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Creating conditions for front line innovation

What does people powered health and social care look like and how can you create a culture that enables it?

In a masterclass with Nesta, a varied mix of leaders from across our North West footprint gathered to hear from a range of individuals who are working to make People Powered Health and Social Care a reality across the region. Building on the July masterclass, this event translates the new power mindset work of Jeremy Heimans and demonstrate how health and care is changing. This half-day collaborative masterclass was part of a North West Collaborative Masterclass series, with partners NHS Mersey Internal Audit Agency (MIAA), North West ADASS, North West Employers and NHS North West Leadership Academy.

Catherine Russell, Head of Development kicks off with an introduction to People Powered Health & Rapid Innovation at Nesta, alongside Louise Endersby, Senior Programme Manager, and colleagues from the People Powered Results team.

Nesta is an innovation foundation, turning bold ideas into reality and changing lives for the better. The People Powered Results team work to shift power by pioneering new collaborative approaches for achieving change and innovation in complex systems, inclusive of citizens and the front line.Within that, health is one of their key strategic priorities. The 100 day challenge enables front line staff and citizens from across a health and care system to collaborate and experiment with new ways of working. 


People Power Nesta Introduction Tweet

“We bring bold ideas to life to change the world for good”

The 100 day challenges create the conditions for front line innovation at pace - learnt the conditions are critical to rapidly testing ideas within health and care settings.

  • Goals
  • Data
  • Experimentation
  • Urgency
  • Sponsorship
  • Permission
  • Diverse place-based teams
  • Coaching mindsets and behaviours

In a series of insights, Catherine shares the impact of supporting change that is top-down and bottom-up. The technique knits the system together effectively, using an essential message of empowerment and enablement. With the permission from executives, the front line staff know they have their back. Subsequently empowered to message back and share insights that will inform where we go next.


Tweet People Power Masterclass


Nesta focus on experiential learning and action stating it's hard to think your way into a different way of acting when you're taken out of your environment into a training session to then go back and fit it into your system. 

The best way to bring people together is often not on process, but about people. “a uniting factor for all of our teams” Shared interest in making the health and social care system a better place to work.

Testing and innovation 

Louise Endersby, Senior Programme Manager at Nesta sets the room a mini fifteen minute tennis ball challenge. Split into groups, each team had a coach, timer and four tennis balls to achieve the fastest time:

1. Every group member must touch each ball once

2. In the same sequence

The challenge explored our motivations and creative solutions, with a number of observations. Each team had a coach who would share the times of how other teams were performing. Having the effect that the wildly ambitious goal was believable. Opening up the idea that there are other ways of completely the challenge and so the team began looking for innovative solutions.

Despite being two rules, rules were continuously questioned by the teams and new rules created that didn’t exist. With reflections that some teams kept repeating the same processes. there was also an ingrained idea that targets were a marker for success or failure. Instead how do we look at the data to see innovation, iteration and experimentation.

Teams were asked how to apply learning and approach to real life challenges they are facing their local area.  

People Power Tennis Ball Challenge Tweet  

Agreement uncertainty matrix

Participants were given the Agreement Certainty Matrix to reflect and plot their top three challenges in work currently. The graph axes are predictability versus agreement. With four segments identified in the table as: simple, complicated, complex and chaotic. Asked to share with a partner, participants shared: Why did you select those? What have you tried? What have you learned? What learning do you need to address in the future?

Creating the right conditions

Using the cycle, leaders were asked to take one challenge and explore the eight conditions to assess their current position/readiness:

Goals and Data

  • What goal are you aiming for?
  • How will you know you’re on track
  • What will shift for: People, practitioners and the system?

Leadership and Support

  • What support might you need?
  • Who would be your champions and ambassadors for your work?

Experimentation and urgency

  • What do you want to test?
  • What are you hypothesis?
  • How might you quickly test this hypothesis?
  • What can you test this month, over three months, in the next six months…

Coaching and diversity

  • How might you get input from other practitioners, communities and people with lived experience?
  • Who will be required to shift their mind-sets and/or behaviours?

People Powered Health in action

In the second half, leaders learnt first hand how new power that connects citizens with the health, care, community and voluntary sectors is enabling new and innovative ways to support people to be healthy and happy.

Case Study: Inverted Citizen Inquiry

Liz Richardson, Reader in Politics, University of Manchester Co-Investigator for ‘Jam and Justice’ research project shared a Jam & Justice case study: Co-producing urban governance for social innovation. 


Jam and Justice People Power in Action


What would it take to help people to have a good life at home for as long as they choose?

Keeping people with care needs safe, happy and well in their own home is one of the biggest challenges faced by individuals, their families, the NHS and Local Authorities. The care at home challenge was approached with an inverted citizen enquiry.  This video explains the Citizens Inquiry process.

Staring at the end, Liz shared the findings as confirmatory findings – not challenging their thoughts but confirming them. As a result, the Greater Manchester Health and Social Care Partnership discussed the findings to inform the Living Well at Home Programme, reinforcing their existing way of travel.

The first difference from a standard Citizens’ Inquiry was:

  • The participants were recruited as self declared “professionals”. That is, in some capacity they were currently working within or had a professional interest in, the Care at Home sector. Therefore, they were not what can sometimes be termed ‘lay’ citizens. Further, and again extending the model
  • The commentators or witnesses were largely those with direct lived experience. That is, they had experience of care at home themselves, were a family member or friend helping to arrange care, or worked closely with receivers of care

The innovative research format, using a deeply deliberative process, released fresh insights. By intentionally blurring the boundaries between professional roles and personal roles they were able to release or at least enable a more emotional, holistic and empathetic response among professionals. Secondly, the approach hoped to produce robust and practical recommendations (in a report), which placed consideration of the ‘individual’ at the centre of the process and placed the ‘system’ second.

The ideas underpinning this work were collaborative service design, using a deliberative process and balancing technical and professional expertise with an objective holistic approach. Liz explains how the experience re-humanised the decision making process, stating “nearly everyone has a story about care at home”. Find out more about the inverted citizen inquiry here.

Case Study: Denton Diabetes Diverters

From Tameside and Glossop Integrated Care NHS Foundation Trust, Jeanette Leach, Neighbourhood Lead and Nicola Wood shared their HSJ finalist project: Denton Diabetes Diverters.

A 100 day challenge Challenge in Tameside and Glossop focused on how to better support those at risk of developing diabetes, who are not currently engaging with health and care services. Front line teams tested new ways of engaging people including holding events in community venues, rather than clinical settings, that provided information about diabetes and made it easier for people to immediately take next steps. For example, people were offered personalised information about their blood sugar levels and introduced to peers in the community. 

A method to invigorate and shift the mindset of the workforce. Practitioners drew in coaching techniques and motivational interviewing to support the  people who they were working with to grow their own sense of agency to make positive change 

At the end of the challenge there were measurable clinical results across the teams: 49 per cent of people engaged were no longer pre-diabetic and 67 per cent had reduced their HbA1c levels. There was an average increase in physical activity and a reduction in waist measurement. The approach if now bring applied to other groups that the system has been less effective at engaging - such as COPD and people who are clinically obese. Read more on Action Together.


Find out more about our collaborative masterclass series. Learning from past events:

To explore development opportunities coming up in the North West, go to What's On.

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