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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What Lies Beneath?

Do you sometimes wonder what is really going on? As the furore around the planned 5-day strikes by junior doctors unfolds, with all the clamour and the noise, the positioning, the power plays, the arguments and the counter-arguments, I wonder where is the truth amidst the madness? How have we reached a stage in which the government and an army of medics, surgeons and psychiatrists are at such loggerheads? What lies beneath all of this?

 

Theresa May, our Prime Minister tell us that “doctors have never had it so good” – I wonder when she last shadowed a Senior Registrar for Acute Medicine on a Friday night in an understaffed hospital? Jeremy Hunt tells us that he is a modern day Aneurin Bevan (I wonder what AB would think of that?!), whilst his shadow counter-part, Diane Abbott retorts that this is a ridiculous suggestion. The PM and the Secretary of State for Health both agree that the junior doctors are playing politics, something the other side refutes, but all agree that this is a disaster and patients lives may well be put at risk. The right wing press tell us it is all about pay and that the doctors are being greedy, whilst the left wing press tell us it is all about an underlying agenda to privatise the NHS. The Junior Doctors admit that some of this is about pay (who would want a significant pay cut for working long and unsociable hours?) but that it is more about resisting a policy to deliver a 24/7, 7/7 NHS, which they believe to be unaffordable and unstaffable due to shortages in funding and recruitment. Senior colleagues appear to be split down the middle in terms of support for the strikes, patient groups are understandably concerned and yet a solution does not appear to be forthcoming.

 

Shouting, anger, fighting, noise, name-calling, power-plays, hate and hollering. So, who will seek the welfare of the people and the nation? Who will make for peace? Both sides tell us this is what they are doing and this is why they stand their ground. The government apparently want to deliver the same standard of service throughout the 7 day week. The Junior Doctors say they are the ones really standing up for the people by resisting that which is unsafe and unfair.

 

So, let us learn from the peacemakers to find a way through. In apartheid South Africa, peace was not reached through hate and vitriol. It took deep courage from men and women to expose lies, to speak truth to power, but most importantly to tell their stories. It was not about the one man, Nelson Mandela, but the many together waking up to an alternative future that was fairer for everybody. In the battle for civil rights in the USA, a nation was awakened to the reality of injustice within its own borders. The story of one woman, Rosa Parks, who refused to be humiliated on a bus became a people movement as numerous as the stars, shining together for an altogether different day. In Rwanda, after the appalling genocide, those who lost everything, found a voice to communicate to their very oppressors, those who had raped and murdered their own families, not only their story, but forgiveness for the atrocities caused and found a way through to a new future. If we want peace and a better future for everybody, then we need to face up to our reality, be willing to really listen and then find that together we can embrace a new future.

 

We have an apartheid of globalisation and free market capitalism across the entire world. Every day, the gap between the rich and the poor is widened. Our entire economic system, founded on the oppression of Empire through expansion (via military violence), the creation of debt (through an errant banking system) and the rule of law (held in place by the state of the exception) is no longer fit for purpose. We see it in the plight of refugees stuck between war and barbed wire fences in a land they cannot call their own. We see it in the disproportionate imprisonment of Black American males in the USA. We see it in the vile island detention centres of Australia. We see it in the slums of New Delhi, the townships of sub-Saharan Africa and the Favelas of South America – in the eyes of children dying from such ridiculous things as diarrhoea and starvation. We encounter it in the streets of Athens and the public squares of Madrid. And yes, we find it in the midst of our NHS and social care system. Our world as we have known it is broken and no matter how much sticky tape or wrapping paper we apply, the centre simply cannot hold. The core is unstable. Everything is shaking. We must have the courage to let go of what we have known and embrace an altogether different future, a future that is fairer for everybody, where things don’t simply trickle down to the poorest, but in which the balances are re-set.

 

We have become slaves of the ‘free market’, fodder of the beast that requires ever more of us. What lies underneath the row over Junior Doctor pay and the forthcoming strikes is a great gaping hole that scares the hell out of many of us. Oh, we can sling mud until the cows come home, but it’s not going to get us anywhere. Top down, pyramidal, heroic leadership that stays its course and demands it’s own way is simply not going to cut the mustard. We must have some brave and difficult conversations about the detrimental effects of making policy from the safety of ivory towers, and learn to really listen to the stories of those affected. We have so much to learn from the Leeds Poverty Truth Challenge, the Homeless Charter in Manchester, the Community Conversations in Morecambe Bay, the Cities of Refuge initiative, the Civil Rights movements, the Mediation work done in Rwanda…..we don’t have the answers right now. The problems facing the NHS are fare more complex than trying to ensure an undeliverable manifesto promise is outworked. We need humility on all sides, collaboration and partnership.

 

It goes deeper than people right across the UK needing to manage their own health and wellbeing more effectively. It is more complex than needing to recognise where there is waste and dealing with it. It isn’t just as straight forward as needing to talk about chronic under-funding and under-recruitment. We face an existential crisis, an ontological question about the future of humanity together. Resting back onto familiar ways of operating or antiquated leadership styles will simply not work for us any more. The black hole we face is either a death or the opportunity for re-birth. A squeeze that will force us into something new. We can’t keep dancing around it forever. We must take the plunge, accept that there is no going back and see what new creation we might just co-create with Love on the other side. Don’t be afraid…….there is light at the other end of the tunnel.

 

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Tweet We live in a political climate in which it appears that those in power do not listen to the voices of the ‘multitude’ (e.g. with the current protests around the NHS and education), but press ahead with their own agendas regardless. This is not only true of the current government, but a symptom of [Continue Reading …]