Lessons From Helsinkii

I’m just returning from 36 hours with the Coalition of Partners for Europe, as part of the World Health Organisation. There were a further 2 days of conversations to occur, but I needed to get back to Morecambe Bay. I have learned so much during my short time with this amazing group of people, some new things and other things learning at a new depth or from a different perspective. I am again bowled over by how using tools from the Art of Hosting can bring a diverse group of people, across languages and cultures together to have really important conversations. Rather than write this in long paragraphs, I’m simply going to bullet my learnings, some of them personal, some more corporate, some amusing, some difficult. One thing is for sure: I know much less than I thought I knew!

1) Finland is 100 years old this year. It has a fascinating history. They also have one of the best Public Health systems in the world and are huge at tackling the social determinants of health. We have much to learn from them and their Scandinavian neighbours.

2) People LOVE the idea of a Culture of Joy! There is a tiredness to the WHO but a recognition across the board that there is a need for cultural change and that culture determines an enormous amount in terms of how well organisations function. Remember a culture of joy is built on good, honest, open, encouraging, kind, approachable and vulnerable leadership, with team members feeling a) that they belong and are loved/valued b) that they are trusted to do their work and c) they share a strong sense of vision.

3) There is wide recognition that Social Movements are vital if we are going to break down health inequalities and see the health and wellbeing of all people improve. We simply cannot come up with ideas in board rooms and ‘do them’ to communities. However, there is also fantastic data and learning available to communtities, which can fuel the social movement. Public Health and Primary care must not sit as separate to or aloof from this emerging movement, but must be a key player and protagonist.

4) When dealing with complex systems, it is good to think of them as gardens instead of machines. To whom does the garden of public health belong? Public Health belongs to the public – it is part of the commons. Therefore communities need to be more involved. There are some great examples of community engagement from across Europe. However, we must move from consultancy to co-production and co-design.

5) Helping people live longer at a poorer quality of life is a pointless goal. The league tables and goals we develop must be co-designed with communities. Our markers of health and wellbeing need some reassessment.

6) People everywhere in the Western world are scared of talking about death and this has huge implications for how we spend money in our health systems.

7)  Our European history is so fragile. This causes its own complexities when European people meet together – it all comes into the room with us and requires grace and kindness as we communicate. The quality of relationships within the coalition is fantastic, but more time is needed to develop this.

8) When trying to drink a yoghurt in a taxi, it is important to seal your lips around it well, otherwise you spill it all down your front and look like an idiot.

9) Public health and Primary Care are the bedrock of any health system. I knew this already, but the evidence from around the World is staggering. If these two foundation stones fail, and the staff who deliver these services are not cared for, the entire system collapses.

10) The UK has some of the best public health systems of anywhere in the world. However, the world is watching the decimation of our public health services with dismay. The vital role of prevention and protection that public health has must never be underestimated. If we do not invest in prevention, the consequences for the health system is devastating. The reorganisation of Public Health into our county councils has seen profound cuts to the budgets, as councils have removed the ring fenced budgets. This will almost certainly have detrimental consequences, especially when it comes to tackling our most difficult health and wellbeing issues.

11) When people tell you that all saunas are naked, this may not actually be true and you might end up feeling pretty awkward!

12)  We have much to learn from other areas and nations. Shared learning is key. We can do this without competition, hierarchy or lording it over each other.

13)  Building good relationships is everything.

14) There is a new generation of leaders emerging who are able to deal with complexity, refusing old silos, borders and hierarchies and finding ways to collaborate through good, honest and vulnerable relationships.

15) We need to learn to hold expertise in one hand and humility in the other. The expertise in epidemiology and the mapping of our health and social issues is vital, if we are going to close the health inequality gaps.

16) Public health is dependent on building partnerships. The wider social determinants of health (poverty, housing, adverse childhood experiences, loneliness, education, environmental issues etc) cannot be tackled by the meagre Public Health budgets. Coalition, collaboration and cooperation across many sectors are necessary for us to begin to tackle these hugely complex social justice issues.

17) Due to public health being underfunded, it leaves it wide open to abuse from those who hold the money strings. Lobbies, donors and national governments hold huge power in determining what does and does not receive funding, often despite the evidence.

18) We need leaders who understand the importance of gift economy and making investments into areas which will not serve their ego nor their profile, but will cause huge benefit to many people.

19) Collecting really good data is important. We need to learn to use it well to shape the conversations and change policy and legislation.

20) Public health holds a hugely important voice in calling governments to account for policy decisions that are to the detriment of a nations health. There is now clear evidence that austerity economics is really bad for people’s physical and mental health and is actually causing people to die. Theory must be challenged hard when evidence does not support it.

21)  The poverty truth commission has so much to teach us. No decision about me, without me is for me. this statement made a profound impact on some of the delegates.

22) Doughnut Economics has caught the attention of the coalition.

23) Fazer chocolate is delicious.

24) One of the most challenging truths I learned is that it is often public health workers and doctors/clinicians working on the front line, who are the biggest barriers to working differently with communities and ironically get in the way of the very thing they would love to see happen. This has more to do with the ways we train people to think and work than anything else.

25) Although my talk went well and was hugely well received, I am learning more about the power of story and how to tell our story more effectively.

26) I am grateful that the coalition of partners does not depend on membership of the EU but I am more aware of the pain that Brexit is causing both for me personally and for many friends across Europe.
I understand that Brexit is happening, but day by day it feels to be one of the worst decisions we have ever made as a nation. It is going to cost us over £50 billion to leave, cause untold issues for our ability to trade, decimate the 3rd sector (which btw is the only thing right now stopping our public services from completely collapsing), undo so much great work built through the partnership of our nations and not deliver on any of the false promises made around extra money for our health system or solve our ‘migration issue’. Yes, the EU needs to change, but we have made a monumental error in leaving, rather than reforming it and I still feel we should just apologise and rebuild our bridges rather than burn them.

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Commissioning the 3rd Sector for the NHS

imgresAmidst the current ‘efficiency savings’, or cuts by any other name, in the NHS, the voluntary or 3rd sector, including the faith communities are an absolutely vital partner in health and social care. Here in Morecambe Bay, we are seeing incredible work done by this sector. Genuinely, the safety net created across this Bay for people with significant mental health issues, chronic physical health complaints, those at the end of life, the isolated and lonely etc is amazing. However, as the financial squeeze increases on the NHS, the 3rd sector, although phenomenally resilient and full of social entrepreneurs with good heart, is really beginning to struggle to secure funding. If the 3rd sector, (which gives far more for far less) begins to crumble, then we will see health and social care completely collapse.

 

I wish truth and solutions were all black and white, but there is complex grey for us to wade through, if we are to see a more resilient 3rd sector emerge for the sake of our communities. The relationship between the NHS and 3rd sector is complex but vital. I want to briefly highlight some of the main issues and then look at two possible solutions.

 

  1. Evidence: in order for commissioners to fund projects/organisations, we need evidence that the money invested a) makes a difference and b) makes a saving. Unfortunately data is often not robust enough to make recurrent funding possible.
  2. Fairness: there is currently great injustice built into the the NHS/3rd sector relationship. For example, I know that some of our more struggling publicly funded services, are now referring huge numbers of people into the voluntary sector, as they can’t cope with the capacity, but the funding does not then follow these people. In essence the NHS is dumping people onto the 3rd sector and the 3rd sector is buckling under the weight of it. But the blame is not on the NHS nor the 3rd sector. I’m afraid under resourcing from central government is a key issue here…..but this isn’t going to change any time soon, unless we have a revolution (!), so we need to be creative.
  3. Numbers: commissioning services is really complex. When there are loads of small charities, often doing quite similar things it can be really hard to know who to fund and how to monitor outcomes and effectiveness (like it or not, we do have to give an account for the money we spend!).

So, where might some solutions lie? I would like to suggest two broad possible solutions. I admit they are not perfect and they certainly won’t be the only solutions.

 

imgresFirstly, here in Morecambe Bay, we are developing ICCs (Integrated Care Communities). These are built around General Practice (be that one or many practices in a geographical area) but incorporate GPs, District Nurses, Community Matrons, Long Term Condition Teams, Community Therapists, Mental Health Teams, Social Care, the City Council, the Poimgreslice, the Fire Service and the Third Sector all partnering together for more effective working and therefore better care for all. One option would be for each ICC to have a capitated budget which would allow each team to decide which voluntary sector organisations would meet the need of their particular areas most effectively and fund them accordingly and fairly.

 

imagesA second solution could be for the 3rd Sector to form one or several larger co-operatives. The huge advantage here is that it would then allow a more straight forward commissioning relationship and would allow the many to be become stronger and more resilient together. In a co-operative model, it would be easier to build research partnerships and accountability between members. It would also give the sector more clout as a partner round the table with the various public sector organisations.

 

My work has taught me how vital the Voluntary and Faith sector is to the ongoing health and social care of our communities. It needs adequate funding and support, without which it will crumble. We need to help partner together to make it more resilient, but in order for this to happen, the 3rd sector must deal with some of it’s default towards self-protectionism and find creative solutions towards a more sustainable future……

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