Brokering constructive conversations

June 2, 2017

Changing together: brokering constructive conversations is a new report from the Social Care Institute for Excellence aimed at encouraging in-depth conversations to tackle issues around implementing new models of care.

Wicked issues – complex problems that cannot be solved in a traditional fashion – are nothing new. However, the current challenges facing the NHS, social care and others are arguably the most ‘wicked’ yet, according to the Social Care Institute for Excellence (SCIE).

It says that there is a danger that the new models of care discussed in the Five Year Forward View will be implemented in ways which fail to recognise their inherent complexity. This is because the issues surrounding integration involve a number of different organisations and people with competing interests, who disagree about what exactly needs to change, and how.

Developing new plans can be tough, partly because of how difficult it can be to win the backing of local citizens for radical change. What happens to a vision that isn't followed by a widely owned and agreed plan? In these instances, it very often gets stuck, opposed by the very people who are most expected to benefit from it: patients, people who use services and the wider public. In order to build visions and plans that are more likely to be sustained, it is critical to have service user, patient and carer involvement in service design, commissioning, and delivery. That’s co-production.

The new report, Changing together: brokering constructive conversations presents the findings from a research study exploring how to better broker constructive conversations. This means having in-depth dialogues between people who commission and provide services and patients, service users and the public to tackle the most difficult issues associated with the implementation of new models of care.

The research was undertaken by SCIE, working in partnership with PPL and the Institute for Government; and funded by the Health Foundation’s Policy Challenge Fund.

Ewan King, SCIE's Director of Business Development and Delivery said, ‘We want to encourage in-depth dialogues between people who commission and provide services and patients, service users and the public – with citizens. This can help tackle "wicked issues" – those really challenging and seemingly intractable issues – associated with the implementation of new models of care. Change on the scale being suggested cannot be “done to” local communities – it needs to be negotiated with their close involvement through co-production and meaningful engagement.’


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