Opinion

‘I need your help’

The four words community nurses should use to address health inequalities – and ensure they see their patients as partners. 

The four words community nurses should use to address health inequalities – and ensure they see their patients as partners 


Picture: John Houlihan

A colleague at our social enterprise got a new job last month. He said his life had been transformed after 13 years of mental health problems by four words: ‘I need your help’. 

When I met him in 2013, he described himself as ‘an alcoholic vampire’ who slept all day and drank all night. We asked him to help judge a children’s competition, because he was a local father. Apparently, we were the first organisation to see him as an asset and ask for his help rather than offer it.

The words ‘I need your help’ overcomes pride and shame.

Desired career

Many people do not like to be seen as someone in need. By using their strengths, however modest, I have witnessed even the most disadvantaged individuals transform themselves. 

My colleague started to volunteer and, after about six months, he got a job with us. Three years on, he has started his desired career in the NHS. The life chances of his three children are changed forever. 

By using their strengths, however modest, I have witnessed even the most disadvantaged individuals transform themselves 

‘I need your help’ shifts the balance of power and helps people to see themselves as a positive not a negative. It requires humility, implying that we do not have all the answers. It requires listening. For me it started when I was learning the trade of asset-based community development.

A resident told me that the business cards I was planning on using to advertise a resident led community partnership ‘shouldn’t be too posh because nobody will read them if they are’. I later learned that it is the person giving out the card or leaflet who is important. Relationships trump slick marketing when it comes to tackling inequality. 

Accountable care

Imagine if the development of integrated services, sustainability and transformation partnerships and accountable care organisations were always preceded by one agency saying to the other ‘I need your help’. 

Visualise a system where leaders said to local people: ‘We need your help’. Wigan Council said this back in 2010 when it received news that it was to experience one of the biggest budget cuts in the land. Since 2010 the council has saved a total of £115m through an initiative called ‘The Deal’. Its ethos is not about ‘fixing people’ or passing people around the system, but about forming a new relationship with the people, regrowing community spirit, investing in the third sector and training more than 4,500 staff to have ‘a difference conversation’. This is about understanding that what matters to people is more important than routine assessments and service offerings. 

Relationships trump slick marketing when it comes to tackling inequality

Unplanned admissions have reduced by 30%; £2.9m of external funding has been leveraged; and the social and economic value of the 59 big projects generated is £5.6m. An amazing 82% of Wiganers support The Deal. 

Asset and strengths-based approaches are not new, but the understanding of how they work and their routine application to create health, rather than prevent and treat ill health, is variable.

New NHS Alliance, in its bid to tackle health inequality differently, is calling on community nurses to see their patients as partners. When the problem is predominately clinical we can still ask: ‘What help do you need?’ 

When the problem is predominantly social, we are suggesting that nurses might change this to: ‘I need your help’. 


About the author

Heather Henry is chair of New NHS Alliance

 

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