Cumbria and the North East
Medical Appraisal & Revalidation
NHS England

Using social movement to transform the NHS - Dr Helen Bevan


In the latest of a series of blogs previewing the CNO Summit in March, NHS England’s Chief Transformation Officer looks at how we can work together to change the future of the NHS:

“The power of one, the power of many” is both the title of my speech at the 2017 CNO Summit and an idea whose time has come in health and care.

Essentially it is about bringing social movement thinking to our change efforts.

I first started to understand the potential of social movement ideas for healthcare improvement in 2002. At this time, I was leading programmes across the NHS to reduce patient waiting times for care and to improve the outcomes of care for people with cancer and heart disease.

I was a strong advocate for these systematic improvement programmes but I always felt that an additional motivational element was needed. Ultimately, if we were going to enable improvements for people who use our services, we needed to build a movement of at least a million change agents.

What could we, as leaders of healthcare improvement, learn from the leaders of the great social movements: the Women’s’ Suffrage Movement, the American Civil Rights Movement, the environmental campaigners of the 1970s? These were leaders who were able to mobilise action that literally changed the world.

I linked up with academics Paul Bate and Glen Robert and we started to explore the potential and possibilities. This led to the publication of our White Paper Towards a million change agents: a review of the social movements literature: implications for large scale change in the NHS which has since been downloaded more than three million times!

This was followed by “The power of one, the power of many: bringing social movement thinking to health and healthcare the first handbook on social movement thinking and practice that was truly accessible to the healthcare improvement community.

There are now multiple examples of social mobilisation approaches applied in a health and care context. One that I am particularly proud of is ‘The Right Prescription a call to action, based on social movement principles that helped to achieve a significant reduction in the unwarranted prescribing of antipsychotic drugs to people living with dementia across England. This, I know, aligns with some of the key prinicples of theframework for nursing, midwifery and care staff, Leading Change, Adding Value.

Interest in social movement approaches in health and care has increased since the publication of The Five Year Forward View and the call for ‘health as a social movement’. As a result of this strategy, Nesta published ‘Health as a social movement, the power of people in movements’ and is working with a number of  New Care Model localities to put social movement principles into action.

And the learning continues.  One of the most important new frameworks is that of Hahrie Han, a researcher from Wellesley College with interests in community organising and social movements.

She looked at has the roles that the most effective civic activists play. She identified three different kinds of activists: Lone wolves, mobilisers and organisers.

Hahrie Han says that the most effective civic activists are a combination of mobilisers and organisers. My conclusion is that the same is true for activists in the health and care system.

We create “lone wolves” constantly. This applies to the promising young nurses that we pluck from clinical practice and give big management jobs to without a similar peer group or support system. We wonder why they don’t flourish. I also conclude that we put patient leaders in the category of “lone wolves” at least 80% of the time.

Even in many of our exisiting “co-production” activities, nursing, midwifery and care leaders of the formal health and care system, we continue to treat patients and families as lone wolves because we set the frame within which the co-production takes place so tightly. The reality is that we don’t often ask patients “what matters to you?”. Rather, we do all the initial strategic planning and priority setting in isolation so what we actually ask patients is “what matters to you about what matters to us?”

Much of the current practice in healthcare improvement is at an individual level through approaches like patient activation, shared decision-making and self-care. I am not in any way detracting from the importance of these strategies. However, on their own, they also have limitations because, in the absence of a wider mobilising and organising strategy, they can be about singular, isolated patients taking action for their own health.

Social movement principles tell us that we should also focus on collective agency, when people act together, united by a common cause, harness the power and influence of the group and building mutual trust.

That means moving beyond the lone wolves strategies of many health and care organisations and supporting and helping develop both the new generation of nurse and midwife leaders and patient leaders to be mobilisers and organisers. And it’s not just about including and/or engaging patients and families and the entire workforce. It’s about working in ways that honour the diverse experiences and skills that people bring and the impact they can make.

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