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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3 Keys for the Future of Healthcare

This week I traveled to London for an interview. The lovely team that I work with have nominated me for the HSJ Clinical Leader of the Year award. Unbeknownst to me, this meant presenting myself before a panel of experts and leaders in the field of healthcare to talk about the work we have been doing. It was a privilege to get to do this. One of the questions gave me an opportunity to explore with them what I have learnt that has the capacity to bring transformational change….another was about the nature of leadership (which I will blog on next time).

 

So, for what it’s worth, here are the 3 key things  which I consider to be vital to unlock the future of sustainable healthcare, just in case they are helpful!

 

  1. Culture Change 

 

Much has been written in the press (and quite rightly so) over the last few years about some of the toxic culture that is at work in the NHS. Sometimes the toxicity is to do with power plays, competition, hierarchy, bullying, low morale and substandard care. But in other cases it is to do with a lack of compassion and care towards those who work in the system which causes the other negative behaviours or leads on to emotion fatigue and poor delivery of service.

 

When I moved into my role as “lead clinical commissioner of maternity services” (we love long titles in the health service!), three and a half years ago, it was just as Sir Bill Kirkup was publishing his report into the University Hospital of Morecambe Bay. It highlighted the failings we had in our maternity and neonatal services that had lead to some extremely sad and unnecessary losses of life. It targeted the negative culture within our teams and directly challenged some of the behaviours. Morale was understandably at an all time low. But there has been a significant change in culture over the last few years. Cultural shift is absolutely possible but involves a willingness to look stupid at times, to persevere when things feel awkward and remain hopeful when the task seems impossible. I believe the secret lies in rehumanising team meetings, connecting at a relational level, being vulnerable with each other, learning from mistakes, challenging unacceptable practice but creating an atmosphere of grace in which people can reflect, learn, grow, develop, change and discover each other with a deeper understanding and eyes that choose to look with kindness. I refuse to start any of the team meetings I chair without checking how people are doing, giving them space to tell a bit of their story. I want to give space for people to encourage each other, say what they love about each other and what they most appreciate about one another’s work. It’s not rocket science. It’s called connection and compassion! I’ve seen it work here in maternity teams, in our health and wellbeing teams and it really can happen anywhere. Without giving it space and time, nothing will change. But where there is a real sense of togetherness and hope, many more things become possible.

 

2. Community Partnership

 

Part of our problem in healthcare is our level of expertise. We know far too much. We “know” what’s good for people. We “know” what people and communities need. We “know” what will make them better. BUT we have not yet really learned to LISTEN. I have found it to be a very humbling and necessary experience to shut my mouth, quieten my need to fix and really listen to the people and communities I am looking to serve and live amongst. When our team hosts conversations to listen to people here around their dreams for this area in terms of health and wellbeing, they don’t talk about extra appointments at weekends or shorter waiting times. They talk about dog poo, safe playing spaces for kids, singing, looking after elderly neighbours, help with exercise and eating well, safe places for people with mental health problems to get together and be understood and many other things. I have found that listening builds partnerships. It creates trust. It means that with our communities, we can co-commission things, and we can do things together rather than the experts doing things to them.

 

If we are going to see the social movement we need around health and wellbeing in this country, we are going to have to let go of some of our “knowing” and be humble enough to learn. We are going to need to partner with people and not do things to them. We are going to need to focus more on prevention than treatment. We are going to need to work differently. Without the vital engagement and listening with and to our communities, we will never achieve the holy grail of a sustainable health service that remains free for everybody. Together, many things become more possible, and we can learn to live in peace.

 

3.  Collaboration

 

Every organisation is strapped for cash. It doesn’t need to be this way, but it is the reality of our current economic model. Collaboration and the sharing of resources between partners and organisations is the only way forward. I love sitting in team meetings that involve healthcare – in its different guises – primary, secondary and community services, with social care, the police, the fire service, mental health teams, the voluntary sector, the faith sector, the city and county councils. Creating new cultures, letting down barriers, discovering shared vision, pooling ideas and resources – seriously good for the soul and definitely the future we are looking for.

 

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