Starting with a bleary-eyed meetup for the 7.30 from King’s Cross to Grimsby, we arrived at a Navigo complex of buildings not really sure what to expect. It looked like a nicer holiday inn or business park, lovely landscaping etc, so possibly their offices? We went straight to the open reception and were met by Simon, their chief exec, in what appeared to be a canteen with nice comfortable chairs too.
Simon explained that this was in fact North Lincolnshire mental health A&E and this was where someone would come at their moment of greatest mental health crisis. But yes, it was also a canteen for staff and service users. The whole conversation with Simon was an eye opener, as he went through the history and ethos of the organisation. Here are a couple of things that struck me.
Firstly, is Navigo’s status as a social enterprise, and that status both within and outside the NHS, makes them feel able to take risks and do things differently, and they certainly seem to.
The aspiration laid out for service users, that they should have somewhere to live, something to do and people to love, feels very human and something we’d wish for all our family and friends whether coping with mental illness or not.
Navigo provide health and social care services together, and acute and community services for the area, so they reduce a lot of the interfaces and organisational handoffs which usually stops people from moving fluidly around the system. This is also facilitated by Navigo’s ownership of a range of housing, acquired using savings generated by reducing expensive out of area placements. However, Simon was very open that this didn’t solve the problem of working around the many interfaces which still exist, that organisational integration is no panacea and there is still a pressing need across ICSs and elsewhere to do those things better together.
We were also pretty blown away that structurally Simon and the organisation’s chair could be voted out by their staff and service users. That spoke to a real commitment to sharing power, reinforced by other formal involvement in the governance of the organisation, and in employment and support of service delivery. The ‘Tukes’ structure is an organisation within an organisation and begins as something people join as members, then as volunteers, with routes into employment too. Tukes provides services like catering, cleaning and the aforementioned lovely landscaping to Navigo sites, employing and developing service users and offering a varied level of things to do, and fundamentally feels like seeing service users as assets to the organisation and community. It is worth noting the far higher rate of employment in the area for those with mental illness from the national average.
We then went for lunch at a lovely garden centre on site with an enormous restaurant, where I can highly recommend the Whitby Bay scampi and chips. The effective running of this business provides not just another range of employment and development opportunities but a significant surplus to reinvest in the organisation.
The strapline of delivering services that they’d be happy for their family to use seems to reflect what the organisation is very much for – the community in North Lincolnshire. This feel is founded in a real understanding of that community, in particular the challenges driven by the collapse of the fishing industry and the communities hope for the future in the renewables industry. This was reiterated when we heard they had no interest in expansion to other areas, and that they wanted to go ‘local and deep’ instead. And further, the closeness of their leadership and service users as joint decision makers was fundamental to that. That felt like really important food for thought given our own aspirations as an ICS to connect with and reflect the communities we serve.
We then visited a unit for people with serious eating disorders, which whilst a very different service, shared some of the things that stuck out elsewhere -lovely surroundings and staff who had a license to innovate to provide the best care to patients. For example, we visited the treatment room where professionals trained in alternative therapies, including reiki and massage, provided these to their residents but also allocated time to staff wellbeing slots too.
Before finishing for the day, we managed a flying visit to their ‘no wrong door’ service and again could see their very prominent presence in the town. The service in short is a preventative service offer from community support workers driven by calls to a crisis line. It is funded using surpluses, because according to the manager it is the right thing to do. This is a common theme and phrase we heard across the organisation – ‘because it’s the right thing to do’.
As I said there was an awful lot to take in, and I’ve not fully processed it all myself, so these are just some initial thoughts I wanted to share. But I certainly feel there are many things for us to learn in Southeast London.