We know the current system isn’t working for many people. Health outcomes, experiences and life chances are highly dependent on where people live, their income and background. Services face ever greater demand, often coupled with decreasing resources, and a high turnover of staff. Support structures are fraying, people’s reserves of energy and money are depleted, and society is experiencing deepening divides.

Most people accept that the wider determinants of health and health equity can’t be achieved by one sector alone - they require collaboration across sectors, and this requires trust. But current conditions mean there is an increasing sense of competition for resources, and even more siloed working across all sectors. So what next?

Part of that answer is a process for visioning the future in a new way. A community for thinking, relating, and turning up differently that leads to better ideas, better solutions, and better ways of building things together. A space for people from all parts of the system to understand and appreciate each other’s sectors - our different opportunities and challenges - and to be midwives for a future that combines everyone’s insights and wisdom.

At HCT Gloucestershire we have learned that relationships are the work, and that creating spaces and practices to nurture them can have a profound effect across the wider system. These spaces are built on trust, respect and openness. They enable people to learn and put into practice the skills needed for the sometimes challenging conversations that will help us create that future together: skills like getting comfortable with discomfort, listening rather than rushing to action, and holding space for divergent views.

This is important because we need to have respectful but robust conversations about difference, equality, possibility, resources. We need to talk about what ideas and ways of working we need to let go of, and how to improve the ones we take forward. We must be able to share the big questions we are holding, and the fear, as well as the hope, that all this uncertainty works in us.

Without a good relational foundation for our work, power structures will fill that void and perpetuate inequity and injustice, even when fuelled by goodwill. To push back against those forces, and instead meet the challenges of the present moment with collective vision, solutions, and will, we need to pool our learning about creating those foundations. We hope by sharing our hard-won learning and applied practice we can add another drop to that pool, and be part of a wave of change towards fairer health.