How Nesta gets health experts to ‘share power’

To most people, terms like user-centred design, co-creation and agile working are terms which scream Silicon Valley. It might be surprising to hear that these principles are shaping health and care services much closer to home.

In places up and down the country, from Dorset to Stockport, Nesta’s People Powered Results team are helping health and care professionals implement what they call ‘people-powered’ health. Through 100 Day Challenges, Nesta supports teams to co-produce health and social care programmes with diverse groups of experts and patients.

“Health and social care systems often find themselves operating in a command and control way. There’s a place for KPIs, set deliverables and tightly controlled plans but we know complex challenges need a different approach. 100 Day Challenges are about creating conditions for leaders and those closest to the work to experiment with how change is done, and play with the rules and roles they operate in,” says Sophie McKechnie, Programme Manager at Nesta’s Health Lab.

100 Day Challenges are an antidote to this: a stimulus for innovation. Across the UK, from Stockton to Scotland, Nesta has been working to support teams and systems to trial new ways of working, as this video illustrates:


People Powered Results builds on Nesta’s work in health and co-production in driving forward more collaborative and inclusive methods of change. Ones which involves professionals, people using services, their families, and communities. Crucially, this approach involves people like commissioners sharing power in new ways across organisations and places. It’s giving patients and front-line professionals a say – remarkable in a tightly-controlled sector like health and social care.

Nesta’s approach is to choreograph the 100 days of activity which brings multi-disciplinary groups together to solve health and social care problems. This has been used to support people at end of life in Bolton, transform children’s care in Essex and to support to live well with long-term conditions in Lincolnshire. By setting milestones and facilitating new team structures and ways of working, they create space for new ideas and free people from some of the day to day politics.

“We encourage leaders to share power differently,” adds Catherine Russell, also of Nesta Health Lab. “We get them thinking less about needing to be the experts and more about creating the right conditions for people with hands-on experience to find new solutions.”

This user-centric organising and design method isn’t entirely new to the health and social care sector. NHS Digital has been implementing new ways of working to create digital services. But in truth, top-down, command-and-control commissioning remains the norm in this space.

“We recognise this approach is highly counter-cultural.”

“It’s an uncomfortable place to be when commissioners want results and deliverables. But with any approach in this sector, there’s no guarantee that things are going to work. By bringing in experimentation and iterative working styles, we’re helping people change the way they think about failure, which is so important,” Russell said.

Losing Control is championing the movement to change that. It’s a space designed to promote these participatory approaches to organising, campaigning and design. Both McKechnie and Russell will host a session to share these methods at the next Losing Control event in Birmingham.

True to the spirit of the event and their day-to-day work, their session will be user-led and highly participatory.

“We’re using the session to illustrate the point that it’s much more valuable to have a really diverse group coming up with ideas than just one person,” said McKechnie.

“We’ll model how it feels to be in the 100-day challenge. We’re really serious about play, and work being joyful, liberating and energising.”

“We’re hoping people will leave with practical ideas for how to use experimentation to play with power and redefine rules in their own organisations. We’ll leave space for people to discuss these ideas in groups and reflect as individuals.”

Find out more about Sophie McKechnie & Catherine Russell’s session ‘Losing Control in 100 days: can action and experimentation redefine the rules in complex systems?’ and read the rest of the Losing Control programme here.