The Extraordinary (Healing) Power of Forgiveness

images.jpgThere are many times when people come to see me, as a GP, and I cannot find a physical cause for their pain. There are various other conditions when people have what we call “medically unexplained symptoms”. For others, they can get stuck in a rut with their mental health and feel unable to get out of it. In the west, we are not as comfortable as we might be in dealing with the concept of spiritual health. Our spirit, the true essence of who we are, can also suffer damage and ill health, which in turn can lead to physical and psychological manifestations of that same pain. One of the things I have seen time and again as one contributing factor is when someone is finding it difficult to forgive a past hurt. In this vlog I talk about the great power of forgiveness in helping us to be more well. In the one after this, I will talk about how we can actually go about forgiving someone who has hurt us.

 

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A Healthier Story

So, we start 2017 with General Practice “skating on thin ice”, the NHS as a whole “creaking on the edge” and major concerns over funding and waiting times. Why don’t we step outside of that rather repetitive and boring story, and find a new one together – one that resonates far more with the ancient paths we once knew?

 

The world is changing, and not in a good way. We are becoming more separated from each other, our organisations and systems dehumanise us and we are becoming less well. The story that the ‘benevolent hand’ of the free market will work everything together for good is exposed in it’s nakedness, like the Emperor’s new clothes. The fabric of our society is unwinding as we become more disconnected from our own sense of wellbeing, our communities and the land on which we live.

 

How do we recover a sense of wellbeing? Where will we find healing for our past, present and future? How can we expand our own vision of what it means to be well, focusing not only on our physical health, but also on our mental, spiritual, social and systemic health?

 

How might the General Practice community move from being a group of health heroes, who fix people when they are unwell, to letting go of that old and unsustainable paradigm, learning instead to co-host, with others, an environment in which a community can be healthy and well? It doesn’t mean doing away with skills that have been crafted, but using them to empower others to be partakers and not only recipients. What if GPs or ICCs (Integrated Care Communities) faced up to the fact that they don’t have all the answers, nor the resources, nor the power to fix the problems in their local populations? What if they allowed themselves to become more of a part of their community, rather than separate or slightly aloof from it? What might a co-operative model look like? If every patient owned a small share of the practice and it truly ‘belonged’ to the community, just how radically might things change, without the need for huge ‘take overs’ by local hospital trusts or private healthcare firms? If we are to find a new way forward, we must all be willing to let go of what we have known and the power which we hold. We have to let go of our need to chase the money and imagine that we are like the city of Detroit, declare ourselves bankrupt, financially and spiritually and then together, break down the walls that keep us separate and find our way together.

 

When we host spaces in which communities can come together, rather than trying to be the experts who know how to fix everything, we let go of our need to be the heroes and come into a space for shared learning. As I spend time with a community of people recovering from various addictions in Morecambe, I find I don’t have the tools to fix things. However, I do find, that together there is a huge heart for a better and more healed society for everyone, so that others do not need to find themselves in the grip of addiction. We need to know less and find more corporate wisdom. We need to share our gifts and find the beauty of reciprocity – that it is in the giving and receiving of one another that we find a way forward in positive peace.

 

The future of our health and wellbeing relies far more on our interconnectedness and our community than on the systems we have built. Our systems must give way to become subservient to the longing of our hearts rather than the task masters which drive how we organise ourselves and live out our lives. Co-operative community gives us an opportunity to live something much more radically loving and kind, in which people and the planet really matter. Today is epiphany! A day in which some people with real wisdom realized that God came as a baby, weak, helpless and in need of community for health, wellbeing and development. If God is and needs community, how on earth have we become so disconnected from that story and made our whole way of being about experts and empires? Here is an epiphany for 2017. If God did not come as an imperial expert, but in weakness and humility, we need to do the same, if we are to find any hope for the future. The system will not change from the top down, it’s too invested in the broken story to be able to do so. But we, the people, can together be cogs that turn in new ways and realign ourselves with a way of being that brings better and more holistic health for everybody, everywhere.

 

 

Here is another interesting blog, from a slightly different perspective about how community really is the future of medicine – well worth a read, when you can make space for a nice cuppa and some left over Christmas cake (good for your wellbeing)!

 

The Future of Medicine is Community

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Understanding Brexit (and Trump)

I’ve been doing a bit of thinking about how the Brexit and Trump campaigns were so successful. (I owe most of ths thought process to a very inspiring session about our shadow selves from Paul and Angie Woods, during a weekend focussed on the Enneagram). What was it, apart from the arguments made and the general feeling of discontent that appealed so deeply to the national psyches of the United Kingdom and the United States respectively?

 

I think there is some real wisdom to be gleaned from the Enneagram about the corporate personalities of the UK and USA, which might help us to understand why the majority voted as they did and how we might want to understand and embrace our corporate mind-sets as we look to develop a positive politics of peace for the future.

 

Richard Rohr has done some helpful work, as have others, on the personality types or dominant psyches of various nations. I agree with his perspective that Great Britain has a Type 6 personality and the USA is of Type 3. The root struggle for a type 6 personality is the need to be secure – therefore any campaign based on fear (of not having enough Sovereignty, of not having control of our money, of the “other” people who keep coming here and taking away our sense of national identity) touches on our deepest need and struggle. For a type 3 personality, the root struggle is the need to succeed and so the promise to ‘make America great again’ strikes the chord that tugs on the heart strings.

 

enneagram-3-6-9-healthSo, focusing in on the UK (maybe some thoughts on the lovely USA another time), if we are to shift the political discourse towards something more healthy for the future, we need to learn to listen to the part of us that feels the need to be safe. We need to understand the ‘shadow’ part of our corporate personality that is anxious and fearful, admitting to ourselves what drives our thoughts and actions. When a Type 6 personality is not in a healthy place, they will begin to regress into a Type 3 pattern of thinking. So, the underlying drive to be safe becomes the need to get noticed and be special. So, post-brexit, some of which was about the need to be safe, we find our politicans trying to re-assert our Soverignty and our ‘Greatness’. Only a couple of weeks ago, Boris Johnson, the Foreign Secretary, was declaring on the radio that we don’t realise quite how the rest of the world sees us. Apparently, they admire us and think we need to continue showing great leadership in the world. We continue to believe this about ourselves, that we are very special and have a vital role which the rest of the world needs us to play. I wonder if we actually asked the rest of the world whether or not this is true, they might laugh in our face, pat us on the head and gently remind us that the world has moved on, but maybe we have not.

enneagram-6

 

Great Britain, as a Type 6 corporate personality, has an innate sense of loyalty. After the NHS, our Royal Family reamins the most popular part of our national identity, according to recent surveys. We carry a sense of being ‘loyal subjects’ who ‘do our duty for Queen and Country’. We are reliable, dependable, a safe pair of hands. But when our security is threatened, when we feel we are losing control, when we are told again and again that our borders are not safe, we begin to seek our security externally. We shut others out, we stop trusting others to make rules we don’t feel we have enough control over, build more weapons and ensure our finances work primarily for us. This then leads us towards a tendancy for workoholism, and so then we cut the nation state, drive people back into work, making an argument that it is the ‘lazy poor’ who are in part to blame for some of our mess. We become much more image conscious of our perceived role in the world and go on a charm offensive to remind people just how special we really are. But let me just state this: this is not a very healthy way to behave or live in the world.

 

I know this isn’t going to sound ‘Great’, but it is my perspective that ‘Great Britain’ left the European Union our of a place of fear, which has drawn us to try and re-discover our ‘special’ place in the world. During the referendum, some of our deepest corporate insecurities were touched on, and rather than see them for what they are, speak to them comfortingly and confront them within ourselves, we were enticed into age old patterns of behaviour which acually prevent us becoming the true gift amongst nations that we could be. You see, in my opinion, the invitation to the UK was (and actually continues to be) this: Firstly, let’s admit it – we’re scared. There is too much going on in the world that makes us feel out of control. We need a sense of comfort and security and we’re not sure how to get that anymore, without shutting our borders and taking back control over our ‘own laws and money’. This is exactly why we need the firendship and help of our neighbours! Secondly, we need to hear the call to us that we are loved, actually (!) and we can therefore allow ourselves to be still and know that safety is not truly found in better barriers and bigger weapons but in the risk that is relationship, vulnerability and being known…..that somehow underneath everything are the ‘everlasting arms’. Thirdly, this allows us to find a new place in ‘just being’, knowing we have inherent value, becoming truly loayal friends to the rest of Europe and the World, without the need to re-establish our status as the ‘Great One’.

 

Yes, the media holds an enormous amount of power, but it was the appeal to our deepest needs, a root struggles that enevitably lead to Brexit. Those, who felt the pull to remain, needed to speak to those very same issues, whilst calling us not towards our ‘3’ need to be Great and Successful, but towards our ‘9’. We must awaken the imagination of these amzing isles to a new place in the world, that is not about reassesrting our own name as Great, but finding our place as a nation of peace, building an altogether different kind of future in which our work does not look to protect our own future and rights, but the future hope of everyone everywhere. The UK has some incredible gifts and we can be a gift within and among the nations. We need a world in which each nation knows it’s inherent value and each can take their place amongst the nations to build a future for generations to come, in which we live in peace. We need to reimagine our place in the world. We need to tell a new and more ancient story. In order to do so we MUST face up to our own shadow, otherwise we will continue to act out of it and be the very antithesis of what we would, in our heart of heats, love to become.

 

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Solutions Focused Thinking for the NHS

One of the main headlines in the news this morning is that without extra funding, the NHS is in dire straits and patients are beginning to suffer as a result of less financial provision than is needed.

 

http://www.bbc.co.uk/news/health-38019771

 

One of the things I have trained in, during my career is Solutions Focused Therapy. It’s a fantastic way of helping someone to open their mind to new possibilities once they become stuck in a rut. So, for example, when someone is struggling with depression, there can be a downward spiral of thoughts that prevents the person being able to see much hope for the future. What SFT does, is to awaken the imagination to some other possibilities. The more colour and variety that can be painted the better. So, if you’re imgresfeeling low/down/hopeless/sad/apathetic/bored/exhausted, I might invite you to imagine what life might be like if you weren’t feeling that way. You might tell me that you’d feel happy and then I would ask you to tell me what ‘happiness’ might be like for you. I’d ask you to describe in as much detail as possible how you would know that you were happy – what would be different? I’d get you to put as much colour on that as possible. And once I understood how you would know you were happy, I would ask how others around you would know – what your partner/children/friends/pets would notice about you…….suddenly your mind is alive with an alternative reality to where you are currently and although things won’t be suddenly better, your mind has been awakened to another way of being!  And that brings a beautiful thing – it brings possible solutions to the problem.

 

imgresThere is no doubting that the problems in the NHS are vast. One of the things I have found is that if you try and enable someone to think about the solutions without allowing them to tel you what the problems are, you won’t get very far. A certain amount of catharsis and expression of the issues is important. So here goes: here is a picture of the problems the NHS faces (and these have already been stated many times over, but let’s just be clear):

 

imgresThe NHS is under-funded. Cuts to other services, like social care have also had a massive impact on the NHS as a system being able to work and targets are being missed as a result. People are living longer and this means more complex health problems and a rise in dementia. There is more obesity and diabetes and this has a huge impact in the cost of healthcare. The way the NHS is funded is ludicrous and puts parts of the system that should be working collaboratively in direct competition with each other. Teams across the NHS are clumsy and clunky with little ability to work smartly due to constraints of historic ways things were set up. Demand and expectation are extremely high and yet there are multiple missed appointments. And I could go on!

 

BUT we CANNOT stay on the merry-go-round of problems. We cannot continue to simply imgreseat moany pie together and complain about the issues. Throwing mud and finger pointing, blaming everybody else but ourselves will solve nothing. The awful tribalism and over politicization of the NHS is preventing us from finding a way forward. What might health and social care in this country be like if open our mind to new possibilities? What if we stopped focusing on all the problems and dreamed of how things might be in 5, 10, 50, 100 years time? We’ve been doing this in Morecambe Bay and we’re moving from not only dreaming but to doing something different!

 

imagesWe’re working with our communities to help us all live more healthy lives, thinking about health as a social movement. 97% of all health monies are spent once people are ill. We’re taking prevention seriously! We are breaking down walls between our organisations and sharing our budgets. We’re building relationships between clinicians and managers across many diving lines. We’re collaborating to share our resources and using our budgets in a way that makes sense for our communities. We’re unashamedly talking a new language of love, building trust and establishing infrastructures of positive peace. We’ve worked out where we are being inefficient and sharing our conundrums with our communities (we do actually have to be responsible about what we spend – the NHS is not carte blanche). We’re working out how to work differently and more smartly. We’re sorting out our IT. We’re redesigning care so it makes more sense for our patients. We’re working on our consultation and communication skills. We’re being more proactive in getting positive messages out there. We’re building for the next 100+ years not just the next political cycle. This is better care together!imgres

 

At this point in time, it is vital that our collaborative efforts are not allowed to fail. We are working hard at so many levels. We are doing all that is being asked of us. We are playing ball. Now we need the government to put their money where their mouth is. Holding the funding as it is will see us and many other areas trying to do the same thing fail in the process and this would be a great tragedy. The solutions, of which there are many, will be in jeopardy. But this is not the time to lose hope. This is the time for us all to make good the dreams we hold for the future.

 

 

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Solutions Focused Thinking in Population Health

My last blog focused on how we can think about solutions instead of problems in the NHS. Well the same is true in thinking about the health of our whole population. Yes there are some problems! We have growing health concerns with obesity and diabetes. We imageshave huge health inequalities. There are major issues with housing, economic policies that are not working for huge swathes of our population, with more people having to use food banks, struggling with fuel poverty, living in damp houses and unable to make ends meet. Yes, our kids are spending more time on screens and less time in activity. Yes, the sugar lobby, alcohol lobby and advertising giants have far too much power. Supermarkets are designed deliberately so that we buy things that are bad for us. And sometimes, we just make poor choices (if you can call them choices, which for some people, they aren’t always) – we do not all live as healthily as we could – we eat the wrong stuff, work highly stressful jobs, and exercise less than we are recommended to. Mental health issues are on the rise, especially for teenagers, due to crazy targets and league tables, with all the pressures they face. We are less happy and more separated than we ever used to be, despite the rise in social media…..(or maybe because of it……)…..Man, I can paint a negative picture – it’s like storm clouds and darkness everywhere……..

 

imagesBut what if it wasn’t that way? What if we got a bit angry about it, but instead of finding someone to blame and pointing the finger; instead of getting all tribal and throwing stones at others, we chose to use our energies creatively to find solutions, to work together and make positive changes?! Let’s put away our pointing fingers and our ranting tongues and let’s work together for a better future for everyone! Doesn’t that sound good?! It’s what we’re trying here in Morecambe Bay, and I’m hoping it spreads like wild fire so that we can become a place where health abounds and beauty surrounds (that’s the motto of this place!). That doesn’t mean we stop speaking truth to power, but we also let our actions (and maybe our votes) speak louder than ever before.

 

imgresWe’re talking together, taking time to dream about what it would be like if we were the healthiest area in the UK. We’re training up many people to host conversations, so that we break down walls and learn to collaborate for the sake of everyone. We’re not just dreaming about physical health, but mental, social and systemic health as well. We’re encouraging those who want to rise up and take some leadership, to be pioneers in the stuff they are passionate about. Even in my little town, we now have a mental health cafe that is literally saving people’s lives, because a lady called Jane wanted to make a difference. We have a cafe for all the people who have circulation problems because one of our nurses wanted to break people’s isolation and improve their healing rates at the same time. imagesWe’ve got a carers cafe, a dementia cafe and will soon have a breathing cafe for those who have severe COPD, sharing ideas and diminishing anxiety. We’ve got exercise classes to help with pain, a community choir, dog poo wardens to help us take more pride when we walk down the street and food banks to help those who can no longer afford to eat.

 

image[1]We have 2000 kids aged 4-11 running a mile a day at school with staggering results for our children here in terms of physical, mental and educational health. We’re hoping over time, this becomes the Morecambe Bay Mile, part of a cultural shift towards being more active. We are working with local chefs and supermarkets to enable people with pre-diabetes or weight struggles to eat more healthily.  We’re choosing to lead by example in the NHS to work well and flourish in our work places. We’ve made a commitment to see the 5 ways to wellbeing in every NHS organisation and we’re hoping many other systems and businesses will follow us in this. We’re finding radical ways to help people who are struggling with alcohol and drug addiction, get free and stay free with amazing results. We’re helping people live well with and beyond cancer.015c74b06779fe8d8496d585fb9865ea We’re changing the way consultations happen in the NHS to enable people to make more informed and better choices about their own health and conditions, so they feel empowered to make changes that work for them rather than beaten up when they go for an appointment! We’re launching the Morecambe Bay Poverty Truth challenge, learning from those who are lived NAWIFUexperts in poverty to help us work together and care better for those most struggling in our society. We’re having difficult conversations about death to help people be prepared for every eventuality.

 

All of this has started in the last year! What else might be possible? What other dreamsimages will be awakened? What other partnerships, collaborations and relationships might be formed? Being all tribal and accusatory of others saps our energy and stops us being creative. Mud slinging and blame will achieve little. We have to work from where we are. We have to build bridges and work together. We have to build a future of positive peace and that means binary thinking is over! The future doesn’t have to be full of doom and gloom. It is alive with hope! What resources might  we find? What talents might we discover? What might we see develop over the next 12 months/years/decades as we look for solutions together for a better future for everybody? Don’t you feel just a little bit excited?

 

 

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Embracing Weakness

imgresLast weekend, I spent the weekend with my wife and a bunch of close friends, immersing ourselves in the enneagram. It’s something I’ve done a bit of before and highly recommend it! The enneagram is an ancient way of understanding the human personality, our instincts, gifts, struggles and strengths. There are several different perspectives on it. There are similarities between the enneagram and various other approaches to understanding ourselves and each other better, like the Myers-Briggs, Strengths Finder etc, all of which I have found really helpful. On Myers-Briggs, I’m an ENFP. My core strengths are ‘believer’, ‘activator’, ‘communicator’, ‘achiever’  and ‘woo’ (the ability to win others over). I love knowing this stuff, especially in team dynamics because it allows each person to play to their strengths and to some extent, cover each others weaknesses.

 

enneagram-mapWhat I love about the enneagram is that it helps me, more than anything else I know, to face up to my struggles, my shadow, my ego and my unhealthy behaviour patterns without leaving me feeling ashamed or condemned. It helps me get to grips with my blind spots when it comes to my raw instincts and enables me to draw on others for support and help in making healthy changes. For those of you, who have never read anything about it, there are basically 9 personality types, each with 3 basic instinct types attached to them. Understanding your type and your instinct (especially your blind spot) can really help you on a journey towards freedom, wholeness and peace. It made me reflect so much on how I practice as a doctor and how often I might actually try and medicate someone or ‘therapy’ them, to try and soothe their pain when they might just be at a monumentally important moment of transition, discovery or realisation.

 

I am a type 7, with a wing in 8. The instinct types are either self-preservation (which isimgres actually my blind spot – I’m just not that great at being disciplined in taking care of my basic needs e.g. diet and exercise, or my motivation for doing these things is not self-care!), social adaptation or sexual attraction (that’s my prime driver – rather unfortunately termed, as it doesn’t mean I’m some kind of sex fiend!). Being a type 7 is actually awesome (of course). It means being an optimist, an activator, an enthusiast, a visionary and an adventurer. I see potential in people and possibilities and carry a strong belief that things can and will change for good. For me, life is fun and full of joy and I love to assimilate loads of interesting knowledge, being a generalist (suiting my work as a GP, rather than a specialist)……What’s not to love, right?! But here’s the thing…..

 

As a type 7, I have a basic need to avoid pain. So, being a doctor is actually one of the best things I could do, as I have to confront pain every day. But when things are painful, I have a tendency to bury things, rather than deal with them. I hate having difficult imgresconversations with people, as I hate causing pain in others. I love to find the next new thing, but this means I get easily distracted, my head is full of new ideas and lots of wonderful imaginings so I find it hard to focus, to stay in the present moment and be at peace. My visionary side can easily lead to idealism and when things don’t turn out the way I had imagined, I can verge towards anger or resentment. Even though I know this about myself, when I am not doing so well, when I am not as healthy as I could be, I see these patterns emerging. And my root struggle (and this is entirely true!) is gluttony! When life is painful, instead of embracing the pain, exploring it and confronting it, I take comfort in eating – (type 7’s often have yo-yo-ing weight or other addictions). I’m on a quest to lose a stone at the moment, but because self-preservation is my blind spot, this isn’t as straightforward as it sounds!

 

Thankfully, there is great hope – as there is for all of us, no matter what type we are. Part of this hope is found in having people of other types around me. My wife, for example, is a type 4 – someone with a creative and sensitive side. She feels pain, not just the pain she experiences, but of those around her, which makes the expression of her emotions very strong. This is an amazing gift for me – it makes me connect with reality. And I am a good gift to her, as I carry a lot of hope. Another beautiful truth in the enneagram, is that my ego, my desire to be self-centred, build the world around me, to remain strong, to be the imagesmost important person in my life, deliberately fools me into suppressing the vulnerable or shadow part of me, which if I embrace, can actually allow me to become a great deal more healed. If I can face up to the little person inside me, that I hide away and try to squash, who feels worried at times that I don’t have enough and that I’m feeling a bit overwhelmed by the build of issues on the inside of me; if I can recognise when I have entered the realm of fake joy and anticipatory energy and instead of veering towards trying to control everything and make everything feel happy but rather admit where I’m really at…..then and only then can I find a place of true contentment, where simplicity is restored, where I can focus, be present and know things are ‘perfect just as they are’…..then I can let go of idealism and enter the realm of sober joy, where truth resonates with hope and allows me to be the very best version of me.

 

Many of us get stuck, because we’re so intent on preserving the ego projection of ourselves, that we never embrace the weakness inside us that will actually help us become the gift to the world we are really made to be……healing and wholeness is so much more than we allow it to be. What are your root struggles? What do you need to avoid? What are your blind spots? Find out, embrace them and be well.

 

 

 

 

 

 

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Here we go round the NHS Mulberry Bush!

One of my favourite songs as a 5 year old was ‘Here We Go Round the Mulberry Bush’. I’ve been involved with the NHS for 17 years now and every winter, we do this same dance around Emergency Departments and the total mess that surrounds hospital admissions, discharges and an ever growing list of missed targets. Unfortunately, it no longer applies only to winter. It really is an absolute shambles and the problems are only too obvious. In this blog, I plan to outline them, but hopefully move away from the classic “who’s to blame” arguments and push through towards thinking about solutions…..none of which are easy, but neither are they rocket science!

 

So, here is a list of problems:

  1. We have an increasingly elderly population, who have increasingly complex health needs. You might not think this really means that much, but it has a profound impact on how long someone might need to stay in hospital and the kind of care they might require both in terms of social care and health care in the community. A recent report by the King’s Fund showed the extra strain on the health service due to a rise in people having multiple conditions is substantial. (http://www.kingsfund.org.uk/publications/pressures-in-general-practice)
  2. Funding cuts in social care and ‘efficiency savings’ in the NHS are having a terrible impact on hospitals and communities alike. If, as in our locality, wards have to be closed in order to balance the books, this has a massive knock on into several areas. If you close wards, it means the hospital fills up more quickly. If the hospital is full, then where do the patients who need to go into the hospital wait? The answer is in the ED. If they are waiting in the ED, then there becomes a back log of patients who cannot be seen and there will be an automatic failure to see, treat and admit or discharge patients within the 4 hour target window, which then leads to a negative rating for the hospital under CQC and pressure from on high to ‘do something about it’. But that’s just it….what can be done? Can people just be discharged home when they are unwell? – This is happening increasingly and then they end up back in hospital the next day in a worse state. The ED departments get the blame, but there is precious little they can do. At the other end of the line are people waiting to get home, but due to the deep cuts in social care, there simply isn’t the provision to put that care in place and so they are stuck. A lack of joined up computer systems between primary and secondary care makes this even more difficult. And even where patients could be cared for at home by community teams, the correct investment has not been made in this key area, hospital staff have not been trained to work in alternative environments (and believe me, they really are different) and so the teams we need in the community simply aren’t in place in many towns, cities and rural communities.
  3. There is a lack of information flow about patients and the care packages they already have in place and so a massive amount of time is wasted due to poor communication.
  4. The ‘A&E brand’ or ED, as it is now called is incredibly strong. Everybody knows it. And so people use it totally inappropriately, sometimes out of ignorance, sometimes desperation, sometimes laziness or convenience and sometimes apathy to the strain it places on services. We either have to work with this or keep on encouraging people not to use the ED. Unfortunately studies from the USA and Canada show that the more you negatively advertise the ED, the more people will use it. The King’s Fund explain with excellent clarity some of the complexities involved. What’s going on in A&E? The key questions answered (http://www.kingsfund.org.uk/projects/urgent-emergency-care/urgent-and-emergency-care-mythbusters?utm_source=twitter&utm_medium=social&utm_term=socialshare)
  5. Our residential and nursing home sector is in absolute disarray and in some areas of the country they are run like cartels, holding hospital trusts and county councils to ransom in terms of affordability.
  6. We are still unwilling to have a difficult and frank discussion about our attitude to death and how we often keep people alive for years, when we could allow them to die naturally and peacefully (I’ve blogged on this emotive subject previously).

 

So what happens is we have a circular blame culture in which everybody will blame somebody else, but nobody will take responsibility and so we will continue our dance around the mulberry bush! But if you have just a tiny bit of faith, you can say to this mulberry bush, “Be uprooted and be thrown into the Sea”. Where systems become oppressive and toxic,  we must pluck up the complex root structure and find a new way.

 

Without real commitment from the government to invest rather than cut at this crucial time of transition, spending now to make huge savings in the long term, we might just continue this dance ad infinitum. The solutions cannot deliver change by the next parliament, but the transition must be honoured as vital and therefore allowed to happen over the next 10-20 years. We need a whole systems approach and it needs to involve the following (we’re trying this in Morecambe Bay):
Firstly, we need the development of Integrated Care Communities (ICCs). ICCs are geographically based, multidisciplinary teams, led and co-ordinated by a GP and a nurse but also include the vital mix of the fire service, police, mental health teams, social services, community matrons/long term conditions nurses, district nurses, community therapy teams and representatives of 3rd sector organisations. The idea of these teams to to keep care closer to home, share information, prevent admissions to hospital, but where admissions happen, ensure they happen in a coordinated way, bringing people back home as quickly as possible. We already have some great stories emerging here of this working really successfully. These teams have the potential to change the modus operandi and bring a culture change to how care is delivered. 
However, these teams will fail for the same three key reasons the NHS is currently on the ropes. Resource, recruitment and IT. 

These teams will be managing complex care in the community. With not too much extra funding, GPs and the care coordinators could do some incredibly effective work, but right now, general practice is at full stretch and so convincing community teams to take on this work will not be straight forward. This resource would be best invested in two areas – recruitment of staff, or retraining of staff and secondment of them from the hospital setting into the community and the strengthening of social care teams, (which to my mind are more accountable and more effective when under the same management as the NHS and provided by the state). The investment in it would also not be huge but it does involve some upfront cash. If each GP/Care Coordinator could have a laptop with Emis Web imbedded in it, with full access to their patients notes, they could go into the hospital setting once a week, do a ward round of their patients, who they know far better than the hospital teams and get them home. With the right team investment in the community this initiative would literally save millions of bed days and save an enormous amount of resource. But the better and more important benefit will be for patients themselves However, there is a warning for the government. In order for this to be effective and have the desired impact, it MUST be double-run, rather than expecting this to be done on top of what is already the status quo. The capacity is simply not in the system, but it could so easily be and this could be utterly transformational.
Secondly, the government must reverse the perverse cuts to funding. It simply bad mathematics to think that you can shrink the size of a hospital and shrink the social care provision available in the community at the same time. We need a serious reinvestment in social care. A strong and well paid social sector will bring more people into work, which btw builds a stronger economy.

Thirdly, we need to ensure all people in residential and nursing care, and those living with complex health conditions in the community have detailed care plans in place to avoid hospital admissions, except when absolutely necessary AND in line with the persons own wishes.

Fourthly, we must co-create urgent care strategies, not designed from on high, but collaboratively between ED departments, mental health teams, the police, GPs, community nursing teams and social services. If we cannot undo fifty years of public mindset about the ED, then let’s work with this rather than against it. We need more people recruited to work in the emergency setting and the pay needs to reflect the complexity and unsocial nature of the work.

Fifthly, we must stop the nonsense around data sharing, make patient records available to patients themselves and front end our EDs, Acute Medical and Surgical Units, Outpatient Departments with the same systems as we find in the GPs, all of whom should agree to share their records. In our area this would be with Emis Web, a very straight forward system to use. It would mean far faster diagnostics, more joined up, effective care for patients and investment now by the government across the UK would save them plenty of money within just a few years. It would also make data gathering, audit and governance easier and safer. The idea of spending literally millions of pounds on apps that can input data straight into patients notes, before we have this far more vital infrastructure in place is quite frankly ridiculous!
Lastly, we must work creatively with communities on public health strategies that can have a lasting impact and so stave off the growing health crises we see emerging for the future.

I don’t know about you, but to me the dance around this mulberry bush has become pretty boring, a colossal waste of time and energy and so in my opinion, we should quite simply stop it and do something different. The solutions are right in front of us. Will the government have the guts to stop what they are doing and make the right investments now for the sake of the health and wellbeing of the population at large and the health and social care system as a whole. They might not get the glory at the next election, but in ten years time, we will see that the right choices were made for the good of all. 
 

 

 

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Making a Key Distinction in the NHS

There are two different narratives that are shaping the debate around the NHS at present. They are different stories, but they are becoming dangerously intertwined. I want to highlight the two stories and make a clear distinction between the two.

 

The first story is that there are some ways in which the NHS needs to be more efficient, work more smartly, integrate its services more effectively, cut some unnecessary waste, be more collaborative and ensure that the service it provides is as affordable as possible in a manner that is safe, learning, compassionate and continually improving. Some of this involves working with communities to help us live in a way (individually and corporately) that helps us to be more healthy and well, taking some strain from the system. It also involves some restructuring and rearranging of services to enable them to deliver care in a more streamlined way. This is a true story.

 

There is another story that is told that sounds like it has some similarities, but it is not the same story. This is the story that tells us the NHS is unaffordable, that it is failing and that we need parts of it to be privatized for it to survive. This is based on an idea that we have to balance our books, cut our cloth, tighten our belts and ‘live within our means’. This story is not true. It is not true because no country has ever lived within its means. Countries are nothing like households. Households are very simple. The economies of nation states are not. Households do not have banks in their back gardens that print money when things go wrong. Households do not give special privileges to rich friends, making life easier for them, whilst treating poorer friends like servants, taking away things they need and telling them are lazy and need to work harder, whilst blaming their problems on other friends who have moved into the area aka immigrants. Cutting public services and seeing the gap between the rich and poor grow ever wider whilst taking away the welfare that helps families in genuine need, cutting the services available to help them (pretending these are efficiency savings and not cuts) is a choice being made by our politicians. We are told there is no other choice, but this is not a true story. The NHS could be better funded (it is currently one of the most under funded health care systems in the entire developed world) and we could choose to manage the money of the country in an altogether different way! The NHS is affordable and the first story is helping to make this more true, but it needs greater investment, not the removal of vital services. Do not confuse the two stories.

 

 

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Healthy Conversations

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 the way in which our entire political systems are set up. Here in Morecambe Bay, we need to recover the power of people movements and decide together what kind of future we want. Here is an invitation to come and be part of the emerging conversations about health, well-being and the health system around the Bay.

 

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Making Meetings Better

iurI’m not a great meetings person. I just generally find them tedious. I lose concentration easily, I get distracted, I end up thinking about a whole lot of things that maybe I shouldn’t be thinking about or eat far too many biscuits and then feel bloated and guilty at the same time! Meetings and me don’t really mix….but I have to go to a lot of them, in fact, I now have to chair many of them and so I’ve been on a bit of a journey about how meetings can be made better.

 

My main beef with them, it turns out as I’ve reflected on why I dislike them quite so much,iu-6 is not that they don’t achieve anything. Nor is it that I’m involved in conversations I don’t care about – actually I don’t go to any meetings in which I don’t deeply care about the things being discussed. So what is my problem? My problem is that meetings, and I don’t think this is unique to the NHS (but this is where most of my meetings take place), are so often devoid of any real human connection. They lack care for those attending the meetings. It’s so easy to get so focussed on the stuff, the business, the discussions, the problems, that we forget that there are other human beings in the room, each of whom arrive in the room (or virtual space) with many different emotions, stories, dreams and realities that may be really important, but we don’t know because we don’t give space to those things.

 

So, as I believe culture change has to start with me and the teams I work with, I am trying, somewhat awkwardly at times, to have different kinds of meetings! When I chair, I refuse to let us get on with ‘business’, until we have taken time to connect with each other. Using iura simple technique from the ‘art of hosting’ I give space for a ‘check-in’. A check in is really simple, it’s just what it says on the tin. There are usually 2 questions and they can vary from meeting to meeting. Often, I just ask: How are you? And what do you love about your job? It is so important to know how each other is doing, so we can create teams that care for each other. People don’t have to be honest, but when they choose to be vulnerable, it opens up a space that is incredible and invites the entire team to go a bit deeper. And giving space for people to focus on the positive aspects of their work automatically changes the dynamic of any meeting from the start. Another of my favourite questions is: What do you love about working with the person on your left? (And if there’s time another round of ‘And what else do you love about working with the person on your left?). It is so healthy for a team to learn to appreciate one another but more than that, to actually tell each other that they are valued. You can get to know one another over a period of just a few weeks so much more and you end up actually caring about one another’s lives and wellbeing.

 

Secondly, I learnt a trick from a great friend of mine, who recently finished an MSc at theShoulderStretch University of East London. In the department of positive psychology there, a bell goes every 25 minutes of a lecture and everybody stands up and has a stretch. Research clearly shows, we don’t concentrate for any more than 25 minutes. And so now, in my meetings, every 25 minutes, my alarm goes off and we all stand up and stretch and get the blood flowing round our bodies. We’ve become so conditioned, like Pavlov’s dogs, that if anyone’s phone goes we all start to stand and stretch! Plus, it is great for low back pain!

 

The other thing, I have introduced is 2 minutes of meditation/mindfulness at the start or CeOnPGFWEAA48hjin the middle of a meeting. Using a very simple technique, I encourage everyone to find a comfortable sitting position. We then breathe in through our noses for the count of 4, deliberately breathing a sense of hope, peace, love and gratitude. We then hold this and hold our breath for the count of 8 (people count at their own pace) and then breathe out to through our mouths for the count of 8. When we breathe out, we deliberately breathe out stress, bitterness, anger, distraction, or anything that stops us being able to connect. And then we continue. The first few times I tried this, we had some giggling (mainly from me), photos being posted on twitter (!) and general weird feelings…..but we have pushed through and it’s amazing how good it feels to just stop and be and let the busyness just wash over us for a couple of minutes.

 

I can hardly say the above is a revolution, but I can say that I genuinely enjoy the meetings now. I know my teams better, I am more connected to those I work with and I am more able to focus. Connecting, stretching and some time to be still……it’s exactly the medicine that NHS teams need right now, and probably a whole bunch of other organisations also!

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