in pursuit of more patient-centred care and shorter waiting times. Launching the latest NHS delivery plan, chief executive Sir Nigel Crisp called for 'faster and better learning across the NHS' (news, page 7, 17 March).
Networks can share learning very effectively, as the Engaging Communities Learning Network (ECLN) - sponsored by the National Primary and Care Trust Development Programme - has successfully shown since its launch in 2002. Covering management of long-term conditions, choice, the expert patient programme and community engagement, ECLN enthused its primary care trust participants, shared good practice and had its results positively evaluated by the independent Henley Management Centre.
Section 10 of the 2004 Health and Social Care Act requires all NHS organisations to put community engagement at the heart of their plans.
Community engagement will also be a prerequisite to progress towards the 'fully engaged' scenario, which Sir Derek Wanless, author of recent governmentcommissioned reports on the NHS, estimated may save the NHS£20bn a year by 2022.
In March, ECLN organised two events to focus on the legacy of what had been learned - both about community engagement and how to share learning effectively in the NHS. A range of primary care trust participants, organisers and guests contributed fully and in a positive atmosphere of celebration which might. At face value, the event might have seemed at odds with ECLN's uncertain future - ECLN was being funded by NatPaCT, which in turn received its funding from the Modernisation Agency, which was wound up in the same month.
PCT managers in particular were clear that ECLN's constructive and supportive learning environment away from the office was vital to help them 'recharge the batteries' and focus on progress.
The fluid, non-centralised nature of the network was also considered essential to creating a 'ripple' effect of change. Several managers commented that ECLN's way of spreading learning was more empowering than a 'centres of excellence' model: it let them feel that they were 'doing' change; rather than it being done to them.
The network's freedom to have a wide agenda was also seen in a positive light.
Managers felt that a body like ECLN requires a more open organisational structure than the NHS tends to support.
They indicated that the ambiguity, complexity and unpredictability of community work suited a network format particularly well.
Participants were unconvinced that community engagement is yet hard-wired into the NHS structure, agreeing that change had begun but that a critical mass was yet to form behind community engagement across the NHS. The recent planning and priorities framework made no mention of public and patient involvement.
With the demise of the Modernisation Agency, NatPaCT was unable to continue funding ECLN. Most PCT participants voiced concerns about the loss of ECLN as a 'learning hotbed'. One praised the 'energy boost' she always got from attending ECLN's participatory events;
another described how it had enabled 'eureka moments... small, maybe, but a personal, internal tipping point'.
This momentum was seen as a key strength of ECLN, summarised as 'validation and reassurance, backed by a network'. All concluded that if the network's legacy were lost, it would set back community engagement in primary care.
ECLN was organised and facilitated by independent practitioners Jane Keep and Bob Sang (experts in organisational change and development, and public and patient involvement respectively). Jane Keep commented that managers participating with ECLN 'have started to shift the culture inside the NHS by building self-efficacy as managers; by realising more fully their own (and colleagues') learning capability; and by being participatory in the very way they work every day'. Bob observed that ECLN participants are 'well on the road to the Wanless fully engaged scenario'.
Not all the best stories have a happy ending, but this one does. ECLN's learning has been taken under the wing of the recently formed NHS Networks.
Learning networks look a good bet to continue to be a big part of the future for the NHS for some time to come.