Unboxing a system: Changing the NHS through community
Rachel Bronstein, Programme Manager, Design Council
We typically expect community-based organisations to effect change at a grassroots level, and big institutions to effect systemic change[1]. But in Blyth, in the North of England, a grassroots boxing company called Boxing Well is bucking this trend, instigating real change by reducing the pressure on the NHS.
I was lucky enough to meet David Bullock, Boxing Well’s founder (thanks to Design Council’s involvement in the Shaping Places for Healthier Lives (SPHL) programme). My attention was captured by his passion and success of applying the Systemic Design Framework principles in the real-world.
Boxing Well have proven that big players in a system are not the only change-makers but that local, community-centred organisations have the power to alter the systems within which they operate — in this case their local healthcare system.
How did a local boxing company go from local impact to systemic change in healthcare provision?
Since its inception David has supported dozens in his community and has the stories to prove how non-contact boxing has changed their lives: someone with Parkinson’s can now walk without a stick and others have been able to come off prescription drugs; one extraordinary case improved his coordination and mobility so significantly after an operation for brain cancer, that he has left his healthcare professionals stunned.
This hyper-local impact is impressive and is the bedrock of the impact that David and Les Welsh (Head Coach) have been able to have. Bringing the community together was an absolute priority at the outset as, according to David, happiness is to be found in community. But this begs the question: why didn’t Boxing Well stop there? What enabled them to journey from hyper-local to systemic impact?
When I dug deeper into the factors that contributed to Boxing Well’s systemic impact, I discovered the following key applications of the Systemic Design Framework principles:
ORIENTATION AND VISION SETTING: Faith in the programme and a willingness to dream big
David’s belief in boxing as a balm to poor mental and physical health, as well as to stretched NHS services, spurred him on to expand the impact beyond the immediate local community. David spoke of his ‘unwavering vision’ and ‘single-mindedness’ from the outset. The success of Boxing Well in Blyth wasn’t taken as a sign that their work was done, but rather as a jumping-off point for wider impact and future success.
CONNECTIONS AND RELATIONSHIPS: Building relationships at all levels
‘Relationships’, says David, ‘are the key to absolutely everything’. He spends a lot of time building and maintaining relationships; inviting people to the gym to see for themselves, meeting for coffees and making sure that there is always an open-door policy.
Boxing Well worked especially hard to reach out to NHS social prescribers, who have the power to refer people to activities like boxing as an alternative to medication or other interventions. After witnessing non-contact boxing sessions first-hand, the referrals started flooding in. To further cement their place in the local healthcare system, David and the team have also been developing strong relationships with other organisations in the community. This regular and determined relationship-building grew the company’s reputation, garnering attention from increasingly prominent people within the North-East healthcare world.
CONTINUING THE JOURNEY: An ability to respond to new information and adapt
Boxing Well supports a lot of veterans, as well as people with PTSD and autism. David and Les have made sure that the club is truly ‘inclusive and welcoming [of] difference’ and open to ‘testing and growing ideas’, willingly adapting their service to suit different needs. This agility means that the club is well-placed to scale and evolve, both of which are pre-requisites to a shift from hyper-local to systemic impact.
To help disseminate the learnings and behaviours of the club, David is currently in the process of creating a manual, educating others on how to work with different types of people, how to welcome people to the gym, what exercises to choose, and so on. By creating a guide that others can use, the learnings and approach that David has taken in Blyth can be replicated elsewhere, with the potential to influence many more lives.
An ongoing journey
For David, the work isn’t over. He has set the foundations for systemic impact and plans on reforming the way in which we think about, and offer, healthcare.
Boxing Well’s story shows the vital role that grassroots organisations can play in influencing a system. Starting at a grassroots level can be an asset because it means that new initiatives can be tried and tested. It also means that people and community are firmly placed at the centre of the impact from the outset, minimising the likelihood of big system shifts that jar with the reality of people on the ground.
[1] A ‘system’ is understood to be a set of things that relate to one another. If an action takes place in one area, it can influence other parts. When we talk about problems being ‘systemic’, we mean that they are deeply embedded challenges that are complex and difficult to resolve.
