Inconsistent and Incongruent Messages

The King’s Fund have just released an excellent video to help explain how the NHS works and some of the complex things going on in it at the moment. It doesn’t shy away from making it crystal clear who is in charge of the money, nor the difficulties we’re facing in staffing and resource allocation. Have a watch of it and then keep reading!

 

 

What is particularly important to understand, especially where we are learning to work in new ways together, like here in Morecambe Bay, is just how inconsistent and incongruent the messages are that we receive from the leadership structures of the NHS.

 

So, here in the Bay, we are forming an Accountable Care System, which brings together different health & social care commissioners and providers to work more effectively together. We are forming great relationships, breaking down walls and barriers to work together, whilst tackling significant budget issues as we try and ensure that we deliver care in the most excellent, safe and sustainable way for our population (whom we are trying to include fully in the co-design of the services we provide).

 

One might think, as we are being actively encouraged to reorganise ourselves in this way, that the Department of Health, NHS England, NHS Improvement and the CQC would all be pulling together to support these changes. One might presume that they would ensure the various contracts and ways of paying and assessing us would enable us to do this important work – the opposite is in fact the case!

 

On the one hand we are encouraged to ensure we work more efficiently and “cut the waste” out of our system, but when we do so, the contracts in place are working against us!! we literally being told to work one way and then penalised if we do! It is an entirely schizophrenic existence and creates an extraordinary amount of wasted time and energy.

 

I’m not exactly sure what it is that is causing the disconnect between the different regulatory bodies. However, as they require of us a new collaborative way of working that ensures greater efficiency and improved models of care…..perhaps it could be better modelled and enabled by those in the “centre”. This would give the entire reorganization a great deal more integrity. Cultural and behavioural change is talked about a great deal and we are enacting it despite the perverse drivers working against us. I wonder if the same is true at HQ, Elephant and Castle. This mixed messaging needs to stop and those of us leading systems, working with great complexity, need to be given the permission, support, and enablers to really flourish.

 

 

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Healthy Schools

Last week, I had the privilege of being at Morecambe Bay Community Primary School. The school is a beacon of hope in this area. I found it extremely moving to walk round, with Siobhan Collingwood, the visionary and big-hearted headteacher and see the incredible love displayed by all staff towards the amazing children there. It made me realise again how centrally driven targets often make no sense for so many of our children and communities, especially when the base from which they start is so very different. Siobhan and her team are doing the most incredible job at caring holistically for the children here, dealing with complex behavioural issues with such kindness and brilliance that it brings tears to my eyes, even writing about it. Not only so, but the standard of teaching to then try and help these kids come up to the ‘required standards’, being creative with the resources available, is nothing short of miraculous. I would defy any school inspector to rate this school as anything else than ‘outstanding’.

 
Siobhan and I had a great discussion about the need for health, social care, the voluntary and faith sector, the police and education to work more closely together for the wellbeing of children and young people in our communities. This is already happening in part, through our health and wellbeing partnership and ‘better care together’, but there is far more we can do. We thought about what it might be like if we parachuted fresh into the community now and had to start from scratch, what we might do together…….

 

We would start with stories – we already have many, from the conversations we’ve had in the community, but we want to really listen and be changed by the responses that we hear. We’re so grateful for the work of the ‘poverty truth commission’, helping us to do just that. We would also definitely pool our resources and prioritise key services that would not be taken away once the community begins to thrive, such as parenting classes, cooking lessons, early support services, a radically caring housing sector, preventative policing strategies (now emerging powerfully in partnership with our town and city councils), social care, mental health champions (something Siobhan has already been part of recruiting 150 locally!), children’s centres and adult education centres as a starter for 10. We would overlay this with the things that are working now – there is so much goodness happening and we don’t negate this. We want to ensure that we could see the health inequality gaps close.

 

In order to build on this idea of ‘healthy schools’, we would see kids being active every day – despite, limited grounds space, this school, like many others locally are running a mile a day. There is a great scheme here in which all the kids are learning to cook healthy, nutritious food, building vital life skills needed now and in the future. The breakfast and after school clubs are providing many healthy meals each day for the kids and throughout the summer holidays the schools cook – another woman with an incredibly big heart, opens the hall to feed families, who cannot afford to eat during the long breaks. A huge amount of work is being done around gender equality (have you seen the amazing documentary series “No more boys and girls: can our kids go gender free?” On BBCiplayer?). Kids are also given a huge dose of self esteem and know that they are loved and belong. If only the same level of caring support could be afforded through the transition to high school…..

 

Over the coming months, we hope to co-host some conversations with the community, not on our terms but shaped together with them. Siobhan spent years trying to think of great ideas to get the parents to come into school and interact with her. It wasn’t until the parents set up their own coffee morning in the old garage of the school playground, that she went to meet with them on their terms and started to build some staggeringly life-changing relationships. We know we are changed every time these kind of conversations happen and it blows our world view up so that we can collaborate effectively and co-design services with them. We want to share data with them about health and educational outcomes in order to create a passion for change and do some appreciative enquiry about all the great stuff already embedded in the community. Through these conversations, we want to connect people together and see a social movement for positive change.

The future of Morecambe is bright and full of hope. The communities are strong, the place is beautiful and the people are amazing. Siobhan is just one of many incredible headteachers in this area, committed to one another and this geography through bonds of friendship. If a genuine partnership between health and education can develop here (and it’s part of my vision and ambition to see this done) then who knows what might be possible over the coming months and years?

 

It is time for Morecambe to find its joy again. It has been the joke for too long, but soon it will become the place where the joke is found and everyone will want to know what we’re laughing about.

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