While it can be easy to challenge existing approaches, it is much harder to crisply articulate and bring about the alternative. Covid-19 has forced governments everywhere to quickly come up with alternatives, as core tenets of traditional approaches have disappeared almost overnight - layers of management removed to enable quicker decision making, targets and regulations from above turned off to allow for more adaptive approaches, and power broadly shifting closer to the problems. At the same time, we are hearing that in other parts of the system, increased levels of scrutiny have led those core tenets to tighten their grip, with hierarchies and top-down control creeping up - it is critical we capture when, why, and how hierarchy helps and hinders. In the face of such rapid change, Upstream Collaborative’s new operating models offer a compelling narrative for emerging approaches we hope will stick.

We at the Centre for Public Impact believe there is a role for organisations like ours, Nesta, and Collaborate to work together to help governments make the case for what the ‘new normal’ looks like as we recover and rebuild from this crisis. Importantly, the approach we describe must be grounded in the practical work of governments, including what has been bubbling up for years and what has rapidly emerged in response to this crisis. Central to this approach is an ability to listen to and enable the staff closest to the problems - in Covid-19 response, this does indeed include the NHS, but also workers such as care home staff.

Further, the approach must be informed and indeed driven by those who are most affected by the crisis but least heard, intentionally moving beyond the ‘usual suspects’. We think this is an area the new operating models could more explicitly address - how are these being oriented around inclusion and equity? How are local governments intentionally sharing power with those most affected by the problems?

Another point worth addressing in the new operating models is the treatment of complex systems. By their very nature, complex systems cannot be understood by breaking them down into their component parts. The specific elements (purpose, mindset, delivery, outcomes, external actors) in the framework - while compelling in the structure they provide - ultimately offer a reductive rather than an integrative view, and it is the latter that is required to gain the most significant insights in terms of systems thinking.

While equity and the treatment of complex systems are areas we think could be addressed, we were very happy to see the explicit description of the ‘mindset’ which underpins the approach. The values and principles indeed resonate with our latest thinking on what a better approach to government could look like.

Lastly, we share Donna Hall’s belief that “we need to start to build a united front and start to work more effectively together”. The new operating models joins a long list of thinking (e.g, NLGN’s community power, a Manifesto for a Collaborative Society, Human Learning Systems, Shared Power Principle) that demonstrates how people are rowing in the same direction towards this emerging vision. We are looking forward to working with partners like Nesta and Collaborate to grow this conversation by putting the voice of governments and the communities they serve at the heart.

Local government is at the crux of a growing democratic and economic crisis. From above it is pummelled by cuts, whilst being told that every local failure is simply a result of its own poor management. From below it gets minimal support from local people who rarely vote in local elections but who still hold it responsible for poor services - even when it has no control over those services (85% of public funding is controlled by Whitehall).

But within this unhallowed space many local leaders are trying to find responses which are positive and which might move us permanently on to higher ground. This is challenging, but the kind of work described by NESTA is a critical piece in the necessary reimagining of democracy and the welfare state for the 21st Century. At the heart of these new models is the rediscovery of very old wisdom: at their best people don’t want to be service users or consumers, they want to be citizens. Citizenship offers the only way up for local government, because it allows us to tap into the innate talents, energies and insights of local people. But tapping into these forces can only be done by listening to, respecting and empowering people to be citizens. The solution is out there - but you have to do more than change buzz words or technology - you need to get out there too and figure things out alongside people.

Ultimately the change we need will not be found in a new model or strategy. What we need is a new constitutional settlement, a new economy and new forms of democratic involvement. We often forget that the creation of Athenian democracy (more than 2,600 years ago) was just one part of sweeping economic reforms that reduced inequality and liberated people to be free and responsible citizens. This is what we will need in the coming months - this cannot be done by local government on its own - but these local government leaders are our pathfinders and they can light the way for deeper changes to come.

There is structure here that should help people inside and outside local authorities attend to the different elements that come together in this way of working. I’m deliberately not interpreting it as a model but more a sort of rigorous aide memoire, born out of people’s experiences and drawing on the literature that has gone before. It is an invitation to think about ‘how and by whom’, which for us are absolutely critical questions. As I read it I was imagining all the different living examples of what people are trying out (how do you recruit for those values? what kind of processes actually help to foster cross-system collaboration?) Finding ways to share these and learn together is critical. Having some structure to order them is helpful as long as it is not overbearing.

The paper adds to the sense that change is most definitely afoot. There is confidence here. It adds substance and solidity, it creates opportunities for solidarity and shared journeying: ‘Ah, that’s what we’re trying to do too!’ The importance of this can’t be overstated, we’ve seen and felt how difficult it is when you are a fairly isolated person trying to promote this sort of approach, when it all feels too loose and amorphous, when you’re trying to explain it and struggle to find the language, when you know it is right but you have to make a case in the face of business as usual. It is hard and you need all the help you can get.

For me this points to something which I think the work hints at but doesn’t fully explore, which is the emotional realm. So much of what’s described implies relinquishing control, embarking on change and letting go of certainty – all emotional processes. Part of describing and modelling the something new is to explicitly welcome this in and give it space.

One final point is the obvious one about the interconnected nature of local systems. There’s still a slight sense here of control, even if it is just control of the agenda. One of the most powerful things we’ve observed in recent weeks is genuine reciprocity in action. Local authorities reaching out to community groups right on the margins to ask for help. ‘We don’t know how to do this but we know you do’. This is a great way to start a conversation with those values and principles at the forefront.

The ideas in Signals in the Noise will resonate deeply with many people working in health and social care. The ‘new operating model’ framework may have been developed with local government in mind, but its vision for a different mindset and new approaches to delivery is equally applicable to NHS organisations and others in the health and care sector. Our work with leaders and organisations that are embracing these new ways of working shows that the potential is real, but so too are the many obstacles that must be overcome in bringing about change.

Within the NHS, a renewed focus on collaboration and place-based working has led to new partnerships being built across England. The initial focus on integrating health and social care services is gradually evolving into a broader attempt to create what The King’s Fund has called ‘population health systems’, bringing on board a wider range of partners to work collectively towards improving the health and wellbeing of local populations. Our work has shown that the areas that have made greatest progress tend to be ones that have invested in strengthening relationships and trust between NHS leaders, local government, the voluntary and community sector and others. A key focus for us is helping people to build the system leadership skills they need to work effectively across these emerging partnerships.

Some in the NHS are also taking a broader perspective that recognises that NHS organisations can act as ‘anchor institutions’ in their communities, with the ability to influence the social, economic and health outcomes of the local population through a variety of means that go wider than the delivery of health care alone. The move towards seeing their joint role in this is one way that the NHS and local authorities have been working more closely together, with a focus on place, population health and inequality reduction – work that The King’s Fund has been supporting in a number of parts of the country.

In addition to supporting this system-wide level shift towards greater collaboration, we have also been learning from individual organisations or local systems which are taking a radically different approach to delivering health and care in England. The common threads in these approaches follow closely the values and principles described in the new operating model.

These include inverting established power dynamics by enabling frontline staff to operate with greater autonomy and striking a new relationship with people using services. Crucially, the organisations we have studied give health and care staff the time and skills to listen to the people they serve, and the freedom to act in partnership with those people on the basis of what they learn. Our recent research for Social Enterprise UK on innovation by social enterprises in health and care (forthcoming) describes exciting new approaches to leadership and governance that change the balance of power and give service users a more powerful voice in how services are run.

Although we have found that the values of empathy, collaboration, flexibility and empowerment are often central to the motivation of individual members of health and care staff, hierarchy and command and control structures run deep through the NHS and aspects of care, and are embedded in professional as well as organisational structures. The extent of the cultural shift required for individuals, teams, organisations and systems to work in new ways cannot be underestimated. It requires years not months to make such changes, and significant resources may be required to support the development of the necessary skills, relationships and learning practices to enable new ways of working to flourish.

Our work on ‘unconventional health and care’, the Wigan Deal and a Buurtzorg test-and-learn explores how and why these new approaches could be spread more broadly in a way which is congruent with the values and world views which underpin these approaches. This means sharing principles (not detailed blueprints) and providing different forms of support to enable local communities and services to explore how these ways of working can help them to meet local needs and priorities, drawing on the skills, motivations and resources in their locality.

‘Signals in the noise’ points out that these new ways of working will co-exist with existing modes of managing and delivering services shaped by the ‘new public management’ approach. An important area for exploration in this agenda is to learn which types of community or service might benefit most from this new operating model, what changes are required at a system level to enable these shifts, and whether there are some areas where more traditional (or alternative) forms of organisation and management are required.

Our work indicates that there is a huge amount to be gained by adopting the mindset set out in the new operating model. We would encourage local authorities to work with NHS partners to make this cultural shift together, and to be patient when it takes time for long-established ways of working to change.