I started this work – the work that now sits under the name Beyond Systems – while my work in the US was going strong. I’d never moved to the US and yet we were gaining significant traction. I wanted to see if we could do the same in the UK.
The core argument that underpins all of my community health work is that communities need a greater voice in the services supplied to them and the systems doing the supplying. This argument stems from the basic fact that, as currently configured, health care in high-income countries is completely unsustainable. We need to find a new configuration, and that discovery has to happen with communities.
I like to try stuff, and I don’t mind failing. Today, I’m putting Beyond Systems on ice because, try as we might, we just couldn’t turn it into something that funders could get behind. There are numerous reasons for this, and I want to use this ‘final’ post to share some of them. Some are about how we worked, some are about funders, and some are about the wider culture in the UK.
How We Worked
One of the things that really mattered to those that volunteered for this work (and were latterly called the Steering Group) was that it should be genuinely collaborative. All of us had been exposed to fora in which we were told that we were co-creating something, only to find little time or space was afforded to truly understanding the issues and thinking through possible solutions. Although I think we did that well, I also think it meant that we moved a little too slowly, especially given how hard it was to find time to be together.
Although our starting point was health, we soon found that the issues we were discussing – essentially the lack of parity between citizens and systems – were apparent in all systems; housing, food access, you name it. We took the view that staying broad, not health-specific, would be good, especially as so many of the social entrepreneurs we spoke with understood the health benefits of their work but did not see themselves as health projects per se. The problem, however, was that by being so broad we became vague, which made it hard for funders – especially issue-specific funders – to engage with us.
I’ll start by saying that I was pretty unimpressed with most of the funders that I engaged with. There were exceptions (I won’t name them) but, in general, it was interesting to observe how few of them were willing to engage with a new face or a new initiative.
One of the better funders we came across spent some time explaining that we needed to be some kind of charity for them to be able to support our work. It was likely that this was – or would have been – an issue for most funders but only one took the time to understand what we were about, share some thoughts on our aims, and then explain why not having a charity-like vehicle was an issue.
One of the repeated pieces of feedback we got was that the idea needed to be worked up further. We agreed with that, and wanted to do it as the first part of the work we were seeking funding for, but only one funder was willing to support this developmental effort. The others seemed to expect us to continue to work on a volunteer basis, which made it painfully clear that they were only interested in working with the privileged (I do, of course, have privilege but I have largely exhausted it through my US-based efforts).
To overcome not being a charity, we explored working through a fiscal agent – an arrangement that has worked well for me in the US – but we heard that if it was a university their mark-up was sometimes as high as 110% (madness) and if it was a social enterprise they’d probably have to put the work out to tender because they didn’t have the expertise to do it themselves (insanity). This latter conundrum was, in fact, the straw that broke the camel’s back.
My final observation of funders was how so few of them seemed to really understand what a community of practice is. Their minds seemed to jump to meetings, which although part of it, is only one part – and not a particularly big one. The very idea of rigorous write-ups of work, robust debates on how to interpret the results of such work, and the need for all of this to happen in the public domain seemed rocket science to them. I think I saw the beginning of the end when one person at a think tank excitedly talked about the £10,000 she got from a funder to distribute their new report. Anyone involved in science communication will tell you that’s barely a drop in the ocean.
I don’t think it’s news to say that UK culture is risk averse, especially compared to the US (back when I worked in ‘innovation’ the most common advice given to UK entrepreneurs was to go to America). The reasons for this are plenty – and beyond the scope of this post – but it’s an important backdrop to trying anything new or being a new entity.
I also sense that current activities in health have sucked the oxygen out of truly new ideas. For instance, the boost in spending on the NHS – a daft idea to any serious observer of the nation’s health (as opposed to agents of health care) – has made it all the harder to ask questions about whether our health care system is working and whether greater parity is needed with the communities it seeks to serve. And, of course, the health care system continues to be seduced by well-packaged solutions, the current flavour of which is ‘social prescribing’ (move over, ABCD). When, as is highly likely, most of it fails (and we fail to take the time to understand why some succeeded) there’ll undoubtedly be a new, well-packaged solution peddled by some lucky entrepreneur whose timing will be right through no skill of his or her own.
The UK is a classist country. I think that inescapable fact also influenced the receptivity to our work. Notions of parity between citizens (for which we largely meant working class people, seeing as they’re the ones most likely to be let down by our current systems) and systems (by which we largely meant the middle-class people that run our current systems) clash with our national understanding of how society is organised. ‘Theirs is not to reason why’, was the unsaid resistance to our efforts. And I suspect the force of this unsaying was all the stronger for me not being white (or agreeing to act like I am).
So, What’s Next?
Nothing. And everything.
I’m going to stop proactively engaging with funders (especially those that are only interested in working with the privileged) and I’ve cleaned up this site so that you can only see the vision. But I’m also going to keep the topic alive through the many conversations that I have about why our systems are failing. I honestly believe our time will come. For now, the camel is having back surgery.
If you fancy a chat, drop me a line.
Dr Pritpal S Tamber MBChB
Founder, Beyond Systems