Cuts and More Cuts – a Disaster for our Population’s Health and Wellbeing

It amazes me, in this 24-hour news world that we live in, that a further £1 BILLION of cuts to our county councils doesn’t remain on the BBC front page until much past lunchtime! It feels a bit more important than some of the stories being picked by the editorial team instead!

 

https://www.bbc.co.uk/news/education-45573921

 

Anyhow….these cuts will be utterly devastating for our population’s health and wellbeing and the “extra funding” for the NHS is simply not going to be enough to undo the damage. Local government will have lost 60% of it’s budget by 2020, with devastating consequences and no amount of local taxation will replace the difference, especially in poorer areas of the country. And just look at what will be cut:

 

  • 58% of councils said highways and transport (including road improvements, streetlights, pothole filling)
  • 47% said libraries
  • 45% said early years and youth clubs.
  • 44% ear-marked public health services like smoking cessation, sexual health, substance misuse
  • 36% said children’s services.

 

 

So:

  1.  We will have far higher risk of road traffic accidents, especially for cyclists/motorcyclists (I’ve seen the effect of people hitting potholes and fracturing their spine).
  2. there will be less access to shops and leisure facilities for our poorest communities, meaning a worsening of the obesity epidemic.
  3. We will have increased social isolation and reduced learning opportunities for our elderly (therefore increasing risk of dementia and depression).
  4. We will have decreased social support for our young people, leaving them far more vulnerable to gangs and substance misuse.
  5. We will have less support for young families, struggling to cope and so less opportunity for parental support and an increase in Adverse Childhood Experiences – with devastating long term consequences for physical and mental health.
  6. Smoking continues to affect 1 in 5 people in a hospital bed, and is still the biggest cause of death in many parts of the country – yep good idea to cut that.
  7. Our drug crisis is rising exponentially, and we’re seeing an increase in STIs and yet councils will not be able to provide services to help.
  8. Children’s services, those vital safety nets that work to prevent serious safeguarding incidents will have to be reduced also!

 

WHAT?!

 

There isn’t a council in the country that wants to make these cuts and the lack of foresight by the government to drive these further cuts through when the ones we’ve had already have been so deep, is utterly ludicrous. I’ve sat with council officers in tears over the choices they are having to make – these are people who love the communities they serve and are trying to do as much damage limitation as possible, whilst being left to take the blame.

 

What does it tell us? It tells us a few things. Firstly, there is a serious lack of joined up thinking about the long term consequences of these cuts. Save money now, but pay for it 5-fold in the future. Secondly, there is a genuine lack of concern for the poorer communities in our country. Thirdly, our current political model is broken and more than ever we need a politics of love/compassion. Fourthly, our current economic model is caput and cannot give us the regenerative and distributive future we need for humanity and the planet. I feel so despairing, sad and am grieving what this is going to mean for so many of our communities. We need to feel this pain and face up to this and find hope in reimagining how we might do things radically but necessarily differently.  This piece in the Guardian is worthy of serious reflection:

 

https://amp.theguardian.com/politics/2018/sep/16/the-eu-needs-a-stability-and-wellbeing-pact-not-more-growth?__twitter_impression=true

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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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Health Spending in The North vs The South

Tweet A few months ago, I wrote a couple of blogs exploring the social justice issue that is the vast difference between the health spend in the North, compared to the South.   This week a graph was produced by HM Treasury to show how overall spending has changed across England since 2012. Here is [Continue Reading …]

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Who is Responsible for Your Health?

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Hosting Conversations That Matter

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Doing the Impossible – Turning the Tide!

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Wake Up to Our Health Crisis

Tweet It’s all over our news today – our health is in a real mess, and this is our wake-up call moment – we really do need to take it seriously. It’s all very well us protesting about the under-funding and under-recruitment in our NHS (and we are right to do so), but we can [Continue Reading …]

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Here we go round the NHS Mulberry Bush!

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The Junior Doctors And Lady Godiva

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

Tweet You 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, [Continue Reading …]

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