Floods, Fire and Fresh Thinking in the North

imgresAs I was driving along the A6 today, between Carnforth and Morecambe, on my way to visit an elderly patient, I experienced in the space of a few moments both exhilaration and dismay. I was exhilarated by the magnificent view of the mountains of Cumbria, just across the Bay in the beautiful sunshine and felt very grateful for living in such an inspiring and spacious place. And then onto my radio, came the voice of the Prime Minister in response to Jeremy Corbyn at PMQs. He was asking David Cameron about the lack of government response to the floods in Cumbria of 2014. This direct lack of action across the North of England (despite clear warnings) contributed to the appalling flooding that thousands of people have experienced over the last month. That, coupled with de-forrestation and the clearing of land upstream was a recipe for disaster once the storms hit us. Mrimgres Cameron, however, seemed to think it more important to mock Mr Corbyn on his shadow cabinet reshuffle rather than address the very serious questions in hand. The floods have been no laughing matter for the North. They have been devastating and could have been avoided had the North been treated with equity to the South.

The North is a remarkable place, filled with people of great heart and courage, a people who have historically had the ability to unite at a level to bring about significant change. As one example, it was a petition of the people of Liverpool, Manchester and Sheffield that saw the end of the slave trade in the UK. So, when the people of the North get a fire in their bellies, you can guarantee that change will come.

imgresWell, the floods are serving as a catalyst for this fire. The floods are only another indication of the injustice the North suffers in favour of the politically lucrative South. The South is not to blame and nor is this post intended to be divisive in any way, but it is high time that the North stood up to be treated as an equal partner and not a poorer brother. In my area of passion, health and well-being, the differences between the North and South are completely unacceptable and indeed detrimental when it comes to making effective change to health outcomes.

As already stated on this blog, despite all the worst health outcomes being in the North, 94% of all health research money is currently spent south of Cambridge. We have conclusive evidence from the Academic and Health Science Network, that health outcomes are significantly better in places where research is carried out , because funding follows the research.

We also know, from Health Education England, that when a direct comparison is made head for headimgres between the North and South when it comes to recruitment and staffing levels there is a £17million deficit in the North. It’s not that we can’t attract people to work here, we’re just not given the money to pay for them in the same way.

imgresWhen it comes to council cuts, again we see the North punished in comparison to the South, even though the need is greater here – which area has the highest use of food banks? The answer is the North West! If you study the map on council cuts (deep red = heaviest cuts, blue = increase in spend) – you will see just one blue area in the North, but major areas of protection and even significant growth in budgets for the South.

 

In Lancashire alone, the county council has to cut £262 million from their budget in the next 2 years. This is going to have devastating consequences to public health provision and social services, which is in in effect a cut to the NHS also. We are already seeing severe bed blockages in our hospitals and without social workers to support our elderly citizens, the crisis will only deepen.

 

imgresMy hope is that the North harnesses the emerging fire to come to a place of equal partnership with the South, raising its voice for justice and love rather than in vindictive, competitive vitriol. I hope that the North will together decide what it is to become a “Northern Powerhouse” rather than being prescribed what it will mean via the ideas and ideals of the Chancellor in Westminster. From my perspective, the North is about a different way of doing things. The North stands for a more equitable and co-operative society. In this moment the North can stand for a forward looking culture in which:

Men and women are equal.

Children are prioritised.

The environment is stewarded well.

Hospitality is an art form, practised and adhered to, where all are welcome and all can find a home.

Inter-culturalism thrives as mutual respect for difference is a core value.

The elderly are honoured and cared for with dignity.

Justice involves much more restoration and less retribution.

The rich do not become ever richer whilst the poor become ever poorer, but cycles of poverty and deprivation are broken through hope and aspiration.

Work is done, not simply to earn money and pay debt, but to create more joy, beauty and care in the world.

Well-being is more important than economic growth which involves people being used as fodder to drive the ever hungry machine.

People take responsibility for themselves and each other leading to more sustainable systems (health/education/social services etc) for all.

Healthcare and education is free and accessible to all.

The North must rise up, not to dominate but to become a different kind of “powerhouse”. A house in which power is poured out for the sake of those who need it most in order to create a more fair, just, loving and peaceful world. This is the new politics, not the farce we are seeing in the corridors of power. People learning to live together differently, having important conversations together to create a future that is more beautiful. Come on the North – let’s use this passion for good!

 

Share This:

Share

New Year’s Resolution

imagesI’ve been thinking about making a New Year’s Resolution. So, this year, taking my role as lead for health and well-being seriously, my resolution is simple. In 2016 I want to improve my well-being and encourage others to do the same.

 

The New Economics Foundation have done some amazing work on how we can improve our well-being. “NEF is the UK’s leading think tank promoting social, economic and environmental justice. Their aim is to imgrestransform the economy so that it works for people and the planet. The UK and most of the world’s economies are increasingly unsustainable, unfair and unstable. It is not even making us any happier – many of the richest countries in the world do not have the highest well-being.” Have a read about their incredible work (www.neweconomics.org).

 

NEF have come up with 5 simple ways to improve well-being and my New Year’s resolution is to use their 5 steps and blog about the effects I experience personally as a result. I hope that this will be replicated in my work as our team engages with communities. So, here are the steps:

 

015c74b06779fe8d8496d585fb9865ea

 

 

 

1) CONNECT – this year I am going to be more present. I have found that ridding myself of my

imagespersonal twitter account and spending less time on social media has already helped this. I am going to listen with attention and speak with intention. I am going to listen with attention to my wife, my children, my friends, my family and my patients (rather than assuming what they will say) and I am going to behold them, dig for the treasure in them and be grateful for them. I am also more well when I connect with God, who is love. For me, more than anything this means taking time to be still. Being part of a community, rather than moping around in self-isolation (a tendency of mine at times – surprising for an extreme extrovert!) is also key.

2) BE ACTIVE – This year we are launching a really exciting sports initiative in our local schools to imagesencourage our kids to have better health long into the future. I am going to continue running and swimming, but I will increase this to ensure I am being active on a daily basis.

imgres3) TAKE NOTICE – I have a painting on the wall in my consulting room (done by an amazing local artist) that has these words on it: “Take time to do what makes your soul happy.” I am going to feed my soul good things this year by noticing what is around me. I live in a world, surrounded by beauty – from tiny rare orchids to vast mountains, the sea and the night sky. I am going to notice this beauty more.

4) KEEP LEARNING – I already have some things booked in. I’m going on a refresher skiing course,images
before we take to the mountains in February. I am widening my culinary skills with some cooking lessons. I am re-learning how to arrange some pieces for our local choir. I am continuing to work with a life coach and the NHS leadership program. This will be a year in which I learn a lot! I love learning.

5) GIVE – At the beginning of every year, my wife and I review our finances and make sure that we are giving enough money away. We try to ensure that we give at least 15-20% of what we earn to various friends or charities. Money can have such a hold and I find as I earn more, it is easier to get sucked into an unhealthy imgresview of it. Money is just money. I am determined to have a relationship with it that is joyful and giving rather and anxious and hoarding. I love the phrase – “Live Generously”. I want to live in a way that gives of my time, skills, energy and resources without burning out in the process! My life coach has taught me well about boundaries – very empowering, as long as the motivation is to be able to give. It’s amazing how much a sense of giving/contributing to community and the world really improves our sense of well-being. It’s not an easy path. It’s all too easy to get one’s sense of self-esteem and self-worth by how much one gives, so I will try and remain honest about this.

So, if you want 2016 to be a year in which your well-being increases, why not try the 5 ways above? And if you fall over, get back up and keep walking!

Share This:

Share

Christmas

In my last blog post, I talked about the concept of meta-narratives and how they effect our health and wellbeing. For me the Christmas story is the ultimate meta-narrative (the big story with which I align my life). It changes the idea forever that God is a far off hierarchical, imperial, power-hungry megalomaniac. It eradicates the notion that we must go to him where he is in some special sacred space and will only find him if we clean up our act and start behaving in certain ways. No. He comes to us. This story (as JRD Kirk says) is not one of God changing his mind about humanity, but about humanity changing its mind about who God is.

iuHe comes to be with us and changes himself in the process. He becomes utterly human, not some weird, ready-break glowing child, but deeply human and in so doing destroys the stories we have told ourselves about what he is like. He comes to us. He comes right to our very situations, our joys, or triumphs, our brokenness and our shame and says, I AM with you.  And if you run away, I’m there with you. And if you turn away, I’m there with you. And if you hide away, I’m there with you. And if you fail, I’m there with you. And if you don’t believe, I’m there with you in your unbelief.  Because contrary to the caricature of Dawkins, I am love itself. A love that will pour itself out time and again.  A love that is stronger than bitterness, hate and division. A love that is willing to be misunderstood, misinterpreted and misrepresented. This is not the story of a God who slaughters his enemies in order to protect himself and those he holds close (a narrative upon which the nation state is built and uses to predicate the violence it does to others – and if you don’t believe me, then you haven’t read enough history). No, this is a story about a love that will lay its own life down for its enemies and enables us to do the same.

As Steve Chalk says, Jesus never came to start a religion. He came to start a political, social, economic and spiritual revolution. God with us – wherever we are. The God who prioritises the poor, the refugee/marginalised/outcast, the sick, the prisoner, the woman, the child, the environment. The powers have never and will never understand Light in Darkness-02or overcome this light. The promise of the light is peace. Peace on earth. If we embrace the way of love, anything is possible. Even in the midst of all the turmoil in our world this Christmas, I find great hope in the idea of God, who is love, with us in it all. I believe that when we embrace this light and this love as our meta-narrative, as our raison d’être, we find healing for ourselves individually and corporately.

Share This:

Share

How Well Are You?

I have the joy of leading some health and well-being retreats with a good friend of mine, who is a life coach. The retreats look at the idea of alignment. Human beings are unique and beautiful, incredibly intricate and are made up of layers, like an onion. Some of those layers are individual and some are corporate, because no person is an island. At the core of who you are is your spirit, your unique self. Then there is your soul – that sweet mixture of emotions, thoughts, ideas, hopes, longings, memories, hurts, resentments, desires, etc. All of that is encased in a physical body, with all the complexities that the intertwining systems entail. And these 3 parts of you are constantly interacting and affecting one anoiuther. For example, physical pain caused to you by another person, may cause you to feel emotionally hurt also (soul pain) and crush your spirit. Or indeed, as I see many times in my work, emotional pain leads to a resentment, which causes a bitterness which manifests itself in a physical pain and so too your spirit is negatively affected.

But you do not just float around in a bubble. You exist in a corporate body, in a family, group of friends and community. You live in an environment of some sort, and your surroundings have an incredible amount of ability to affect your health and well-being. This is evidenced in the effect of air pollution on respiratory disease or the effect of isolation or indeed bullying on mental health. We are all aware of the sights, sounds, smells and stressors in our physical geographies. Added to this corporate body is our corporate soul. And in the corporate soul we find corporate memories, ideas and beliefs, fears and dreams, things we have been taught, world views that shape us and all of this feeds into our meta-narratives, the stories with which we align our lives, that give us some sort of meaning. Surrounding all of this? The corporate spirit. Love. God is Love, not fear, or hatred or violence or bigotry or judgment, but Love. We find time and again in our own lives and in the lives of those who come on retreat the misalignment/disalignment/nonalignment that happens so easily, not necessarily through anyone’s fault, but because life is so complex.

 

It’s not as simple as tweaking one thing and then everything falls into place. Many of us still have to live with chronic and enduring illness of various sorts, be that mental or physical and achieving images“perfect health” may not be possible. But alignment is possible and it is this that gives us a sense of well-being. So, how well are you? Do you know how much you are influenced by the corporate body and soul? What are your meta-narratives? How aligned are you? There are things we cannot change, but we can chose how we respond to them and the choices we make within them. I want to unpack this a bit more in subsequent posts, but this might just kick off some musings.

Share This:

Share

Love – It’s a Two Way Street

There is a lie that has been told, to clinicians in particular, that it is wrong to get too close to patients. One is told to keep a healthyimgres separation, perhaps to make the tragedy we often deal with somewhat more bearable. We have shaped medical ethics around the four core principles of beneficence (do good), non-maleficence (don’t do harm), autonomy (respect a person’s own wishes) and justice (treat everyone the same). But as the black eyed peas would ask us (!), imagewhere is the love? Where is the love and compassion that makes us human and deeply connects us to the ‘other’ and even the ‘other, other’ (someone so different to us that we find it almost impossible to connect to them)?

 

I was involved in a conversation recently with Phil Cass, a psychologist and CEO of a healthcare company, from Ohio, about this very subject. He told me some very stark facts. In the USA, the highest suicide rate is now amongst physicians and 67% of medics suffer with depression. Studies found that although these people were motivated by love, they found it very hard to receive love back from those they were giving love to.

 

imgresWe have made the clinician-patient relationship a one way system, and we shut down the reciprocity of the love we give in the name of ethics and professionalism. But this is to our great detriment. Patients love and trust their doctors, nurses and therapists and this love could be a huge source of resilience, courage, support and hope. We must let down our guard and receive back the gift that we give in order toimgres become more healed ourselves. It will allow us to enjoy our work more, reconnect with the core motivation inside us and encourage us, because when we give and receive love it spurs us on to keep going when the system feel like it is against us.

 

Share This:

Share

Why Better Care Together?

imgresThere is an ancient proverb that says: without vision, people perish. I believe we in danger of watching the NHS perish in front of our eyes, not because we don’t know what to do or even how to do it. I believe we have been so focused on the what and how of healthcare, that we may have forgotten why we do what we do.

 

The NHS is an organism, made up of many living cells, called human beings, who have a vast range of complementary skills and interpersonal connectivity. These cells work imagetogether in tissues, joined to each other in complex systems to function as a body, a body which gives itself for the health and well-being of the nation. This body is not a robot, who’s performance can be processed like a machine for a predetermined output, but it has been treated as such, just another example of biopower, where people are used, rather than cherished. So now we have more of a Tin Man with no heart, than a living, breathing body.

 

But at the heart of the NHS is what we find in the heart of every human being, if we dig deep enough. The heart of the NHS, the very core of its being, it’s true raison d’être, it’s driving force is in fact, love. And the people, the cells who work in this loving imageorganism, also carry love in their hearts for other people. It is stamped through the DNA. It is the motivation. It is the reason people get out of bed in the morning, or work through their weekends and nights. It is why the wards are clean and the beds are made, why the bloods are taken, the investigations are done, the research is carried out, the people are washed and fed. It is why the hours of study and audit are diligently pursued, it is why the training is so robust, it is why the skills are acquired, it is why the time is given. It is why the NHS was founded in the first place, because all people, no matter how rich or poor, saintly or depraved, are worthy of love.

 

And yet we find that the human beings who join together to form this body are often struggling with severe stress, anxiety, depression and low morale. How can this be so? Is it possible that the structures we have put in place to try and support this body have instead become a hindrance? When my wife was born  she imageshad congenital talipes aka clubbed feet, due to a positional issue in her mum’s womb. When she was born, her feet were turned in and she had to wear painful calipers for 2 years until she was operated on by a very skillful orthopaedic surgeon. Now, in her mid thirties, she can run and dance because the calipers were taken off in childhood. As the NHS grew and developed, structures were put in place in its formative years to help the right sort of growth and strength to happen, but many of these are no longer useful and in fact are now a hindrance. We have become slaves to serving structures and ways of doing things that work against us as we try and stay true to our core motivation of love.

 

Part of what we are exploring through ‘Better Care Together’ hereiu-4 in Morecambe Bay is how to dismantle and reform these structures in order to allow this amazing body to function more naturally and freely. This organism is constrained within bizarre silos that make the what and the how of healthcare provision so complex that the why of what we are doing so easily gets forgotten amidst the complexities of service delivery. So, first and foremost, we must recover/rediscover/reconnect with/strengthen our vision, founded upon love and compassion for other people. Galvanized by this vision to provide continually improving, high quality, compassionate and loving healthcare to all in our community, we must tell the structures again and again, that we do not serve them, but they are only there to help us in our task. Right now, they need remodeling, and this is happening. We need less care in hospitals and more in the community, we need better integrated IT, different payment methods, new ways of working in General Practice (in larger more resilient practices, federations or co-operatives) and across the old boundaries, better pathways for patients and communities to be able to care for themselves and each other more effectively. But unless we have love, all these things are like a great symphony orchestra, playing a great new score but void of any connectivity with the audience. The form, as our chief commissioning officer, Hilary Fordham, rightly tells us, must follow the function, but I believe both the form and the function are motivated and under-girded by love and compassion.

 

So, why Better Care Together? Because the world has changed and the health needs of the population have changed and we simply can’t afford for things to remain as they are. But the deeper reason is so that we can provide continually improving, high quality, compassionate and loving healthcare to ALL in our community. This involves a mindset change. No more can we think of our own little patch. No more can we think ‘I’m just a GP of 1500 patients’, or ‘I’m just a nurse on the cardiology unit’ or I’m just a physio working in one particular area’ or ‘my practice only looks after 17,500 people’ (though of course this kind of personal care is still absolutely vital), but the paradigm shift in our thinking is towards being a member of a healthcare system that cares for the 350,000 people around the Bay. It’s about allow our hearts and our vision to grow bigger whilst giving brilliant care to individuals where we are located. That means learning to work differently, always motivated by the love and compassion we have for people.

 

 

Share This:

Share

Doctors Must Unite Together For the Rising Generation

This week the health secretary, Jeremy hunt, tweeted this: “Moderate doctors must defeat the militants”.

Here is a man I truly admire speaking some (slightly rude) truth to power. Sir Sam Everington knows a thing or two about the power of protest.

Share This:

Share

Morecambe Bay – Better Care Together

Morecambe Bay

 

Knox Family-180Known for it’s fast moving tides, mud flats, quicksands, islands, rare birds, natural gas, submarine building and nuclear power; Morecambe Bay is a place whose motto is “where beauty surrounds and health abounds”. The first part is true – it is a place with some of the most spectacular views on offer in the entire UK and hidden treasures of wildlife and wonderful walks. A place where I live with my family and I now call home. But it has some of the worst health outcomes in the country, sitting bang in the middle of the North-West – the worst place for health per head of population for any of the regions in the UK. We are the worst for cancer rates, the worst for heart disease, the worst for respiratory problems and the worst for early deaths. And please avoid the rhetoric that would have you believe that it is because of low aspiration and poor choices made by the people here. The North-West is underfunded in terms of health training, according to Health Education England, to the tune of £19 million every year, when compared head to head for other regions. And given the fact that health outcomes are so poor here, it is fascinating that 94% of all health research monies are spent south of Cambridge.

 

Looking at the health system here, it would be easy to be disheartened. The recent Kirkup enquiry into drastic failures at the University Hospitals of Morecambe Bay Foundation Trust, to which the trust has responded with humility and learning, highlighted just how much change is needed here. We also face the vast complexities associated with local tariff modification. And as if the local challenges are not enough, we have the added recruitment crisis that is affecting the entire country (worse in rural areas), the undermining of our junior doctors and their pay, the berating of nursing colleagues from overseas who don’t get paid enough to remain here, severely low morale in the system as a whole, and a maltreatment of General Practice in the National Press at a time when the profession is on the ropes; then there is the huge debt of the hospital trusts – compounded by the PFI fiasco and the creeping privatisation of our services, which has led to  the shambles that is out of hours care and staffing issues due to agency working. And iu-6all that is on the background of a hugely underfunded healthservice, with only 8.5% of GDP spent on health compared to the 11% most other OECD countries spend. The truth is, we simply do not spend enough of our GDP on health care for it to be sustainable in its current form, and the government knows this.

 

For the last three and a half years, I have been working here as a GP, having previously spent 14 years in Manchester. Three days a week, I work clinically in my practice, and the rest of my work time is given over to being part of the executive team for the Lancashire North CCG – I am the lead for Health and Wellbeing. Although the odds are stacked against us, something really wonderful is stirring here. I would go as far to say that believe it or not, Morecambe Bay is one of the most exciting places to be involved in health and social care anywhere in the UK. Let me tell you why I feel so hopeful (and why you should consider working here)!

 

Understanding the Purpose of Healthcare

 

iu-2A chap called, Phil Cass, who is an (unmet) hero of mine in the medical field, lives in the state of Ohio. He has been been doing some work with local communities to try and make healthcare affordable for everybody – a truly noble quest in a country where 50 million people cannot afford any. He took the conversation out to the community and they tried various questions, but found they weren’t really getting anywhere. He and team of people then realised that they needed to ask a better question. The question they needed to get to was “What is the PURPOSE of our healthcare system?” – Once the communities began engaging with this question, something remarkable happened – time and again, the same answer came through – the answer was this:- “to provide OPTIMAL healthcare to everybody.” The word optimal recognised that every person would achieve different “levels” of health depending on age, underlying health problems, genetics etc, but the vision of the community became that they wanted every individual and the community as a whole to live as well as they could. The community then realised that in order for this to be achievable, they had to fundamentally change their relationship with the healthcare system and this then made care much more affordable. Here in Morecambe Bay, we are taking a similar conversation to the 320000 citizens who live here.

 

Starting and Finishing with People

 

The NHS has become a horribly target driven culture and amidst the stress and strain, in which staff themselves often feel dehumanised, it is easy to forget what we are here for – human beings. Putting people (rather than patients) at the heart of how we think about health is a vital starting point.

 

FullSizeRenderSo, we are learning to truly engage with and listen to the people here. With the help of an amazng team, I have been hosting conversations here in Carnforth, in the form of ‘World Cafe’ discussions (a fantastic way to ensure every voice is heard). Our hope is that from Millom to Morecambe, we will see conversations springing up as we talk about how Morecambe Bay can become the healthiest place in the UK. And by being healthy, we do not mean just physical health. We are talking about mental health, social health (there really is such a thing as society!) and systemic health (including issues like road safety – still the biggest cause of death for our children, the environment and pollution, the real effects of austerity on our communities, the power of advertising and the high cost of healthy food). And as we talk with our citizens, we are not coming in with ideas of how to fix things, as though we are some kind of experts. People are the experts in themselves the their communities, and we have some expertise in a variety of fields. So, we have a meeting of equals. We are waiting to see what rises within the communities themselves and looking to support initiatives where that is wanted. Communities are having some really exciting conversations and some people are standing up to become ‘health and well-being champions’ (the photo is taken from a recent event, supported by our Mayor in Carnforth, looking to do exactly that), who want to help steward the well-being of the community and the environment. It is incredible to see how many people want to get more involved with making this area more “healthy”. Volunteers are springing up with ideas like gorilla gardening, shopping for elderly neighbours, cooking meals for those coming out of hospital, setting up choirs, starting youth clubs, community transport services to help housebound people get to appointments, cleaning up our streets, creating safe parks  and being hands on with support for those receiving palliative care. People are learning to ‘self-care’ and care for each other more effectively.

 

 

iu-3Atul Gawande, another hero, has written powerfully in his book ‘Being Mortal’ (a manifesto for change in how the medical profession deals with the whole topic of death). It challenges the ways in which we don’t face up to our mortality very well. We end up spending an inordinate amount of money in the last year of someone’s life on drugs which have a lottery-ticket chance of working, when all the time, we could help people live longer and more comfortably if we introducediu-7 hospice care earlier and treated people with compassion. We are looking to launch compassionate communities here, where we are not afraid to talk about the difficult issues of life. We want people to have the kind of care that allows them to make supported choices to live well, right to the end. Our BCT Matron, Alison Scott, is a true champion of this cause, along with Dr Pete Nightingale, the recent RCGP national lead of palliative care, Dr Nick Sayer, Palliative Care Consultant and Sue McGraw, CEO of St John’s Hospice.

 

From the moment of conception to the moment of death, we want people to have optimal health in Morecambe Bay. We want people to be able to live well in the context of sometimes very disabling and difficult circumstances and illness. We want to see care wrapped around a person, recognising that this cannot always be provided for by the current ‘system’.

 

Better Care Together

 

iu-4Before the government launched its five year forward view for the NHS, we were already in the process of learning to work very differently here, around the Bay. We have been blurring the boundaries between various care organisations (including the acute trust, the mental health trust, the GP practices – now forming into a more cohesive federation, community nursing in its various forms, the police, the fire-service, local schools, the voluntary sector, the county council and social services), building relationships between clinical leaders, sharing the burdens of financial choices and care conundrums, strengthening the pillars of the various players, redesigning care pathways across the clinical spectrum to ensure better care for patients and infusing everything we do with integrated IT.

 

 

The creation of integrated care communities (ICC) is at the heart of the vision to transfer more care out of the hospital setting and back into the community, whilst ensuring that the funding follows the patient. Our care co-ordinators become the new first port of call for our most vulnerable or ‘at-risk-of-admisison’ citizens. The idea is to wrap care around a person in the community, with the appropriate services being called in. Many times a care coordinator can bring in help from allied professions/volunteers and avoid unnecessary admissions or overlap of services. This means less pressure on the Emergency department and less pressure on General practice. We are also working to ensure our Urgent Care provision is fit for purpose with GPs, NWAS (our ambulance/paramedic service) and Out of Hours care offering much more of a buffer for our Emergency Departments.

 

 

Radical Leadership and the Challenges Ahead

 

 

There are many challenges ahead and both local and national threats remain. We are steering a huge ship through an iceberg field, and the so the waters are dangerous. We risk a lack of transfer of funding towards General Practice making it difficult for appropriate ‘buy-in’ for the changes we need to see. GPs ourselves have some brave leaps of faith to make. We will not be able to guarantee more money in our own pockets, but we must decide between protecting what we know or federating more fully for a more sustainable and excellent provision of care in the future (providing better education and career development in the process). We risk disengagement from senior clinicians in our hospital trust if the vision is not fully owned and shared by all. We have huge risks associated with the truly shocking cuts being forced upon our county council and a destabilisation of social care. We risk our nursing care home provision causing a halt to the entire program due to the vast complexities involved. Political whims, rules and pressures often seems to knock the wind out of our sails and could still utterly destabilise and destroy what is tenderly being built here.

 

 

mMiFlAqp_400x400However, one of the things which I have found most encouraging here is the quality and attitude of the leadership. Andrew Bennett as the SRO for BCT and iu-5Jackie Daniels, the CEO of UHMBT (the acute trust), have built stunning teams of people! I have the privilege of sitting on the executive board for the CCG and we have exec to exec meetings with the acute trust, in particular. The truth about Better Care Together is that for some it may mean doing themselves out of a job, letting go of power, and choosing facilitation and servanthood over domination and self-preservation. Leadership that is determined by the future and is able to lay itself down for the sake of what is really needed in our communities is exactly the kind of leadership we need. The leadership here across the spectrum is brave, it is altruistic, it is kenarchic, it is relational and it is rooted in the community.

 

 

And so we press on, knowing that we cannot remain as we are, knowing that in building together with our communities, we are finding that the future is not as bleak as it might otherwise be. Together we are wiser, braver and kinder. Morecambe Bay is no longer the butt of the jokes.  It is becoming a place of hope, a place of potential, a light that is beginning to burn, dare I say it – a place shaped by love. It will be a place where health abounds in the beauty that surrounds.

Share This:

Share

Walk Out, Walk On

walk-out-walk-on-logo

 

 

I’ve recently returned from a fantastic holiday in one of my favourite places – La Belle France. It was a wonderful time of relaxation, restoration, reconnection and reflection. My summer reading was the quite simply stunning book, “Walk Out, Walk On”, by Meg Wheatley and Deborah Frieze, recommended to me by Prof Stuart Eglin. It resonated with me, provoked, challenged, encouraged and envisioned me and I heartily recommend it as a MUST read, if you haven’t done so already.

It flows in the same stream as ‘The Art of Hosting’ and is refreshing in its style – one of learning, rather than teaching, an invitation instead of an instruction manual.

The basic premise of the book is this: many of the current systems we have, “are failing to create solutions to the very problems they were created to solve.” They have become large, over-organised, lumbering bureaucracies that stifle creativity and use people to support and uphold the structures, rather than releasing the people and supporting them to live and work more resiliently.

When we recognise that a system is failing, we can spend an enormous amount of time and energy trying to put sticky plasters on it, attempting to fix and repair what is there. Perhaps this is because we are afraid to let go, perhaps because we develop a kind of idolatry or sentimentality towards what was or we simply cannot imagine a different way of being. But there are pioneers who look for new alternatives and they fall into two types.

1) Some will look to create new alternatives within the structures and help the old transition into the new.

2) Others will create new alternatives outside of the old system and invite others to slowly join as they discover new ways.

Both pioneering types are vital – and share the same core DNA – they are ‘Walk Outs’. What is vital is that they don’t just walk out, but that they walk on to reimagine a different future. Walk Outs are not motivated by greed or power, but by love and kindness, recognising the damage caused by the current system and looking for an altogether better way.

2Loops-FirstLoop-500w

 

 

 

 

 

 

Walk Outs can often feel quite isolated and alone, but once they begin to find each other, connection and community become key ingredients to finding the way forward.

images

 

 

 

 

 

 

 

This challenges our management school and well rehearsed ideas in western thought about how growth and change occurs within organisations and systems. We do not need to continually look for maximising growth and profit. There are alternative motivations and more sustainable futures than the ones we are currently choosing.

My personal focus in the next few blog posts will be to apply this to the NHS and healthcare at large. I will take each chapter in turn and draw out some of my learnings from the amazing communities around the world brought to life in this book to help reimagine what healthcare is for.

Share This:

Share

Death – A Difficult Conversation

I hope that our towns and cities can become compassionate communities in which people live and die well. We need to break through our fears, especially in the UK in talking more openly about death.

Share This:

Share