The NHS as an Anchor Institution

The Preston Model of economics has set many heads turning and tongues wagging! If you don’t know the story, it is well worth reading about, as it offers much hope for the future. Alternatively, you can hear Cllr Matthew Brown talking about it here.

 

If the NHS really took on board what it means to be an anchor institution, as the largest employer in the UK, it could have a seismic effect on the economy, the environment, the health and wellbeing of the people and social justice. It is well within the gift and grasp of the NHS for this to become a reality, both locally and nationally and would involve some basic and fairly straightforward changes (and some more slightly complex ones!) Here is a starter for 10:

 

1) Pay everyone in the NHS a living wage

2) Reinvest the NHS pension pot, taking it out of global corporations or off shore tax havens and instead putting it into local infrastructure and regeneration schemes

3) Ensure the physical and mental health and wellbeing of all staff, through developing the 5 ways to wellbeing in the work place and leading by example by ensuring healthy food options for patients and staff. This could also include all staff having 1/2 day per month to volunteer with local charities, communities and schools around health and wellbeing initiatives

4) Create positive discrimination to employ people and offer apprenticeships/training opportunities to people from more economically deprived neighbourhoods (as per Oldham) to help generate more economic wellbeing

5) Only procure from local/regional companies, again to improve local investment and ensure these companies also have a good health and wellbeing strategy for their own staff

6) Take responsibility for developing a green strategy

7) Join with other large local employers to develop this wider strategy and economic development plan, e.g around green transport, job creation and supporting worker cooperatives – this needs to include local councils and universities

8) Be part of the new local bank/credit unions being set up so that new banking systems are more accountable

9) Work with local schools which are struggling, and create healthy school partnerships which both secure the wellbeing of future generations and can create a more committed and secure workforce through new training schemes

10) Support the community voluntary and faith sector with both practical resource and infrastructure support through the primary care networks and integrated partnerships

 

This is by no means an exhaustive list, just a few examples. Imagine, though, what a huge difference it would make if NHS England, every Integrated Care System, each Integrated Care Partnership and every Primary Care Network adopted this kind of plan. We might focus less on the effects of poverty on health and more on what we can do to make a difference to it, because we would be a part of generating wealth and improving health! This takes the NHS into the doughnut and creates an economy of wellbeing – why wouldn’t we do this?! It’s easy to understand and not too hard to implement!

 

 

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Love Economics – Part 2

When the economic crash of 2008 happened and the banks needed bailing out, the City of Preston in Lancashire, refused to blame the poor or adopt an economics of austerity. Instead, they developed an alternative economy, which is being hailed globally as one of the most exciting possibilities for the future in terms of social justice, environmental sustainability and human flourishing. The ‘Preston Model’ has now been well publicised and is being considered by cities such as New York as a viable model for the future. It is based on a few key principles, one of which is ‘Anchor Institutions’ (which the health foundation have written about in some detail in terms of the role the NHS could play).

 

I could not recommend a better way to spend half an hour, if you want to be inspired and filled with hope about what is possible. I don’t think the Preston Model is perfect, nor would it claim to be, but it does begin to offer exciting options for a way ahead. Here is Cllr Matthew Brown, leader of the Council, talking about the key principles involved and how they are working in Preston. We were really happy to welcome Matthew to Morecambe Bay as we explore an economics that is fit for the future. Enjoy!

 

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Love Economics – Part 1

Is an Economics of love and kindness even possible? It may seem so beyond our current context that it may seem like a dream too far. However, economics comes from the Greek word Oikos, which literally means household. Whoever heard of a household that was really flourishing that wasn’t built on love and kindness? It is true that the simple model of a household is a bit defunct when comparing it to complex economic systems, but the foundational ethical principles need not differ.

 

Our recent “Love Economics” event in Morecambe Bay was kicked off by the excellent Prof Imogen Tyler, head of the Sociology Department at Lancaster University, who sets out the case for the utter failure of the economics of austerity. Her devastating diagnosis of the current trickle-down economic model to (ever) deliver real human flourishing and environmental sustainability is not easy listening. Her insights and wisdom based on sound data and research set the foundations for our conversation in the current reality and pain which our economic models are causing every day. You will find in parts 2, 3 and 4 loads of reasons for hope. However, our hope must not be based in denial of what we are experiencing now, otherwise, we will go on to repeat the same mistakes over and over again.

 

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The Art of Connecting Communities – Why Bother Connecting? (Day 2)

As with any training, we kicked off day 2 with a “feed forward” – there are loads of different ways you can do this, and the idea is to bring day 1 into day 2 and remind everyone what has happened in the previous day. It helps people to be ‘present’ and have a sense of continuity. Day 2 is always hosted by participants in the training, with the team acting as coaches for them. Our hosts decided to use a large heart in the middle of a circle and asked each of us to write a few words of reflection about what had really stood out for us on Day 1. It was a great way of collating a collective sense of what had happened and gave us a really positive platform to build on.

 

Following this, Mike Love, a really experienced and excellent host from Leeds, who has been such a key person in helping us on our journey in Morecambe Bay, framed the day for us by helping us think through the process of opening up conversations (divergence), how to hold the groan zone (emergence of ideas) and the process of bringing a conversation into a point of agreement/next steps (convergence). The diamond of participation, as well call it, is a great way to understand our own preferences in conversations. Some of us love to open things up with great questions and get a conversation. Some of us a really comfortable hold the space for the emergence of ideas and love to see what is generated. Others of us, like to focus more on tasks and getting something delivered. The truth is that all of these are REALLY necessary if we’re going to create spaces in which we can discover collective intelligence. There was a real ‘aha’ moment when someone from the public sector said – “Our consultations are not really consultations at all, in any way. They are really a con and an insult”. This insight really provoked some great discussion!

 

Having fed forward and framed the day ahead together, we then checked in before heading into Open Space! Open space is a fantastic way of having the conversations that the people in the room want to have! Ours was framed around the question: “What do you believe we can achieve locally?” There were so many great conversations!

 

Then it was time for more theory. Mike Love, helped us again with thinking through ‘complexity theory’. We work in incredibly complex and chaotic systems and yet we often approach and measure them as if they were simple and complicated. If we are really going to learn to work well, we have to examine what it is we believe and how we see complexity, so we can learn to be far more adept in how we work in connection and relationship to others.

 

Designing for Wiser Action’ is another art of hosting tool, which is extremely useful if you are designing a project and would love to get the help and insight of others in knowing how to make it as effective as possible. We took most of the rest of the afternoon for people to work on ‘live projects’ which they wanted help with or needed to refine – another immersive practice where we learnt as we went along. This is a great tool, but also takes some guts! There is a point in the process where, having designed your project, you listen as other people come and find all the holes in it and offer some alternative solutions, whilst you have your back turned, cannot interject no try to justify yourself! Brutal love in action!

 

We ended the day by checking out, talking about our next steps and inviting people to help us plan for the 3rd day of training, where we will welcome back other members of the community of practice. We have now seen 250 people go through Art of Hosting/Art of Connecting Communities training in Morecambe Bay and are growing a wonderful network of hosts, who are learning to host ourselves, be hosted and host others (alone and together) in a way that creates space for new things to emerge. I am full of hope for the future!

 

 

 

 

 

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The Art of Connecting Communities – Why Bother Connecting? (Day 1)

Over the last few years, ‘The Art of Hosting’ has been transformative to my thinking and practice as a Doctor, as a Commissioner and as a Director of Population Health. Part of the core theory that undergirds this way of working is the 4-fold practice. It involves learning to:

 

  • Host Yourself
  • Be Hosted
  • Host Others
  • Host with Others

 

Hosting yourself means doing the inner work, and tending to your own needs. It is important, if I am to give my best-self to those around me. As a type-7 personality, for me this has meant learning to embrace disciplines like silence and fasting. It has also meant learning to rest, learning some healthy boundaries, to take care of my physical needs, embrace pain rather than running from it and become more aware of my emotions, resisting the need to rationalise everything. In being hosted, it’s about letting go of control, embracing humility and receiving the gift of others. In hosting others, it’s about learning to hold space for someone else, to deeply listen and to resist the need to fix things, but rather to respond and to coach, where this is welcomed (perhaps the very art of the classic GP consultation!). Hosting with others, is about learning to collaborate, to play to each other’s strengths, to enjoy the dynamic of relationship and to create a space together which opens up exponential potential!

 

We have now hosted 5 different trainings across Morecambe Bay in the last 2 years, and hosted many more conversations. Our latest training, in the City of Lancaster (our first without the incredible Linda Joy Mitchell), was an amalgamation of some of the ‘art of hosting’ practices with our own developing practices, here in the Bay. We called this training, “The Art of Connecting Communities” and together we explored some of the theory and practice under the question: “Why Bother Connecting?”

 

We began with the amazing, Yak Patel, CEO of the CVS in Lancaster District welcoming everyone and framing our 2 days together. Yak has become a good friend and is one of the best connectors of people I have ever met. He is deeply humble, kind and compassionate. He has lived and worked in this area all his life and has taken the time to build really wonderful relationships across many communities, which means he is trusted. So when someone, like Yak, puts out a call across the area to invite people to come and learn together about how we connect communities, people respond very eagerly. there has, perhaps, never been a more important time to connect together. Isolation and loneliness is literally killing us, and our walls of division and suspicion are leading us into dangerous territory. Bringing people and communities together is an art form and one which is worthy of serious collaborative learning.

 

To welcome everyone in, we did a ‘check-in’ using circle practice. Circle is an ancient practice, and is great for breaking down hierarchies, welcoming everyone into a space and ensuring that every voice is heard and every person knows that they matter. It can be quite simple and straightforward, though my experience is that it tends to go quite deep, quite quickly. For us, in Morecambe Bay, this has always been helped by having members of ‘The Well’ communities with us. People from The Well know how to be community at a level you won’t encounter in many other places. They know how to be vulnerable, with such a natural humility and so when they open up, it gives permission to the rest of the room to also go deeper. When this happens, we find people meet at a very human level and relationships form within the group easily. in this circle, we gave people pipe cleaners and asked them to make something which represented them. We than asked them to share this with the circle. Our harvest from the circle was very rich and the amazing Jon Dorsett, a truly brilliant host and one of the best graphic harvesters around, transformed it into a stunning piece of spoken word.

 

 

After a short break, the team hosted a world-café. Hosting a good café, depends on taking time to set the room well, explain the process and have a really good couple of questions. Our café took an appreciative enquiry approach. Our first question was: “What gives the Lancaster District It’s Heart and Soul?” – after two rounds of incredibly rich conversation, we than asked: “Where and How do you Experience This?”

The beauty of a world café is the ability to find great connection and synergy in a room. The sense of positivity this conversation brought about the assets we have in this district was palpable and it created a dynamic in which everyone felt like a real participant and collaborator in the process.

 

Sue Mitchell, one of our team, a seasoned, wise and excellent coach and host did a teach-piece on ‘Deep Listening’, which we could also call ‘Transformative Listening’. Listening is an art form and one that many of us never really learn – at least not to the deepest levels. Sue, expertly took us through those levels and helped us develop a framework to challenge ourselves about how well we really listen. Level 1 ‘My Turn’ is when we’re not really listening at all and we’re just waiting to jump in with whatever it is we want to say. Level 2 is when something the speaker says sparks a memory in us and we start contributing about our own (perhaps) similar experience – oh yeah – ‘me too’! It’s about us trying to sense make and find connection, but can mean we really miss what is actually being said! Level 3 ‘My Fix’ is about the listener stepping in and trying to fix the problem. It’s a level at which we don’t really want to connect too deeply, so we try and sort it and move on! Level 4 is where it begins to be about real listening – ‘I WITH you’ – it’s quite a sacred space. It’s where we allow ourselves to feel real empathy, to be with someone in their moment and experience, putting our own thoughts and experiences aside and creating a space for them. Level 5 is where ‘we begin to hear’. It is the art of self-awareness, it’s where we allow ourselves to be changed by the encounter and have our previously held perspectives and understandings changed. If we are to really connect within and across communities, we need to learn this art of listening.

 

Having learned about the art of real listening, we practiced it, using one of my favourite practices – Triads! The concept is pretty simple – three people, together – one is the speaker, one is the listener and one is the witness. The three people take it in turns to be each role, and each time, the same question or theme is explored. The theme we worked with was: “Share a story of a connection you made that changed your life. What was the impact?” – The listener asks the question, the speaker has 10 minutes to speak, with perhaps a few questions of clarification. At the end of the time, the listener sums up what they have heard and then the witness can give any feedback on what they have seen, things which have perhaps remained unspoken or anything else they have noticed. It is a very powerful experience to be listened to and to really hear another human being.

 

Learning to harvest is one of the most important aspects of hosting well. We harvested the learning from the triads, by bringing two triads together and asking this question: “What do we know about what builds connection?” – We then asked the 6 people together to come up with one sentence that reflected this knowledge and learning. Our harvesters then cleverly weaved a web of the learning.

We finished the day by checking out, again in a circle, simply speaking words of gratitude for the day and how we left feeling ahead of Day 2. As always happens on these days, people left feeling encouraged, hopeful and connected. I love it, because it is in the spaces formed between us that creativity is catalysed, ideas are formed and new things begin to emerge.

 

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Love Society – Part 2 – Triads, Weaving a Web and Panel

Bev Skeggs gave us so much to think and talk about with each other. If you haven’t had a chance to watch her amazing talk yet, then please do so! You can find it in Part 1 of this blog series. She left us with a question – “How can we build value with those who are devalued?”

 

 

One of my favourite ways to explore big questions like this (and there are many methods we use through our ‘art of hosting’ training) is Triads. Triads is a simple and effective way of helping people have really meaningful conversations whilst being deeply listened to. It’s a very powerful experience. It involves breaking into groups of three (obviously). One person is the ‘speaker’, one person is the ‘listener’ and the other is the ‘witness’. The listener asks the speaker the question that everyone is exploring. The speaker then has 10-15 minutes (depending on time constraints) to answer the question in whatever way they want to. The listener listens deeply, might ask some more questions, or encourage the speaker to unpack what they’ve said a bit more. They stay curious, trying to draw out the wisdom of the speaker, but not slipping into the role of ‘speaker’ themselves. At the end of the time, the listener reflects back what they have heard. The witness holds the whole process and watches over the time and might offer some reflections of the process or things that have gone unspoken or unheard. Then everyone swaps round into different roles, so that by the end of 40-45 minutes, everyone has had a turn in each role.

 

When everyone was back in the room together and after a good coffee break, we asked the triads to reflect on the following question (moving from singular to combined wisdom – from ‘me’ to ‘we’), having heard from each person in turn: “What have we discovered that  builds value?” 

 

Each triad (or pair of triads) was then asked to come up with one sentence that captured their corporate wisdom. Here are the sentences that were spoken into the room – they are worthy of much reflection. I love how much synergy can come from a diverse group of people!

What have we discovered that builds value?

Non-judgemental education from an early age builds intrinsic value into everyday life, regardless of circumstances.

We have found in the Poverty Truth Commission that through listening, understanding develops, people recover value and become actively involved in pathways forward.

Trusting that we can subvert pre-packaged judgements and values for the value of the common good.

Accepting that we all make judgements, we grow awareness of how to work with judgments in a positive way that is empowering.

Positively engage with and welcome ‘others’ without judgement and recognise the value of individual contributions.

Discovering/Recognising/Empowering/Encouraging/Nurturing the fact we all have unique value and have power in value.

Value (like energy) cannot be created or destroyed. It can only be recognised/transformed/moved around/flow.

Removing prejudices, titles and labels – going back to our humanity and finding joy in sharing life, food and experiences.

In daily interactions, conversations and opportunities by being positive role models in local and regional settings.

Positive disruption focused on an individual level, driven by a moral imperative and brave vulnerability can create a movement of enfranchised, knowledgeable, solid people focused on social justice not social judgement.

Eating or talking around a table builds individual and social value through real connection.

Recognise the common value of humanity and our vulnerability to build empathy and non-judgemental connection.

Knowing that someone understands, accepts and respects our values. 

Recognising and acknowledging value through relationships and being rather than achievements. 

Awareness of self and therefore others.

 

Jon Dorsett and Lou Andrews, part of our team and outstanding graphic harvesters (if you ever need any help!) turned this wisdom into a spider’s web of learning. This is a kind of framework for a renewed society, maybe! However, none of this is straightforward and my friend Roger Mitchell has also done some really helpful reflections of his own, in his excellent blog.

If we want to build a society based on love and kindness, we have to examine the value we place on people and the environment and the values which shape our society currently. That guy Jesus, once said, “What you value (treasure) is where your heart will be also….”

 

To finish the morning we had a reflective panel discussion – it was packed full of wisdom – enjoy!

 

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Love People! – Part 2

Continue reading “Love People! – Part 2”

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An Open Letter to NHS Staff – This ‘crisis’ is not your fault – you’re doing a great job!

If you work in the NHS, in any capacity, this letter is for you, no matter what your role.

 

Dear NHS Staff Member,

 

I write this to you as a GP, who cares for many people who work in the NHS and sees the huge stress many of us feel under. I write it as a ‘system leader’ in my role as Director of Population Health and as someone who has been a patient myself, twice in the last 12 months.

 

We are constantly told that the NHS is in crisis (I’ve even written blogs about it myself!), that we’re not meeting targets, that we’re getting things wrong, that we’re struggling to cope under the strain of demand but not being efficient enough and it can feel like what we’re doing isn’t up to the mark. With all the other current surrounding narratives we live with (like Brexit and Climate Change), things can so easily feel overwhelming.

 

So, I just wanted to write and tell you that the NHS is not in a crisis. We’re just underfunded and understaffed and we’re doing the best we can in those circumstances. Demand is growing year on year and we’re dealing with real complexity. We’ve been under the biggest and longest squeeze on our finances in NHS history, for the last 9 years, and the 3.4% uplift we’ve been promised, although welcome, is not enough to keep us running as we are and do the transformational work required of us. We don’t have enough people to deliver the work we’re being asked to do and so it’s no surprise that morale is low and burn-out levels are high. None of that is your fault. You are doing an amazing job. Every day, you turn up to work, in the context of everything else you have going on in your life and you are helping to deliver a truly world-class health service. Good job!

 

Amidst all the rhetoric you hear, the targets you feel under pressure to meet, the constant flow of people through the doors, the blame and complain (and sometimes bullying) culture that can grind you down, the traumas that you deal with every day, the pain that you help people process, the love and compassion that your pour out, the siloes and frustrations with the clumsiness of the system at times and the long hours – of which you work above and beyond most of the time…..know that you are more than your job and you are valuable just for who you are.

 

So, in all the busyness, remember to listen to and look after your own needs and those of your team around you. You can only do what you can do, and you’re doing a great job. Think about Maslow’s hierarchy of needs and how much you are attending to those things.

 

Physiological Needs – are you listening to your body? Are you getting time to have a drink, eat well, stretch, sleep and get to the toilet ok?

Safety – Are you feeling safe in your work? Do you feel protected? Are you worrying all the time about making mistakes? Do you feel it’s ok to make a mistake and be able to talk about it and learn from it, without fearing some awful consequences?

Love and Belonging – Do you feel like you are an important member of your team – that you matter, that you belong, that people around you care about you? Maybe in the humdrum and mayhem of everyday, we forget to tell each other.

Esteem – How is your self-esteem? Do you feel confident in who you are? Are you treated with respect and kindness and treating others with the same – no matter who they may be?

Cognition – Are you in a place where you can think clearly, make rational choices and in an environment which values learning and development?

Aesthetic Needs – Are you taking time to admire the beauty around you and enjoy life? Without this, it’s really hard to keep motivation alive, especially when things are tough and work feels really pressured. Taking time for this changes your perspective on everything else. How is your perspective? Is it in or out of kilter?

Self-Actualisation – Are you able to be spontaneous, making wise and creative, moral choices, problem solving without prejudice whilst accepting the facts in front of you?

Transcendence – This is the place we are aiming for as human beings – that ability to move out of our ego and into the place of gift from which we can love the ‘other’ and even our ‘enemy’ with the kind of transformative substance that changes the world.

 

The truth is, you can’t get to this place of self-actualisation and transcendence if the other areas aren’t looked after – so what needs attention? What are you noticing that needs taking care of? Don’t worry about all the pressures from on high – it’s all part of a system of biopower that needs to measure things to keep control. You – yes you, are valuable and important and the contribution you are making every day is phenomenal. You will certainly make some mistakes. It’s likely that you’ll feel overwhelmed at times, so listen to what your body, mind and heart needs and give yourself some space to attend to those things. Your own health and wellbeing really matters. So if you need help – and most of us do at different times, then please talk about it and give it some focus. We need to take care of each other – it’s ok not to be ok. Only when we create supportive environments for each other can we bring our ‘A game’ and keep providing the phenomenal care, innovation and transformation that we do every day.

 

Thank you a million times for everything you are doing, despite the struggles and pressure. Together, we need to create a culture of joy and kindness. That is partly the responsibility of leaders, but its incumbent on all of us, to treat ourselves and those around us with gentleness and respect. Go ahead and keep doing the great work you are doing every day – you really are a wonder!

 

Love and gratefulness

 

Andy

 

 

 

 

 

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The Morecambe Bay Approach to Population Health – The Double Pentagon

In this podcast (iTunes or Spotify), I give an overview, as Director of Population Health in Morecambe Bay, about the approach that we have developed as ‘Bay Health and Care Partners’ (BHCP) around population health. The double pentagon model draws on learning from across the UK and the world, leading think tanks, like the Kingsfund and local communities. The model has been developed with Dr Jane Mathieson – our wonderful Public Health Consultant, who retires this month, Prof David Walker – Medical Director at UHMB, Marie, Spencer, Jacqui Thompson, Hannah Maiden and Vicky Hepworth-Putt. BHCP is an Integrated Care Partnership which includes the GP Provider Alliance, The University Hospitals of Morecambe Bay Foundation Trust, Lancashire Care Foundation Trust, Morecambe Bay CCG, Cumbria County Council and Lancashire County Council and is committed to ‘better health, better care, delivered sustainably’.

 

So – if you’re interested in Population Health and/or you work as part of one of the organisations within BHCP, then listen in, enjoy and let’s continue this conversation.

 

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World Autism Awareness Day

Autism affects so many of our lives and families, and yet so many of us know very little about it, make unfair assumptions about people who live with it, or make crass jokes about people, using it as a derogatory term. In this episode of the Black Swan Podcast, I interview, the amazing Deborah Brownson, who recently won an MBE for her incredible work around autism. I am so glad that she is here in Morecambe Bay, though her work has a national and international reach – and rightly so!

 

World Autism Awareness Day is a good time to talk about Autism! The podcast is full of profound wisdom from a woman who has two sons with Autism and is working tirelessly to raise awareness, change perspectives and create practical resources and support networks to help people who live with Autism and the carers who support them. I hope you find it interesting, challenging, comforting and inspiring. Here are the links to the podcast, depending on your preferences!:

 

iTunes

 

Spotify

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