How NHS Lanarkshire created a corporate parenting plan with the voice of care experience at the centre

What were you trying to understand?

NHS Lanarkshire have created a corporate parenting plan, with the voice of care experience at the centre, which is mapped to Plan 24-30 route maps, different pieces of legislation and statutory duties.

Beth-Anne McDowall, the promise lead officer in NHS Lanarkshire explains how the plan was created.

What were you trying to understand?

I wanted to know:

• Where do we need to be with the corporate parenting plan?
• What is the expectation of our care experienced community?
• How do they feel about the care and the compassion they receive from NHS Lanarkshire?
• How are we going to measure and track progress to make sure that we're delivering what the community needs us to deliver? 

I guess the biggest question was— how do we make this more than just a plan on paper? How can it be an authentic process, full of integrity, that honours the care experienced community and acknowledges that there are probably things that we should have been doing for a considerable period of time that we haven’t been able to achieve— and that we need to own this, rather than skirt over it?

We needed to know what good looked like, so I used the Promise Story of Progress to see some of what was there.

What did you do?

Setting out seven priorities

I had a strategy group of folks from NHS Lanarkshire and the two local authorities, and took regular guidance and steer from care experienced young people.

I was acutely aware of not asking the same questions to young people, because there's enough data.

So, I looked at children's services plans from both local authorities, both of their corporate parenting plans and the work of Champions Boards, and tried to benchmark all of their priorities over the last few years, see where there were gaps and how they aligned with the statutory duties.

We came up with seven priorities, what they aim to achieve, and how we’ll know if they’ve been successful. They’re fundamentally rooted in asking what matters to children and young people.

Then I went and spoke to care experienced people and shared with them why we were doing this. But I also offered up an apology that it’s already taken a long time. I said that while change is happening, it's not going to feel quick enough for some of you.

Mapping out where route maps link into statutory duties

I then looked at other documents, including the route maps on Plan 24-30.

I wallpapered my house with flipchart pages, writing out the statutory duties we needed to meet, then went through the 25 route maps on Plan 24-30 looking at the actions and the role which health has to play.

Then I wrote out what mattered to children and young people and families with lived experience as well and adults.

I colour coded all the route maps, with a colour for each different one. So, for example, Documenting Decisions was blue. I could then see where Documenting Decisions links to statutory duties of recording and monitoring and governance.

As I went through, I saw the synergy amongst all of those different pieces of legislation, policy and outputs.

What did you learn?

What I've learned is that this is really hard and really complex and I don’t need to know everything— but that we do need to, in the words of John Carnochan, Co-chair of “Best Place in the World” Workstream at The Independent Care Review, “Start where we are, and do what we can”. By knowing where to start, what we need to do, both incrementally and across the whole organisation, I can then see how everything can be aligned, even if it is in areas we wouldn’t normally look.

Another key bit of learning is to not get paralyzed by overwhelm, because this is big. We have to allow ourselves to go “this is really hard.” But we can’t allow ourselves to stagnate in that overwhelm and complexity. We need to build solutions, not barriers.

What helped and what got in the way?

It helped to be within a supportive environment

To start with, the fact that NHS Lanarkshire is the first health board in the country to have a promise-centric role demonstrates that there is an appetite and a commitment.

Then, the support from my colleagues. There are so many phenomenal people within NHS Lanarkshire that want to do the right thing, but need help on how. So, I've taken their hand and showed them how to connect into different places and spaces with experts who will be able to show us how.

I had support from The Promise Scotland and Each and Every Child on linking to the route maps and framing.

It helped to be anchored in what people tell us they care about

Another key thing that helped is being anchored in what children, young people and families and adults with lived experience have told us matters to them. Plan 24-30 has numerous themes which I struggled at first to navigate, corporate parenting legislation has different opportunities, the UNCRC has lots to it. It can be hard to disaggregate all of that to find out fundamentally what promoting opportunities for health and wellbeing looks like. So being anchored in what you’ve heard helps when going through everything.

It can be challenging to talk to colleagues about the complexities which we’re all facing

I also needed to show that if we come together and talk about some of the complexity and try and find a solution, then we will see the richness in that. This wasn’t easy, but I had to do that because I'm asking colleagues to put things in corporate plans to change how they practice and to change their policy positions, and that's hard for them. And I guess I thought it would help if they understood why we’re asking for the changes. Because care experienced people have consistently told us they need healthcare services to look and feel radically different.

It can be challenging to have varying levels of participation from people with lived experience

Another thing that can be challenging is around varying levels of lived experience participation. You have peak participation activity, peak membership, peak attendance, and then you go to nothing and you have to do a rebuild, get new young people through, because life changes, new opportunities arise and young people have new priorities— and that should be celebrated and championed! It’s about understanding that young people’s lives change, and their lives are allowed to do that.

But that doesn't mean to say that our work then stops. Actually, care experienced people have told us repeatedly - and for many years - what needs to change and what good would look like. We shouldn’t rely on physical attendance at participation sessions to underpin our work. We just need to get on with implementing the changes the care community have asked us to make for decades.

What difference did it make?

The plan has just launched, so moving forward we will see the difference.

But the process in producing the plan is just as important as the product of the plan at the end of it. Because the process is very different to what folks are used to. It has been more participatory and less directive. This has changed how we have our meetings, our content, our updates and our structure have looked very different. The process has allowed us to humanise how we work as well, which has been really, really important. 

The young people are feeling really hopeful right now. Folks within NHS Lanarkshire are connecting with them, they're feeling more heard and more valued and more seen as well. It has inspired other senior management colleagues to go out and meet those young people as well.

Why does this matter?

The plan was designed differently, to be implemented differently, and it needs to be. What we've tried to implement up until this point hasn't had the desired outcomes, because families are still struggling.

It honours voice and people with lived experience. I know how frustrating it is to ask for change and not always see it. I wanted to be really honest and gracious in saying we haven't always got it right. I know things aren't good enough, but I need you to work with me and I'm determined to make it a little bit better.

I think the third reason this matters is that there is a lot of change across public services which can feel really scary and really overwhelming. So, I wanted to create a little bit of comfort and assurance for folks that we're still committed to actioning the changes demanded by the community.

And, of course, the final reason is that we are legally mandated as a corporate parent to produce a corporate parenting plan.

What could other local areas learn?

I think the biggest thing is to not get paralysed by overwhelm. I found starting the process by putting everything out in front of me and trying to theme it was really helpful.

Another thing that I tell folks all the time, which makes people a little bit nervous, is that we are not going to meet everything in our plan. We won’t get to the end of our three-year cycle and find every KPI or action is green. That is because we are in the very early stages of being able to map out, implement, track and monitor both our corporate parent activity and our promise activity, and to enhance that offering together.

As we go through this process, we need to push ourselves as an organisation and an institution. We can't disrespect or dishonour the care experienced community who have been so steadfast in their pursuit for massive systemic change. I just can't allow that.

But there's also a bit in there about having grace and humility. We need to understand that the community expect a significant amount from us and we are not always going to be able to deliver or meet that expectation within one single corporate parenting plan. It will take time, commitment and action. And there will be mistakes made along the way. But we can’t not try just because we’re scared of making mistakes.

So it’s about creating the space and the permission for folks to know that it's okay that we're not going to have all the right answers.