Walk Out, Walk On

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I’ve recently returned from a fantastic holiday in one of my favourite places – La Belle France. It was a wonderful time of relaxation, restoration, reconnection and reflection. My summer reading was the quite simply stunning book, “Walk Out, Walk On”, by Meg Wheatley and Deborah Frieze, recommended to me by Prof Stuart Eglin. It resonated with me, provoked, challenged, encouraged and envisioned me and I heartily recommend it as a MUST read, if you haven’t done so already.

It flows in the same stream as ‘The Art of Hosting’ and is refreshing in its style – one of learning, rather than teaching, an invitation instead of an instruction manual.

The basic premise of the book is this: many of the current systems we have, “are failing to create solutions to the very problems they were created to solve.” They have become large, over-organised, lumbering bureaucracies that stifle creativity and use people to support and uphold the structures, rather than releasing the people and supporting them to live and work more resiliently.

When we recognise that a system is failing, we can spend an enormous amount of time and energy trying to put sticky plasters on it, attempting to fix and repair what is there. Perhaps this is because we are afraid to let go, perhaps because we develop a kind of idolatry or sentimentality towards what was or we simply cannot imagine a different way of being. But there are pioneers who look for new alternatives and they fall into two types.

1) Some will look to create new alternatives within the structures and help the old transition into the new.

2) Others will create new alternatives outside of the old system and invite others to slowly join as they discover new ways.

Both pioneering types are vital – and share the same core DNA – they are ‘Walk Outs’. What is vital is that they don’t just walk out, but that they walk on to reimagine a different future. Walk Outs are not motivated by greed or power, but by love and kindness, recognising the damage caused by the current system and looking for an altogether better way.

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Walk Outs can often feel quite isolated and alone, but once they begin to find each other, connection and community become key ingredients to finding the way forward.

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This challenges our management school and well rehearsed ideas in western thought about how growth and change occurs within organisations and systems. We do not need to continually look for maximising growth and profit. There are alternative motivations and more sustainable futures than the ones we are currently choosing.

My personal focus in the next few blog posts will be to apply this to the NHS and healthcare at large. I will take each chapter in turn and draw out some of my learnings from the amazing communities around the world brought to life in this book to help reimagine what healthcare is for.

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Death – Allowing it to Happen Naturally

Twice a week I do a ward round at our local nursing home. All of my patients there have profound dementia, and none of them recognise me from one visit to the next. Most of them are doubly incontinent and many of them are unable to communicate and are bed bound. And in that place I find the very best of human compassion and care; real, genuine dignity. I completely understand why families feel unable to care for their loved ones when they reach this stage of life and these kind of care facilities, although imperfect, are of huge value.

But, I believe we need to have an emotive conversation about advanced care planning, living wills and how to allow people to die in a compassionate way without needing to kill them. Most of my patients in this particular home have had at least one urinary tract infection and a chest infection in the last year. Our current default position as medics is to treat the infection and keep the person alive. And I want to ask some tough questions: – For what? For how long? Why? Isn’t there a difference between living and being kept alive?

Now, please hear me. I am not saying that people with dementia are worthless and we should just let them die. Indeed my lovely Nanna has vascular dementia, but she is truly happy and doing very well. I recently went to see her for a weekend. On the first night I took her out to dinner with my family. The very next day she had forgotten all about it, though she still knew who I was! I’m not suggesting that next time she gets a chest infection, we shouldn’t bother treating her. I am saying that every human life is precious, and each person should be honoured and loved. But there comes a point when we have to ask if our ability to sustain life becomes more inhumane than genuinely loving.

Although most of our patients in nursing homes have a ‘Do Not Attempt CPR’ order (because not one of them would survive such an attempt and it would be an horrific ordeal to put them, their family or staff through it), we actively keep them alive when they have an infection. It has caused me to personally reflect that I will make a living will that if I develop dementia one day, and become doubly incontinent, bed bound  and unaware who my family are, I will not want to be treated with antibiotics. I would like to be kept comfortable and let the natural consequences of an infection overwhelm my immune system and allow me to die in peace.

 

I understand that this either takes a living will or should involve team decisions with doctors, nursing staff and where possible the family of the person or next of kin.

We are keeping literally thousands of people alive in this country every year who would be able to die peacefully, without the need for euthanasia if we took our ‘healing hands’ out of the way and allowed compassionate hands to nurse them into the grave. We have every drug we need to keep people comfortable. We have the most amazingly caring staff to treat them with dignity. Are we afraid of letting go? Are we scared of what is on the other side of death? Whatever our reasons, we have to ask if our current management of our elderly citizens with end-stage dementia is kind or compassionate or indeed sustainable.

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Death – A Difficult Conversation

I hope that our towns and cities can become compassionate communities in which people live and die well. We need to break through our fears, especially in the UK in talking more openly about death.

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Compassionate Communities

I hope that Lancaster, the city in which I live may become the first official compassionate city in the UK. I don’t mind if it isn’t, but I do hope that many cities choose to take on this mantle.

Here is a beautiful and moving animation of what becoming a compassionate community is about.

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Overcoming Hopelessness

This guy, Nick Vujicic, is undoubtedly one of my heroes – watch him, and be inspired, challenged and healed.

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Lessons from the Secret Garden

SEC3If you have never read ‘The Secret Garden’  by Frances Hodgson Burnett, then read no further, go and read that book and then come back! Seriously – it is one of the most beautiful children’s stories ever told and I have just finished reading it to my eight year old daughter.

 

It is a story at many levels, but ahead of its time it reveals the power of our psyche in affecting our physical health and how changing the way we think can alter our wellbeing – both physical and mental. Colin, a rejected and yet thoroughly spoilt boy believes he is going to develop a hunch back and die young. His entire life is driven by anxiety of what might happen and a kind of hatred of himself and the world around him. That is until a girl, who was once very similar to him and a boy, who is as free and loving as any human could be, enter his life and awaken the possibility of transforming hope.

 

I have seen so many patients over the years who believe incredibly negative things about themselves and the world around them. Some of them have evidence to back this up and others most certainly do not. What amazes me time and again is that those who allow their minds and thought patterns to be transformed become much physically stronger and more whole. Those who refuse to change the way they think (because it is actually a choice and a retraining of our thoughts – no one else actually makes us do it) stay as they are and get worse, which always makes me sad. It is not simply about the power of positive thinking. It is choosing to align yourself with a wholly different story, with a different set of imaginings, with hope for the future in place of despair, with love in place of fear.

 

Colin finds the ‘magic’ that helps him to change. The same magic that causes the plants to grow and the seasons to change; that allows creatures to give birth and the birds to sing their songs. The magic that teaches a boy to walk, a girl to reach out, a hardened old man to cry and a father and son to restore a broken relationship.  The magic that allows the place of our greatest pain to become a place of redemptive joy. The magic that allows a human heart to soften and learn to love. It’s what John Newton calls ‘amazing grace’. It’s what I call the Holy Spirit. The dancing One who breaths life through everything and invites us into this same dance. To throw off self-pity and shame and to find life in all its fullness instead. All it takes really is the deliberate choice that we can change and once we open up the possibility, well, truly anything can happen!

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Integration and Collaboration

In my opinion there are two main systemic barriers to providing great health care on the NHS, currently (there are other ones also but in terms of the system itself – these are the two biggest). The answer to overcoming them btw is not privatisation via the TTIP. I like to look for solutions to problems, rather than focus on the negative….

So, firstly (and it really isn’t that hard to do, it just requires some funding, which in the medium/long term would be money seriously well spent):

 

iuAmalgamate patient electronic records and share them across the system. There is so much time/money wasted and clinical errors made because of this very easy to solve issue. I’m sure there are reasons why citizens may feel concerned and I really do understand them, but given the great work already going on in Tameside at the hands of the excellent, Dr Amir Hannan, and the positive feedback from patients, this needs to rolled out as far and wide as possible.

It helps patients feel more able to manage their own health conditions and ensures notes are always available at each consultation. It means medication changes are managed more safely and effectively and information is shared between professionals in a timely way.

 

And secondly:

iuBreak down the silo mentality and reality of the various care organisations. Breaking down the walls that prevent effective team working and amalgamating the budgets of health and social care will be a huge breakthrough for care. We are already seeing this with the establishment of Integrated Care Teams within general practice. The teams comprise of: GPs, Community Matrons, District Nurses, Community Therapists, Midwives, Health Visitors, Mental Health Teams, Social Workers, the Police, the Fire brigade, and a Care Co-ordinator to pull it all together. If you also throw into the mix third sector organisations aligned with practices and patient volunteers, you have an amazing force for good!

 

There are some warnings to put in place. Manchester, which is the first place to really try this under ‘Devo Manc’ is having a huge overall budget cut (20%) as it launches into it. The hope is that by working more collaboratively and in an integrated way, savings will be made. But the ‘Save our NHS’ group have some major misgivings.

 

 

If you wanted to know more about the details of DevoManc and the health impacts of that. You can find the Memorandum of Understanding here: http://www.nhshistory.net/mou%20(1).pdf and the Five Year Forward View here: http://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf
Innovative collaboration and integration of our health and social services does not have to mean the privatisation of them. But if the TTIP comes into effect, despite huge public opposition, then the NHS as we have known it will be over. IMO the TTIP deserves a full referendum by the people of Europe. If you don’t know about the TTIP, you need to, and you should seriously think about writing to your MEP to tell them why this deal needs to be stopped.

[1] Independent: What is TTIP? And six reasons why it should scare you:
http://www.independent.co.uk/voices/comment/what-is-ttip-and-six-reasons-why-the-answer-should-scare-you-9779688.html
Huffington Post: Corporate Courts — A Big Red Flag on ‘Trade’ Agreements:
http://www.huffingtonpost.com/dave-johnson/corporate-courts—-a-big_b_5826490.html
[2] MEPs will be voting on a resolution on TTIP in Strasbourg on June 10th. It’s not a legally binding vote, but what MEPs decide will send a strong message back to the European Commission about where we all stand on TTIP. If there’s enough opposition, especially to the worst parts of TTIP, it could damage the deal for good:
Euractiv: What will Parliamentarians vote on TTIP?
http://www.euractiv.com/sections/trade-society/what-will-eu-parliamentarians-vote-ttip-313845
[3] You can find out more about the European Citizens Initiative and who’s involved here:
https://stop-ttip.org/

 

If you want to, you can sign a petition here:

https://secure.38degrees.org.uk/page/s/eu-ttip-petition#petition

 

We need to continue with the kind of healthcare we actually believe in, improving it where this needs to happen, without it being stolen from those who need it most because of greedy trade deals.

 

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Healing our Corporate Soul

In my video blog about ‘Reimagining Health’, I talked about the fact that our well being is not and cannot be an isolated, individualistic experience. The truth is that we are part of a Corporate Body (that is a community of people with a physical environment in which we live) with a Corporate Soul (a set of beliefs/mindsets/worldview) and a connection to the Corporate Spirit (which in my view is either the spirit of love aka God or the spirit of fear). These corporate experiences have a massive impact on our individual sense of health and wellbeing, and actually, as we are part of the corporate, our individual wellbeing has an impact on others around us also.

Our Corporate Soul is the issue I want to concentrate on in this post. It is complex and something to which I believe we pay little attention. However, it’s effect on our individual and corporate wellbeing is vast. Take a moment to think about the subliminal messages that come through our various forms of news and multimedia everyday.

“Your life isn’t as good as your ‘friends’ on Facebook”

“You need to be on Facebook or you are missing out on so much”

“Unemployment is being caused by Immigrants – be wary of them”

“Be afraid – people hate our country and are trying to kill us for the ‘values’ we uphold”

“The way our country does things is right and just and those who die for ‘our country’ are never to be forgotten”

“Pollution is rising – we are heading for natural disasters”

“Buy the new car – you need it, don’t worry about the pollution – live for the now”

“The chocolate industry is built on the slave trade”

“You can’t change anything, so keep on eating all the chocolate you want”

“Banks are to blame for the financial crisis”

“We have bailed out the banks with taxpayers’ money, because we need them so much.”

“Really the reason for our national debt is the poor, who claim too many benefits – we should blame them because they are lazy – we won’t bail them out”

“We all need to live longer”

“We can live however we want – our healthcare is free”

“Our children aren’t doing as well as some other children around the world when we measure them against a set of very narrow targets – therefore we need more targets and more testing”

“The only way to keep our nation really safe is to keep the nuclear deterrent – in the end, this is what makes us safe”

“Our armed forces protect us by using violent force to topple regimes which do not suit our national interest. Power vacuums are now left in those nations with untold turmoil and the rise of significant extremism of which we should be even more afraid and need to silence. We will do this with more force. The use of violence make us feel safe”

 

No wonder we are so messed up. We have some very damaging and also conflicting messages coming at us, especially through the (social) media 24/7. When do we stop to ask ourselves how healthy our worldview/beliefs/mindsets are? How much of our life is driven by fear? A fear of want? A fear of lack? A fear of the ‘other’? A fear of loss? A fear of debt? A fear of attack? And how much of this feeds our individual(istic) souls of self-protectionism?

How badly we need some conversations together that enable us to challenge some of our current core beliefs. We will not find a place of health and well-being, happiness or wholeness until we do. We have aligned our lives with the Spirit of Fear and our Corporate Soul is entirely broken as a result. We must realign ourselves with the story of Love. There is so much goodness out there. Can you see it? Only love can drive out fear. Only love can heal and awaken our souls to another holistic way of being.

 

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Well Cities and How They Can Flourish

I am someone who has many dreams – I mean the night kind of dreams….very seldom would they be a night mare, but they come with incredible detail! Maybe this is because my mind is processing, maybe it’s because I’m a bit weird or maybe it’s because I’m finally quiet and the Spirit of God can talk to me!

 

iuAnyway, one of the things I’ve been thinking about quite a bit is the ‘corporate personality’ of cities. My great friend, Martin Scott, has previously done some work on this. Just as people, with their own history and nurture form their own personality, so too does a place. Personally, I’m a fan of the Enneagram as a way of helping understand who we are, why we are, what our shadow self is like and how to become more our ‘true-selves’. I believe this can also be applied to our towns/cities/regions and nations. If we understand the personality of the place we live in, we can help it become fully flourishing and enable it to become the right kind of ‘gift’ to other places. If you don’t know anything about the enneagram, then I would recommend Richard Rohr’s excellent take on it.

 

 

iu-1Anyway, recently, I had a dream about the city of Coventry (the city where I grew up – I love it!) which I think is a type 4 personality.  In the dream, I was in the New Cathedral (one of my all time favourite buildings) and I was helping to facilitate a discussion with a diverse group of people from all over the city. The discussion took the form of a ‘world-cafe’ (a brilliant technique taught by the ‘Art of Hosting’). The underlying premise for the discussion was recognising that the 3 main ‘gifts’ of Coventry’s personality are as follows:

1) A place of peace and reconciliation

2) A place of refuge and healing

3) A place of creativity, innovation and development

 

And so the question being discussed was this:

 

If Coventry was ‘well’ how would it be flourishing in it’s primary gifts?

I wonder if we connected more with the personality of our cities and asked our selves similar questions, just how different our cities (places) could be? One of my passions is for health and wellbeing……what are the places we live in like – what do they look like, sound like, smell like, taste like, feel like, behave like, when they are healthy and well?

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UK, You’ve Had a Heart Attack – How Are You Now?

MIYou might want a cup of tea whilst you read this! I often see patients a week or two after they have been discharged from hospital with a Myocardial Infarction (what we often refer to as a heart attack). In this part of my home county, once someone is diagnosed with having a MI, they are admitted to Blackpool Victoria Hospital, where an amazing team of cardiologists literally save their life by putting stents into arteries in their heart that have become clogged up. It has been a phenomenal breakthrough in medical science in the last 15 years and has revolutionised how cardiology services are configured.

New medicines are prescribed to help keep the heart and kidneys healthy and patients are reviewed to see how they are getting on. What I always love in the initial consultation following a heart attack is how reflective a person becomes. Everything in their life gets assessed and reprioritised. Key questions are asked about how much stress they have been under, and why they were living at such a fast pace whilst forgetting about what is really important – living well, relationships, love, beauty, people and connecting with the story of who they feel they really want to be for the rest of their life. It is very rare to find a person who is desperate to get back to business as usual or someone who doesn’t ask some fundamental questions about what life is for. It is possible in some of these consultations to have some of the best coaching conversations a practitioner can ever hope to participate in. Asking some questions of the patient about what they are going to change and how they are going to do so.

And yet, in the UK (and indeed the west), we suffered a heart attack beyond all proportions with the economic crash of 2008. But we have not really reflected on the major warning sign that it was to us. We have a government and financial system intent on “getting us back on track” – and I wonder to what, exactly? It isn’t that the financial system alone, just happened to have an infarction. It’s like assuming that a heart attack happens simply because of a defect in the cardiac system itself – this simply isn’t true. The crash was only a sign of just how broken our entire body is and we would do well to reflect a great deal more about how we are living as a nation and whether it gives us any real sustainability for the future of the planet and the generations to come. Our current response is not only to “get back on track” with where we were, but  to “tighten our belts” (which means to cut benefits left right and centre without regard for the dehumanisation of people in the process). It’s like believing the correct response following an MI is to emaciate and punish yourself, without asking some fundamental questions about how healthy your whole life is.

So, what about about a national health check – let’s look at each system in turn and ask some questions – because the truth is, we haven’t faced the fact that we are in an age of transition in which answers are not obvious and we don’t have any experts who have been to the alternative future we long for. So, we have to learn together and ask open questions that provoke better conversations to help us.

Let’s start with Education. George Monbiot has written a stunning piece in the Guardian about the current health of the education system: http://www.theguardian.com/commentisfree/2015/jun/09/aspirational-parents-children-elite?CMP=share_btn_fb – well worth a read. Our education secretary, Nicky Morgan on the other hand isNicky Morgan intent on more testing of our children and has recently given a speech in which she claimed that arts and humanities subject choices close down a child’s career options and they will earn 10% more in their life if they do Maths at A level – whooppee do dah. For an alternative and altogether more inspiring approach, look to the lovely Ken Robinson:

Couldn’t education become about real learning in which our children feel inspired and find hope for the future?

Ecology – Oh dear – so far a string of broken promises on the environment from the western governments. It turns out that oil and industry is more important than the future of the planet. Is it? If not, what are we going to do?

Defence – undergirding our entire nation are three things: Money as debt (see finance), the state of the exception (see law and order) and military violence. The ultimate trust of our nation rests on nuclear warheads. How healthy is this? How much fear do we have to create as a narrative to believe this is actually a good thing? Do we want that to be the undergirding faith of our nation? And what about the change in rhetoric regarding soldiers who die in war. David Cameron recently referred to soil from the battle fields of WWI (which was brought to London) as ‘Holy Ground’ and he described those who died fighting for the ‘allied forces’ as ‘martyrs’. Is the nation state therefore the ‘saviour’? If it is, what on earth do we mean by this? If not, then is there other language we can find to use about the two world wars without creating a very dangerous worldview?

Housing – 69% of the land continues to be owned by 0.6% of the population and there is a real lack of social housing available in deprived areas. This is causing significant problems for those already under huge financial strain, given the effects of austerity measures. Who does the land belong to and why?

Justice – How many of the perpetrators of crime are victims of a system that left them with little or no other choice but to commit crime? How restorative is our justice process?

Law and Order – our prisons are full to breaking, our police force is being cut and replaced with private security firms. How effective is our law and order system? And what undergirds it? Georgio Agamben cuts through to the heart of the issue in his exquisite book ‘State of Exception’. Underneath the whole of western ‘democracy’ lies the right for the government to suspend the rule of law i.e. invoke Marshall law if deemed necessary. I look at the people movements emerging across Europe right now and wonder how far we are from the ‘state of exception’ being invoked. All it will prove, as we already know, is that democracy is a vain imagination. What is it that undoes ‘the powers’? Could a movement for positive peace, founded on love offer any realistic alternative? If so, what?

Immigration – apparently the answer to our problems is to become more fearful of the ‘other’, create a politics of fear and blame immigrants for our financial problems. We are barricading our doors Syrian Refugeesand building up our walls to ‘protect our way of life’. And while there are currently 4 million homeless Syrian refugees, the UK has welcomed 147 of them in total. Did you know that the entire world population could fit into Texas? Our concerns about lack of space and lack of jobs is really unfounded and we seem willing to ‘love our neighbours’ with great initiatives like comic relief and generous charitable giving, just as long as it doesn’t actually have to affect us and our way of life…..how loving is that? How healthy is love that does not truly cost us and change us?

Health – this whole blog is about it, but 1 in every 5 pounds spent in the NHS is due to poor lifestyle choices we are making. We can’t live imgresexactly how we want if we hope to continue with a health service that is free for everybody. How will we change the culture? Can we find innovative ways of working collaboratively within the system that breaks down the silos in order to work more effectively for the good of our national health? Is privatisation the answer? If not, what are we willing to change/protest about to keep it public?

Government – a majority with 36.4% of the vote? Deeply wrong. There continues to be profound disengagement with the system and a deep cynicism that the current style of government can bring any real lasting change. We need a new politics – what might that be like? Where are the leaders who will choose to facilitate instead of dominate?

imgresEconomy – ah yes, that old chestnut. Do we want an economy in which the gap between rich and poor continues to widen? Do we want a system in which the poor are punished whilst the rich are exonerated for their greedy crimes? The entire western economy is based on a system of debt that requires us to continually grow and expand our borders so that the debt can be serviced. We have become slaves to the economic beast. Where are the alternative experiments emerging? What can we learn from them? Are we brave enough to try something new? I have posted this before, on my other blog – www.reimaginingthefuture.org  but Charles Eisenstein is so worth watching:

The human heart provides us with a great metaphor. The health of our nation(s) is not good. We’ve had the wake up call, and if we’re not careful (this is a warning from a doctor, so take heed), the next heart attack will be even more catastrophic. We have to reflect on where we are and ask ourselves where our current trajectory will lead us. I don’t want to get back on track if it leads us to more depression, destruction and decay. I want to find the road less traveled by – the one that leads to life, hope, love, regeneration, recreation and a beautiful future for our children. So many questions. So much to learn.

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