Common Ambition A programme for partnerships developing collaborative communities where people, families, health care professionals and researchers work together to improve health care.

The partnerships were all able to create collaborative communities that involved service users, alongside health care professionals, the voluntary and community sector (VCS), and researchers, working together to improve health care by making decisions about the design and delivery of services. The programme evaluation indicated that three of the partnerships led to commissioners committing to new ways of working and/or funding, and there were some early indications of improvements to services (4.27, p31).

The Common Ambition programme provided new insights into the value of community collaboration to improve health care, with community members holding knowledge that health care staff could not about access to services, experience of engaging with services and what is important to them in achieving improved health and wellbeing. The collaborative communities allowed health care staff to access perspectives from marginalised groups that would otherwise be hard to reach thanks to the established links to the VCS.

An AWARE-IBD stakeholder shared, 'This is the hardest time in NHS history to be trying something like this. The Department of Health and Social Care will be asking specific questions of trusts about waiting times. They’re not being asked, "how good is your information for people with inflammatory bowel disease?". This programme wasn’t seen as a priority by our trust because it’s not a priority for the nation. That needs to change. That would be the message from this, that we need to pay more attention to what matters to patients, to good quality information but also rapid access to see someone who can deal with their condition'. (5.31, p43).

Working with small, local community-based groups to recruit under-represented or marginalised groups meant the lesser-heard parts of a population were involved in shaping the work. These people are often least well-served by services and experience the worst outcomes, so their perspectives are crucial for tackling health inequalities. These communities have a greater level of trust in VCS partners (5.3, p.36), so there is value in building community collaboration with organisations that have pre-existing links in the target community.

Aligning partnership activities with local service or commissioner priorities seemed to play the largest role in whether ideas were implemented and sustained, with commissioners’ appetite for change being a big factor. For example, there was close alignment between Bristol City Council’s priorities and the work delivered by the CA-Bristol partnership. As a result, the partnership was successful in obtaining funding to continue in its existing form (p43 5.29).

Effective collaboration is contingent on taking the time to build trusted, meaningful relationships between community members and health care professionals. The partnerships took many months to build these trusting relationships, particularly with community members who had previous poor experiences with services. The programme evaluation indicated that the greater the investment in relationships, the greater the pay off in terms of being able to use those relationships in constructive collaboration.

A CA-Bristol stakeholder shared, ‘For the community there is absolutely no reason to trust any of the faces around our table. As such there was an element of holding back, until we all got very honest, very real and very personal. Then an understanding was reached and we moved forwards stronger and in a better position. The wider community trust also took a really long time to earn and it’s really only now in the last months of what was our original time frame are we seeing that community trust emerge.’ (p.50, 6.19).

Multiple projects experienced events that threatened these relationships, for example internal perceptions of power imbalance and external providers not understanding the needs of the group. Through the community members’ shared understanding of the principles and values underpinning community collaboration, namely equity, inclusivity, trust, and genuine opportunities for communities to contribute, it was possible to overcome these challenges.

This can be challenging for funders, evaluators and partnerships alike. Ensuring there is space and opportunity for community members to inform and shape the content, direction, and delivery of a project meant the partnerships themselves had some level of uncertainty about what they were going to do and how. The programme evaluation found that the partnerships managed this through a variety of methods, such as building trusting relationships, leaders modelling confidence in the process and developing a partnership framework. The Health Foundation adapted their approach, removing the need to define specific outcomes at the outset and opting for more fluid theories of change enabling partnerships to genuinely coproduce areas of focus with community members.