Background
The HCT Gloucestershire
Journey
10 Min Read
Looking back over the past four years, none of us could have predicted where this journey would take us. There are many different stories we could tell about our origins, and how we’ve got to where we are. This is one of them.
Stepping Stone 1:
Roots and readying
Healthy Communities Together (HCT) Gloucestershire emerged from years of groundwork by people, communities and organisations across the county.
At Barnwood Trust, early work focused on connection with Gloucestershire County Council on an Asset Based Community Development approach – centred on strengths, not problems. This led to non-agenda-driven spaces like the 2013–18 Stewardship Circles, where people working in the Voluntary, Community and Social Enterprise (VCSE) and statutory sectors explored together open questions like: “How do we create a county where we want to raise children and grow old?”
Meanwhile, relationships between the Local Authority, NHS and VCSE sector were strengthening through social prescribing and shared approaches to prevention and wellbeing, especially through arts, culture and sport. People from different parts of the system were exploring the role of partnership and the negative impact of power differences across sectors, and these conversations helped shape a grant proposal for HCT within Gloucestershire’s Integrated Care System Partnership Board (Enabling Active Communities & Individuals).
At the same time, Create Gloucestershire, in partnership with leadership innovation specialists Nowhere, were adapting leadership development work, looking at how to build a culture of collaboration and innovation to support their mission of arts and creativity every day for everyone in Gloucestershire. They noticed that too often leaders ‘took up space’ rather than ‘holding space’ for others to shine, and that this model of leadership worked against co-created outcomes. The initial focus was developing the talent of hidden or silent leaders in Gloucestershire and the need for those with influence and power to listen to what enabled and what undermined their path to becoming change makers. To achieve this a ‘Sweeper Group’ was set up - leaders clearing the path for others - which sparked a broader question: what might this look like across the wider system?
Each partner had their own version of this groundwork. These outward-facing conversations helped them recognise a shared frustration that, despite lots of investment and effort, health inequalities were not being solved in any meaningful way. Together this meant we were ready to take the next step…
Stepping Stone 2:
Partnership and Programme Mode
A group of statutory and VCSE leaders – connected through the Enabling Active Communities & Individuals Board – came together around the shared concern of health inequalities in Gloucestershire. A grant from The National Lottery Community Fund gave us space and confidence to explore a different kind of partnership.
Our premise was that we knew partnership was vital to tackling health inequalities and were excited by the potential. But at the time we didn’t quite understand the constraints of each sector, and how deeply the current service delivery frameworks were embedded across the system.
Gloucestershire became one of five national HCT sites, and we formed a collective local Stewardship Group with the starting position that business as usual wasn’t working to solve health inequalities. Having tested and dismissed other models of what we might be - a board, a leadership group, a steering committee - we settled on Stewardship Group as it sounded most like the type of space we were trying to develop: creating conditions for resources to be used for the common good. We had a hunch that the common cycle – commissioning/funding → projects → outputs → evaluation — sometimes created individual or local impact, but often in silos, and it wasn’t shifting the broader systems behind inequality. This felt important because we were noticing that pre-determined outputs by funders or commissioners were not enabling the space or freedom for co-creation with communities.
We sensed something deeper was needed –something systemic. We shifted from “reducing health inequalities” to “building trust for fairer health” – a strengths-based phrase that centred trust and placed people inside the work, not outside it.
The Stewardship Group contained a range of different starting points and perspectives. As a group we were still in programme mode - logic models, themed work strands, events. Some people were immersed in delivering programmes, others were more familiar with co-created practice. We found this difference in experience was useful to explore with others, so we tested bringing people together using Open Space events that started with a question – for example around cross-sector issues like food poverty – rather than an agenda. These raised some important questions. Who was responsible for taking action? What was our role? Who were we accountable to?
Holding money in the form of our grant from the National Lottery Community Fund created discomfort. We didn’t want to replicate the power dynamics that we hoped to change. The funding couldn’t be re-granted and, as an informal group, we didn’t have the tools for commissioning and contracting.
Elsewhere similar questions about how to distribute funding differently were being asked. For example in Matson, Create Gloucestershire were testing out a Community Chest, seeded with NHS funding – a model in which funding was available to everyone but owned by no-one, and which understood the importance of trust as a pre-condition for shared and equitable decision making over finances.
We met regularly – monthly in person to start with, then weekly online as we got to know each other and realised how much there was to check in about. At first, these gatherings still assumed the work was ‘out there’. Gradually, we saw that the real change was happening ‘in here’ – in trust, relationships and how we were showing up in the group, our day-to-day jobs and beyond.
Stepping Stone 3:
Spaces to Connect and Reflect
As our relationships grew, we started to notice the programme delivery paradigm we were working from, and recognised the need for this vital but unfamiliar relational practice — how we work, what supports it, and what infrastructure might sustain it. We realised the learning is the work. We were not representatives from organisations delivering a project, but people in a system working and aligning together.
To test and share these ideas we initially planned an event on leadership, but co-designing it revealed some underlying assumptions - namely that leadership is usually about the top of a hierarchy, and/or expertise as power. This wasn’t the right fit for the collaborative approach to change we wanted to explore. Instead we arrived at a shared interest in togetherness - the structures that enable us to be together and surprise ourselves with what we can co-create. The result was Structures of Togetherness, an open space event exploring how people were already working relationally. At the time this was radical - rather than a traditional programme launch event we were holding space for a question. It revealed an appetite for change – and that we weren’t alone.
It also raised questions. HCT had carved out its own identity within a system —but how could others take part, especially those with less access, power or autonomy?
Stepping Stone 4:
Skills, Structure, Support
The HCT co-laboratory (co-lab) was born out of this desire to create an intentional, ‘supercharged’ version of what we’d learned. Co-designed through open roundtables and built on the foundations of earlier work from Create Gloucestershire and Nowhere, it asked: what becomes possible when people committed to fairer health learn and grow together across a system and county?
HCT co-lab brought together people from across sectors to build skills, deepen relationships, and develop confidence in system-wide practice in a way that impacts far beyond those individuals. Learning flows in and out – through participants, mentors, speakers and wider networks – and continues to ripple across Gloucestershire.
Stepping Stone 5:
Collaborative Architecture
As this chapter of HCT comes to an end, we’re left with more questions than answers. Inequality is growing. Services are stretched. The system around us feels increasingly fragile.
Yet we’ve seen what’s possible when people keep showing up: collaboration rooted in trust and shared purpose is essential for long-term change.
So now we’re asking: what kind of architecture can support a healthier civil society? What roles, resources, structures and spaces help people stay connected and keep learning together?
The seeds of this work already exist across Gloucestershire. The more visible and connected they become, the more likely we are to reach a tipping point – or many small ones – towards a new way of working. Not as isolated individuals or organisations, but as a shared system of care and change.
