(We have reproduced this blog with kind permission from Leeds CG and West Yorkshire and Harrogate Health and Care Partnership.)

Hello my name is Tim.

I’m often struck by the challenges that face us and the dichotomy of solving wicked issues at scale versus locally-led co-created responses.

On a visit to Meanwood Urban Valley Farm, a charitable urban farm in Leeds, I met Isabel. She is a Physio Horticulturalist; a new one on me if I am honest. She runs group sessions mainly with older people that provide a combination of clinical inputs to address issues with balance and gait, at the same time as doing some expert led gardening and enjoying a cuppa and a chat. They also have a purpose supporting the farm.

Isolation and frailty are big wicked issues which we’re all dealing with and we understand the profound implications not just on NHS and social care budgets but on wonderful and valuable individuals living in our communities. I’m also minded to say that the word ‘frailty’ itself presents a wicked issue, one for another time I dare say. We know that people don’t like being called frail yet frailty assessments help health and care professionals understand the type and level of support someone will need.

One of the principles of our West Yorkshire and Harrogate Health and Care Partnership is that of subsidiarity; understanding that a higher power or authority only takes on tasks itself that can’t be done effectively more locally. We talk of sharing good practice, addressing together issues best undertaken at scale and tackling wicked issues. Wicked issues are an outcome of a number of things but are often rooted in complexity and a product of complex systems.

So my question is, “are we sure that wicked issues are best solved at scale?” or perhaps to nuance the question a little more, “are we being discriminating enough about which elements of wicked issues are addressed at the West Yorkshire and Harrogate partnership level?” This might sound at odds with the Partnership ethos to some but it’s a question that we all ask when we are balancing the needs of place, organisation and partnership.

The “Looking out for our neighbours” campaign, which our communications team along with many others have played an important part in, could be seen as an example of where the scale of West Yorkshire and Harrogate is adding value to addressing the challenge of isolation. And yet the practical and detailed response has to be very local: alive to the assets within the particular community; the local family and community networks; the various cultures and sub-cultures as well as the unique distribution of services. The campaign has provided a unifying brand but the actions are taken at a very local level with your neighbours – this just creates the conditions to help people make those connections.

This wicked issue, and I think many others, is not solved by pushing up from place to system in an assumption that scale and brain power at the centre are the answer but, rather by putting the resources with the staff, third sector and communities in which the issues manifest and allow them to develop tailored answers. There are and will be many more Isabels in our communities who are yet to emerge and through our closer working as partners we must create networks that foster local solutions to many of the wicked issues. Is Isabel an example of an imaginative way to solve a wicked issue at a local level?

This is a hard task and requires deep rooted change in organisations, like mine, and it would be much easier but less effective to let the Partnership take the responsibility.

One of the things that struck me most about the gardening physio group is they had a purpose beyond themselves – helping the urban farm develop. T E Lawrence once said that happiness is a “by-product of absorption” being immersed in a cause beyond yourself. I visit my father in a sheltered housing complex in Ilkley once a week. It’s clean and beautiful with kind staff, activities and trips, and he has friends visit but he has no purpose.

I met an older rather down at heel gentleman at a recent Big Leeds Chat who I think lived in a hostel and he told me of how he had for a time gone around Chapel Allerton each evening collecting litter (until scared off) so that he could, “contribute to where I lived and meet people”. Addressing those men’s desire for purpose and connection require local solutions.

I know that a lot of people dislike the NHS social prescribing name and to some extent the model. And yet in those places that are making good use of it, it’s become another mechanism to connect people and provide purpose with a very local feel to it. In Leeds it has seen us set up a unique three year contract worth £4.5million that’s led by a third sector organisation working in partnership with a range of other community and voluntary organisations. I recently visited Woodhouse Medical Practice where Hilary Benn MP wanted to see the impact on the ground. It was so exciting to see the passion of Dr Mohammed Sattar and hear how that practice was engaged with the community on this issue. The GP practice actively engages with its community and has employed Jess to create those community connections. They’ve already got a weekly coffee club and recently combined a bake sale with flu jab sessions. Wicked issues with local solutions.

So ‘Wicked Issues’ are not someone else’s issue they are our issue and the solutions often reside in the imagination, inventiveness, passion and desire for purpose of individuals who live and work in our local communities. As one of the national pilots from Population Health Management we’ve seen the power of providing frontline staff (GPs, social care, community nursing, third sector) with great information and a goal and watching them develop life changing and life affirming solutions for individuals and localities.

Wicked issues are not new, the challenges we’re facing grow every working day so it’s only right to look at things differently and see how we can all make an impact in our communities, in our places and at scale across the Partnership.

Tim Ryley
Chief Executive, Leeds CCG