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 better health in
harder times
A c t ive ci t i z ens
and inn o vat i o n
o n t he f r o n t line
Copyright © 2012. Policy Press. All rights reserved.

eDITED BY
CELIA DAVIES • ray Flux
mIKE HALES • jAN wALMSLEY

Better Health in Harder Times : Active Citizens and Innovation on the Frontline, edited by Celia Davies, et al., Policy Press, 2012. ProQuest Ebook
 Better health in harder times
Active citizens and innovation on the
frontline
Edited by Celia Davies, Ray Flux, Mike Hales and
Jan Walmsley
Copyright © 2012. Policy Press. All rights reserved.

Better Health in Harder Times : Active Citizens and Innovation on the Frontline, edited by Celia Davies, et al., Policy Press, 2012. ProQuest Ebook
 First published in Great Britain in 2013 by
The Policy Press
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ISBN 978 1 44730 693 1 paperback
ISBN 978 1 44730 694 8 hardcover
The right of Celia Davies, Ray Flux, Mike Hales and Jan Walmsley to be identified as editors
of this work has been asserted by them in accordance with the 1988 Copyright, Designs and
Patents Act.
All rights reserved: no part of this publication may be reproduced, stored in a retrieval system,
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Copyright © 2012. Policy Press. All rights reserved.

The statements and opinions contained within this publication are solely those of the editors
and contributors and not of The University of Bristol or The Policy Press.The University of
Bristol and The Policy Press disclaim responsibility for any injury to persons
or property resulting from any material published in this publication.
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Better Health in Harder Times : Active Citizens and Innovation on the Frontline, edited by Celia Davies, et al., Policy Press, 2012. ProQuest Ebook
 To Bob Sang (1948–2009), advocate, compulsive networker,
facilitator, convivial commuter, social entrepreneur, from
friends, for the future; and to Lisa Sang and their children and
grandchildren, who remember him far more than we do.
Copyright © 2012. Policy Press. All rights reserved.

Better Health in Harder Times : Active Citizens and Innovation on the Frontline, edited by Celia Davies, et al., Policy Press, 2012. ProQuest Ebook
Copyright © 2012. Policy Press. All rights reserved.

Better Health in Harder Times : Active Citizens and Innovation on the Frontline, edited by Celia Davies, et al., Policy Press, 2012. ProQuest Ebook
 Contents
Contributors’ biographical notes viii
Acknowledgements xiii
List of abbreviations xiv

Introduction 1

Section 1: What business are we really in? Managing and 5

self-managing well-being
1 Money matters! Personal budgets and direct payments 7
Nan Carle
2 Mainstreaming a chronic disease self-management programme – 10
reflections on the NHS Expert Patients’ Programme
Jim Phillips
3 Health promotion – connecting people and place 13
Angela Flux
4 Is a long-term condition a disability? Schools of thought and language 20
Jan Walmsley
5 Life as an active citizen – full engagement, hard work and well-being 24
Mike Hales
6 Genuine partnership 27
Laurie Bryant
7 Overview: Looking for a new social contract around the NHS 28
Ray Flux

Section 2: Questions of quality – not just ticking boxes 35

8 A cataract journey 37
Jan Walmsley
9 Using Experience-Based Co-Design to make cancer services more 39
patient-centred
Catherine Dale
10 How patient stories can change the commissioning culture 42
Georgina Craig
11 Turning ‘care’ into ‘share’ 45
Copyright © 2012. Policy Press. All rights reserved.

John Worth
12 Let me tell you a story 48
Tim Craft
13 Quality, leadership and moral responsibility 51
Rick Stern
14 Accounting for quality – eight tips for producing reports for the public 55
about the quality of care
Catherine Foot

Better Health in Harder Times : Active Citizens and Innovation on the Frontline, edited by Celia Davies, et al., Policy Press, 2012. ProQuest Ebook
 Better health in harder times

15 Overview: Quality – fantastic journey but bumpy ride? 59

Celia Davies

Section 3: Governance – how can we really work together? 65

16 Reminiscences of an advocate 67
David Sines
17 Researching together – pooling ideas, strengths and experiences 69
Rohhss Chapman and Lou Townson
18 Becoming accepted 73
Kate Ansell
19 Supporting ‘experts by experience’ – a champion idea 76
Beryl Furr
20 Engaging communities – sharing the learning 81
Jane Keep
21 The engagement industry – some personal reflections 85
David Gilbert
22 Overview: Colliding worlds – the journey towards collaborative 90
governance
Celia Davies

Section 4: How can information technology work for well-being? 97

Data, dialogues and digital media
23 Records help us make sense of our lives 99
Yvonne Bennett
24 Records access and empowered patients, 2017 101
Brian Fisher
25 Learning to build a high-quality information system to support 105
high-quality renal care
Lawrence Goldberg
26 Embracing social technology 111
Tris Taylor
27 Enlightening the next user 113
Neil Bacon
28 Patients’ stories – digital gifts that can change the world 115
Paul Hodgkin
Copyright © 2012. Policy Press. All rights reserved.

29 Temptations of cheap data 119

Valerie Iles
30 Overview: Innovation in cultures, feelings and roles 122
Mike Hales

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Better Health in Harder Times : Active Citizens and Innovation on the Frontline, edited by Celia Davies, et al., Policy Press, 2012. ProQuest Ebook
 Contents

Section 5: What kind of learning, what kind of leadership? 131

31 Managers and leadership, now and then 133
Alastair Mant
32 Harnessing a Hydra – managing to change the NHS 135
Celia Davies
33 “Ask the patient what they want” 139
Jon Willis
34 The heart and art of leadership 141
Kate Hall
35 Health leadership for the 21st century – a new, holistic, 143
co-productive endeavour
Ed Nicol and Simon Eaton
36 Forty years of innovation in community responses to the needs of 149
people with learning difficulties
Simon Duffy
37 From hard to reach to within reach – the ‘how’ of community 153
engagement in the era of the Big Society
Malik Gul
38 Disciplined conversation, facilitated dialogue, measured progress 157
Tim Sims and Fiona Reed
39 Leadership as if people matter – the Innovative Headteachers 160
Programme
Ian Cunningham
40 Overview: What kind of leadership? 164
Jan Walmsley

Postscript: Better health in harder times – towards a 171

sustainable NHS
References 177
Index 185
Copyright © 2012. Policy Press. All rights reserved.

vii

Better Health in Harder Times : Active Citizens and Innovation on the Frontline, edited by Celia Davies, et al., Policy Press, 2012. ProQuest Ebook
 Contributors’ biographical notes
Kate Ansell is a patient representative at a local and national level and chairman
of the Shropshire Patients’ Group. She originally worked in town planning, which
led to the setting up of the Ironbridge Gorge Museum Trust, and later established
an outside catering business employing 50 staff.

Neil Bacon is an entrepreneur and former nephrologist, founder of Doctors.net.uk

and owner of the ratings site, www.iWantGreatCare.org.

Yvonne Bennett is a patient with online access to her medical records and
secretary of the patient participation group of her GP practice. She is involved
in promoting online access to medical records, through articles and presentations.

Laurie Bryant is a graduate and is supported by mental health services. He has

worked nationally and internationally in developing improved services. He has
found that genuine partnership was always a prerequisite to any success.

Nan Carle is a passionate and seasoned advocate for inclusive communities. She
has successfully challenged and changed policy and practice to give communities in
several different countries the skills and knowledge to resolve conflicts effectively
and unleash the power of individuals to manage well and live fully, at work and
at home.

Rohhss Chapman has worked in partnership with learning-disabled people

since 1990 and is a lecturer in learning disability studies at the University of
Manchester. She supported Carlisle People First (now People First Independent
Advocacy) to set up their own self-advocacy company.

Tim Craft is medical director at the Royal United Hospital in Bath and leads
continuous improvement programmes that weave together safety, patients’
experiential feedback and clinical outcome data.

Georgina Craig is a member of the NHS Alliance executive, leading on

Copyright © 2012. Policy Press. All rights reserved.

pharmacy commissioning and co-leading on the Alliance’s patient and public

involvement network. In 2011, she completed a Department of Health-funded
pilot of ‘Experience-Led Commissioning’ (ELC) and is now working to spread
ELC across the NHS and build its evidence base.

Ian Cunningham has worked with organisations on organisation-wide change,

with Boards on strategy development, with teams on their development, and
through individual mentoring and coaching of Chief Executive Officers and

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Better Health in Harder Times : Active Citizens and Innovation on the Frontline, edited by Celia Davies, et al., Policy Press, 2012. ProQuest Ebook
 Contributors’ biographical notes

other senior leaders. He has created innovative development programmes for

more than 40 organisations.

Catherine Dale is programme manager for patient-centred care in King’s Health

Partners Integrated Cancer Centre. She has 12 years’ experience managing in
acute trusts, has set up a PALS service and developed the King’s Fund’s online
Experience-Based Co-Design toolkit.

Celia Davies is a sociologist with a long-standing interest in research on and

with the health professions, and Professor Emerita of Health Care at The Open
University. She carried out a pioneering small study of lay members on health
professional regulatory bodies in 2000 and is a lay member of the General
Pharmaceutical Council.

Simon Duffy is director of The Centre for Welfare Reform, an honorary research
fellow at the University of Birmingham and policy advisor to the Campaign
for a Fair Society. He was an early pioneer of supported living, person-centred
planning, self-directed support and citizenship-focused public policy. He has a
doctorate in moral philosophy.

Simon Eaton is a consultant physician and diabetologist in Northumbria

Healthcare NHS Foundation Trust based at North Tyneside General Hospital and
clinical lead for long-term conditions for NHS North East. He leads a programme
to drive transformational change and quality improvements in services, to improve
outcomes for people with long-term conditions. Simon was a Health Foundation
Leadership Fellow in 2007–09.

Brian Fisher is a semi-retired GP and a founder-director of PAERS Ltd (Patient

Access to Electronic Record Systems). He is active in patient and public
involvement in the primary care sector in Lewisham and in the NHS Alliance,
and is a fellow of the Centre for Welfare Reform.

Angela Flux has been a teacher focusing on religious, personal and social
education, an adult educator in health issues, and a pioneer in adolescent peer
education, particularly in sexual health. She has worked on the interface between
Copyright © 2012. Policy Press. All rights reserved.

local government and community groups, designing and managing health and
well-being programmes at local level.

Ray Flux has worked for more than 20 years as an independent consultant on
the interface between clinical professions and services and the people who use
or work alongside them. Before that, he was a fellow at the King’s Fund. He
works to develop partnerships and dialogue in health economies at local and
regional levels.

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Better Health in Harder Times : Active Citizens and Innovation on the Frontline, edited by Celia Davies, et al., Policy Press, 2012. ProQuest Ebook
 Better health in harder times

Catherine Foot is a senior fellow in policy at the King’s Fund, focusing on

aspects of quality. Previously, she was head of policy at Cancer Research UK and
she has helped to lead a number of voluntary sector coalitions.

Beryl Furr has worked with many individual patients and communities of interest,
in roles that include non-executive director in a Primary Care Trust, chief officer
of a community health council, independent facilitator, community activist and
Ambassador for Public Appointments.

David Gilbert is a former mental health service user, a Leeds United supporter
and director of InHealth Associates, which supports organisations and individuals
in turning patient and public engagement and co-production into everyday
practice. Current initiatives include developing The Centre for Patient Leadership.

Lawrence Goldberg is consultant nephrologist and chief of specialised services

in the Brighton and Sussex University Hospitals NHS Trust.

Malik Gul is director of the Community Empowerment Network in

Wandsworth. Through a 30-year career in front-line community development
he has sustained a belief in the power of people to make a difference. Learning
and reflecting within the Masters in Public Administration programme at the
University of Warwick has enabled him better to join the dots between public
agency working and the communities they are seeking to serve.

Mike Hales is author of Living thinkwork – where do labour processes come from? (CSE
Books, 1980). He and Bob Sang, while colleagues at the University of Brighton
(Brighton Polytechnic) business school, worked in some surprising places as allies
in the cause of self-management and dialogue across communities, in contexts
of information technology systems development. He is a former user of mental
health services.

Kate Hall joined Monitor in April 2010, working on board development. She
is a Fellow of the Improvement Faculty for Patient Safety and Quality, and a
Leadership Fellow with The Health Foundation.
Copyright © 2012. Policy Press. All rights reserved.

Paul Hodgkin is chief executive of Patient Opinion, a not-for-profit social

enterprise operating a website where patients, service users, carers and staff share
their stories of care across the UK. He was a GP until 2011.

Valerie Iles is an independent academic consultant in health management,

director of the Royal College of General Practitioners’ leadership programme,
honorary senior lecturer at the London School of Hygiene and Tropical Medicine,
and fellow of the Centre for Leadership Studies at the University of Exeter.

Better Health in Harder Times : Active Citizens and Innovation on the Frontline, edited by Celia Davies, et al., Policy Press, 2012. ProQuest Ebook
 Contributors’ biographical notes

Jane Keep has worked at local, strategic and national levels in and around the
NHS for more than 30 years as a personal and organisational development and
change facilitator and consultant. Themes include patient and public engagement,
inclusive working cultures, health and well-being at work, productive working,
and leading as peers.

Alistair Mant is an author and consultant who has worked in public sector
organisations all over the world. He is chairman of the Performance 1 consultancy
and of the Socio-technical Strategy Group. His latest book, The bastard’s a genius
(Allen & Unwin, 2010), is a case study in inventiveness and entrepreneurship.

Ed Nicol is a consultant cardiologist and general physician in the Royal Air Force,
and works at Royal Brompton and Chelsea and Westminster NHS Foundation
Trusts. He has an academic and practical interest in health leadership and advocates
a holistic approach to service improvement, utilising skills and experiences of all
who use or work within health services to improve outcomes for people using
the NHS. Ed was a Health Foundation Leadership Fellow in 2007–09.

Fiona Reed is a coach, facilitator and trainer, and leads Fiona Reed Associates. A
main theme of current NHS work is supporting people to develop the resilience
needed in the current tumult. Another is how to influence across boundaries.

Jim Phillips works internationally as a consultant on health behaviour change,

advising institutions, multinational companies and governments in the UK and
abroad. He helped set up the Expert Patients’ Programme in the UK and has
advised and overseen the development of a range of self-management programmes.

Tim Sims works to strengthen NHS teams attempting new or challenging tasks
that will deepen their impact on the health of their patients. For the Health
Foundation, he and Fiona Reed designed and tested innovations in leadership-
for-improvement with clinicians and managers, which they are now applying
across the NHS and internationally.

David Sines is pro vice chancellor and executive dean and Professor of
Community Health Care Nursing at Bucks New University. He is a fellow of
Copyright © 2012. Policy Press. All rights reserved.

the Royal College of Nursing and received a CBE for services to healthcare.

Rick Stern is chief executive of the NHS Alliance and a director of the Primary
Care Foundation. At the time of writing, he was urgent care lead for the NHS
Alliance, leading a network of urgent primary care providers including most of
the out-of-hours providers across England. Previously, he was chief executive of
Bexhill & Rother Primary Care Trust.

xi

Better Health in Harder Times : Active Citizens and Innovation on the Frontline, edited by Celia Davies, et al., Policy Press, 2012. ProQuest Ebook
 Better health in harder times

Tris Taylor composes music and occasionally does web, education and social
justice projects (including: http://bobsangopenspace.org). “Bob helped me to
understand and practice involvement, which has profoundly improved my life.”

Lou Townson has been an independent consultant in the field of learning

disabilities for 18 years. She is a member of Carlisle People First Research Team
and of People First Independent Advocacy (Cumbria) and a visiting lecturer on
the University of Manchester degree in learning disabilities studies.

Jan Walmsley is Visiting Professor of Leadership and Workforce Development

at London South Bank University,Visiting Professor in the History of Learning
Disability at The Open University, and former assistant director at The Health
Foundation. She runs an independent research consultancy.

Jon Willis qualified as a nurse in 1996 having previously worked in the banking
and insurance industry. He is currently Ward Manager of an acute care of the
elderly ward at the Royal United Hospital in Bath. In 2009, he won a place on
the Health Foundation Leadership scheme and for three months led the work
stream on patient safety.

John Worth is founder of Know Your Own Health, an online self-management

service. For 15 years he ran a successful digital communications agency producing
large public behaviour-change campaigns and digital communications systems
(websites etc) including many for the NHS.
Copyright © 2012. Policy Press. All rights reserved.

xii

Better Health in Harder Times : Active Citizens and Innovation on the Frontline, edited by Celia Davies, et al., Policy Press, 2012. ProQuest Ebook
 Acknowledgements
A book in response to the sad and untimely loss of Bob Sang could not
conceivably be made without contributions from many people in his wide and
vital networks. In addition to the contributors whose chapters appear here – all
specifically written for this collection – the editors also want to acknowledge and
thank the following people who worked with us along the way: Andy Cowper,
Graham English, Phil Greenham, Pip Hardy, Rachel Hawley, Sarah Pearson, Ed
Rosen, Maria von Hildebrand, as well as contributors Valerie Iles and Tim Sims.
The book was initiated by Lisa Sang, Bob’s partner, who convened the editorial
team. We are glad to acknowledge the key contributions that she made, furnishing
essential summaries and maps of his networks, commitments and ideas. We
deeply appreciate the trust she placed in us as a team while we sorted ourselves
out and got on with it, and the touchstone she has provided in occasional timely
discussions over the past 20 months.
Copyright © 2012. Policy Press. All rights reserved.

xiii

Better Health in Harder Times : Active Citizens and Innovation on the Frontline, edited by Celia Davies, et al., Policy Press, 2012. ProQuest Ebook
 List of abbreviations
ADHD attention deficit hyperactivity disorder
BMA British Medical Association
BME black and minority ethic
CCG Clinical Commissioning Group
CCs community champions
CDSMP Chronic Disease Self-management Programme
CHC Community Health Council
CIC Community Interest Company
COPD chronic obstructive pulmonary disease
CPI classic professional identity
DEMOS (the name of an independent think tank in UK politics)
EBCD Experience-Based Co-Design
ECLN Engaging Communities Learning Network
ELC experience-led commissioning
EMIS Egton Medical Information Systems Ltd
EPP Expert Patients’ Programme
EPR electronic patient record
GMC General Medical Council
HERG Health Experience Research Group
HQIP Healthcare Quality Improvement Partnership
IAPT Improving Access to Psychological Therapies
ICT information and communication technology
IHTP Improving Head Teachers Programme
IT information technology
LINks Local Involvement Networks
LTCs long-term conditions
MBCT mindfulness-based cognitive therapy
MRSA methicillin-resistant staphylococcus aureus
NaPaCT National Primary Care Trust Development Programme
NEET not in employment, education or training
NEF New Economics Foundation
NESTA National Endowment for Science Technology and the Arts
Copyright © 2012. Policy Press. All rights reserved.

NIACE National Institute of Adult Continuing Education

NICE National Institute for Clinical Excellence (later National Institute
for Health and Clinical Excellence)
PAERS Patient Access to Electronic Record Systems
PALS Patients’ Advice and Liaison Service
PCT Primary Care Trust
PPE patient and public engagement
PPI patient and public involvement
PROMS patient reported outcome measures

xiv

Better Health in Harder Times : Active Citizens and Innovation on the Frontline, edited by Celia Davies, et al., Policy Press, 2012. ProQuest Ebook
 List of abbreviations

QIPP Quality, Productivity, Innovation and Prevention Programme

RSA Royal Society of Arts
SML self-managed learning
TDA The Disability Alliance
UPIAS Union of the physically impaired against segregation

Common abbreviations used but not in the list:

AIDS BMW CBE DVD GP IBM HIV IBM EU RAF NHS
PC UK
Copyright © 2012. Policy Press. All rights reserved.

xv

Better Health in Harder Times : Active Citizens and Innovation on the Frontline, edited by Celia Davies, et al., Policy Press, 2012. ProQuest Ebook
Copyright © 2012. Policy Press. All rights reserved.

Better Health in Harder Times : Active Citizens and Innovation on the Frontline, edited by Celia Davies, et al., Policy Press, 2012. ProQuest Ebook
 Introduction
In today’s hard times we need to think differently about how we do
healthcare. Changing expectations, changing health needs and economic
retrenchment together add up to an urgent argument for change, a call for the
‘fully engaged scenario’ that Sir Derek Wanless made so eloquently (Wanless,
2002, 2004). This change is now urgent. The sustainability of public healthcare
and public service values is threatened by the belt-tightening of global recession,
and compromised by a ferment of institutional change that is extraordinary,
even in a culture that for years has been fraught with ‘compulsory innovation’ in
organisational forms and funding arrangements.
But how to make these fundamental changes? Policymakers exhort engagement,
involvement, co-design and co-production; but what do they look like in practice?
The book seeks to ground these ideas through stories from day-to-day experience,
where engagement and involvement are central, not ‘add-ons’ or extras. Most
contributors write about what they know in practice, and have actually done. The
practices they describe are not always entirely new. In some cases, they have
been going on for decades, particularly since systematic challenges began to be
made to the prevailing ethos of the welfare state in Britain: that the professional
decides what is right for the citizen, and the citizen shows due gratitude. It is
the different starting points and the collective impact of these practices that is
important. There never has been a more important time to review and reinvigorate
strands of thought and practice in the fields of co-production, full engagement
and citizen activism. This book sets out to demonstrate what these well-worn
clichés mean when fleshed out in practice, and it communicates the excitement
and enthusiasm of those who do this.
The book weaves together the voices of three groups. There are people whose
well-being substantially depends on public healthcare services (and those who
advocate for and support them); there are people who provide healthcare and those
who give them professional support in continuously improving their services; and
there are people who ‘do management’ in healthcare institutions (with or without
the word ‘manager’ in their job titles). Some of our contributors write regularly
for publication. Most do not. They are activists and front-line service providers
writing to engage and inform others and promote better practice.
Copyright © 2012. Policy Press. All rights reserved.

The inspiration for the book

The book owes its genesis to a very special person, Bob Sang. His sudden and
unexpected death in 2009 closed a 15-year career in leadership and organisational
development in and around the NHS, and an active and innovative commitment
to advocacy for patients and service users going back more than 30 years. At the
time of his death, Bob occupied the UK’s first (so far, the only) Chair of Patient
and Public Involvement, at London South Bank University.

Better Health in Harder Times : Active Citizens and Innovation on the Frontline, edited by Celia Davies, et al., Policy Press, 2012. ProQuest Ebook
 Better health in harder times

Bob believed in developing the capacity for self-management – and, through

this, the well-being – of people whose lives are enmeshed with healthcare
institutions. The readings in this book are designed to ensure that Bob’s ideas and
inspiration continue to inspire others. You do not need to have known him to
get a great deal of value from the book – but in the end, you may wish you had!

Who should read this?

This book can be read by different people in different ways. Some will want simply
to dip in, finding a topic that relates to their experience. There are some very short
and memorable contributions: describing an experience, challenging thinking
or adopting a particular point of view. Other pieces provide more detailed case
studies or arguments. Some readers will want to take in a whole section at once,
asking themselves what the message is, for them, in the context in which they find
themselves. Other readers might want to bring together chapters from different
sections – certainly, there are cross-cutting themes that can be explored. We think
the book will work particularly well in opening windows on worlds of practice
for students, giving them down-to-earth examples to put alongside the critiques
of policy and practice that they will find in the more academic literature. As
readers become familiar with the book, they will be able to use it in ways we
editors had not imagined; we have provided an index to help in this.
Each section has a brief introductory page or two, helping readers choose what
interests them. Each also has a concluding overview that puts the contributions
in a wider context, drawing attention to some lessons that might be learned or
placing first-hand accounts in the context of some of the research literature.
The book does not involve itself in a systematic way with contrasting theoretical
ideas, or the career of concepts: active citizenship, well-being, innovation, co-
production and so on. But it is informed by knowledge of these, and teachers will
find material that brings issues to life in a way not available elsewhere. Although
at times we have gone out to find contributions of a particular kind or in a
particular area, the editors have not solicited contributions deliberately to cover
public health, primary care, acute services, social care or other specific areas of
practice; or to ensure that contributions come evenly from across the UK.
Largely, contributors are people with first-hand experience of working with
Bob Sang. That is apparent at various points, as they write about how and why
Copyright © 2012. Policy Press. All rights reserved.

they did whatever it is that they are writing about. We explained, though, that it
was not direct tributes that were wanted, but stories of better outcomes and better
ways of working, which pay respect to his principles and commitments. Some of
our contributors did not know him, and the work they are doing serves equally
well as an instance of the values and practices that he aspired to.
Our readers are likely to be similar to our writers: activists; people whose well-
being depends on healthcare services; and professionals, managers and workers
motivated to do better work in difficult circumstances. We are keen to ensure that
this book appears on reading lists for healthcare professionals and managers, either

Better Health in Harder Times : Active Citizens and Innovation on the Frontline, edited by Celia Davies, et al., Policy Press, 2012. ProQuest Ebook
 Introduction

seeking to qualify or on programmes of continuing professional development. It

offers all these readers a rich fount of ideas, perspectives, approaches and stimulating
real-world questions.

The structure of this book

The book is divided into five sections, each with an orientation that was
characteristic in Bob Sang’s thinking and practice.
Section 1 asks: What business are we really in? It is widely acknowledged that
the lion’s share of time and money in public healthcare is devoted today to long-
term conditions. Doing things differently, driving down costs and reducing
complexity are vital. It is much less widely understood that getting the social
relations between service users and service providers right has the potential to
transform lives, services and costs. The focus here should not be on long-term
conditions alone. Self-managing better health and well-being at all stages of life,
and working together in local communities to achieve healthier lifestyles and
life choices, are part and parcel of what is needed. The contributors know this –
they give us examples of types of practice and ways of talking about long-term
conditions that reflect this approach.
Quality is the theme of Section 2. Here, practitioners, patients and others
each take ownership of what a quality service means for them. The redesign
and the commissioning of services – in dialogue with patients and with their
needs at the centre – is now occurring in a number of places, as the readings will
show. Cost pressures make it challenging but all the more important to get things
right. Learning from mistakes is also a key part of quality – requiring courage and
maturity from all. Being able to account for quality in ways that are meaningful
and accessible to different audiences is a skill still under development.
Section 3 discusses aspects of governance, focusing on what happens when
everyday worlds and healthcare worlds confront each other. The gulf can seem
unbridgeable and service users will sometimes decide to ‘do it for themselves’; we
have an example of people with learning difficulties successfully doing research and
making it count. Advocates and intermediaries, however, can play valuable roles
when everyone is outside their comfort zone. Small organisational adjustments
and practical support for outsiders can pay dividends for service improvement, as
several writers show. ‘Involvement’ and ‘engagement’ are not simple concepts to
Copyright © 2012. Policy Press. All rights reserved.

put into practice, but contributors suggest how to move forward, acknowledging
the complexities that will be met.
Innovations in the exploitation and implementation of information technology
(IT) are absolutely relevant to a vision of well-being and service, and contributors
in Section 4 explore the question: How can information technology work for well-
being? They take different approaches to harnessing the potentials of IT to
enable participation and self-management, bottom-up development and service
improvement, quality of care, and a managerial culture of caring.

Better Health in Harder Times : Active Citizens and Innovation on the Frontline, edited by Celia Davies, et al., Policy Press, 2012. ProQuest Ebook
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