How Does Change Happen?

How does change happen? This has become an incredibly important question to me over the last few years, and I am still on a big learning journey in discovering some answers. There is so much that needs to change – so much that is currently going on in our communities that simply doesn’t work for people. So I keep asking – how does change happen?

 

I recently read a book called ‘The Moral Imagination’ by the great peace-builder and activist, John Paul Lederach. In it, he talks about the concept of ‘critical yeast’. Yeast is itself changed in a new environment (surrounded by flour) and then begins to bring about phenomenal change around it. You don’t continue to see the yeast, but you surely get to see it’s effect!

 

For me, change begins with listening, and by that I mean deep, generative listening to those who we could think of as ‘critical yeast’. The kind of listening in which you can no longer continue to see things the way you did previously. As you listen in this way and find your self changed, you can longer continue with things as they are – you realise that things around you need to change also.

 

It’s one of the reasons why I am absolutely committed to putting myself into uncomfortable surroundings or situations which challenge my neatly held world views and beliefs. I try and make sure I take the lanyard off my neck, step out of the clinical settings I know and the board rooms I sit in and spend time in and with the communities we serve. I really believe it is vital for all leaders, especially those in senior positions to regularly take time away from the boardroom and really sit with the communities they are paid to serve. If you don’t have your finger on the pulse of the pain people are experiencing, then it’s all too easy to make decisions on behalf of them which utterly lack compassion or kindness.

 

So, together with my good friend, Yak Patel, who is the CEO of the Lancaster CVFS (Community Voluntary Faith Sector) and a man of real humility who holds our communities in his heart, we went to be with some people doing amazing things across our district. Yak is great at holding me to account and ensuring that I put my money where my mouth is!

 

We started on The Ridge, the largest council estate in Lancaster. There we spent time with Lisa, who we know through ‘the art of connecting communities’. She runs the community centre, and we wanted to listen to the experiences of people living on The Ridge and understand some of what they are facing. Simple things, like a cut on their bus service (as timetables massively favour the University) is leaving people isolated and cut-off, especially elderly citizens at weekends.

 

I asked Lisa what she thought about the growing rhetoric that the problems communities like ‘The Ridge’ are facing are not to do with ‘resources’ – she rolled her eyes and retorted – “easy for people to say that, but over the summer, I couldn’t pay myself a salary for 2 months, so that I could ensure that the youth provision needed through the holidays could actually run – the funding for those kind of activities has been cut so much, it’s a joke….” Lisa, like so many other big-hearted and socially-conscious community workers, had to work 80-90 hours a week, holding down a second job, simply to be able to pay her own bills – similar to what happened at Christmas, when she worked long hours to make sure that 75 children on the estate actually had something to eat and a present to open on Christmas Day. People of good heart are feeling overwhelmed, unsupported and burnt out. I asked Lisa what she would love to happen – she wants to bring the community together, to talk about what’s strong, not what’s wrong, ask the community what it is they actually want and need, rather than assuming the providers of public services somehow magically know (!) and focus on what The Ridge could become – for the community, by the community.

 

On The Marsh, we met Debz. Debz also came to ‘the art of connecting communities’ last year. You might describe Debz as a ‘salt of the earth’ person. Down to earth, she has seen it all. I asked her what the biggest problem is for her community…..”drugs…..the place is overrun with drugs – and people are on the ropes”. The food club was happening, thanks to fareshare, when we arrived (although huge trays of strawberries were already completely mouldy)….and there were queues down the street….she shared with us some of the complexities involved for young people and the situations they find themselves in – multi-generational trauma….but what she struggles with most is that those who are supposed to care, don’t seem to want to understand. She told us of difficult encounters with the local GPs, the local hospital, social services (one family had had over 24 social workers – what’s the point in that, she asks?), police, schools and city council….although she has noticed some attitudes begin to change (perhaps because of the poverty truth commission).

 

She feels that people on ‘The Marsh’ are judged, looked down on and it’s reputation is very hard to break. But she also knows that people who live there want things to change and they want to be part of the change. That can be really tough, with the threat of violence and the very real involvement of gangs from Liverpool and Manchester, bringing intimidation. “Why would people not do drugs and get involved in selling them? It pays better than any work available”, she shrugs.  She believes the community can find some more hopeful dreams and she talks about the difference a new church in the community centre are making (a conglomeration of a few different congregations working together)….She wants to bring the community together to talk about what they want to see change, but especially how they can be part of that change….however, she doesn’t think it can happen through some kind of new found motivation alone – it’s going to take real investment. She tells me that if we want to stop seeing men dying in their 20s, from drugs, violence and suicide – we need to think altogether differently about how we work together with communities. Yak nods in agreement – he used to have Debz’s job, before he became CEO of the CVS. He tells me how many funerals of young men he has been to from this community. I feel deeply sad.

 

Then we’re on to Poulton (which has the worst health outcomes in North Lancashire), to meet our friend Joanne, who runs Home Start for Lancaster and Morecambe. What an amazing lady! And such a great charity! We sit with Joanne and one of her trustees, Sheila (who used to work in children’s services at Lancashire County Council, before she saw the decimation of her team and the unacceptable levels of stress she and her team were having to work under, which she deemed to be totally unsafe). The work they are doing for young families is extraordinary. Most of their referrals come from Health Visitors, but they are now full, and simply can’t take any more referrals unless more volunteers arrive. What I love about Joanne and her team is the collaborative-coaching approach they take. As they have worked alongside families, and discovered what they want and need, they have seen co-produced groups around issues like Domestic Violence and Autism support. What Joanne is most proud of is that they have created a culture in which you can walk into a room and no one knows who is a ‘client’, who is a volunteer and who is a member of staff – brilliant! “A community of mutuality” – she beams! Humility is the order of the day and it leads to real relationships that bring real change. As services have been cut and fragmented, increasing pressure has fallen onto the charity sector to hold things together – but resources have not followed. Despite great connections across the sector, the pressures are mounting, the cracks are showing and the risks are increasing.

 

I have no idea how much money Lisa, Debz and Joanne must be saving the public services every year, in terms of health and social care….but I do believe we could be making some far better and wiser investments with the ‘public purse’. We should be putting a whole lot more faith in community centres and workers, like them. If we do so, we will find it much easier to tackle deep-seated health and social ineqaulities right in the heart of our communities, taking an asset-based approach, being brave enough to redesign around relationships rather than transactions (as my good friend Hilary Cottam says in Radical Help) and find that communities really do want to be a part of transforming their own futures. Just like in Wigan, there needs to be a New Deal between communities and the public services to ensure that there is mutual vision and accountability for the resources that are available. What are we brave enough to stop doing, so that we can learn to do what is altogether better? Are we able to change? Not if we remain in our silos and ivory towers and continue to tell ourselves the same old stories. But might we dare to step outside the fortresses of what we know and learn to deeply listen? If we can do so, we cannot help but be changed….and as we begin to change….well…..then change begins to happen!

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How Do We Build a City That Works For Everyone?

I recently hosted a couple of conversations for people in the city of Lancaster, UK, in which we explored this question together: “How Do We Build a City that Works for Everyone?” We framed the conversation (which we had using a ‘World Café’)from two current and important concepts. Firstly, the great work of Kate Raworth in ‘Doughnut Economics’ – how do we create a city that is socially just for the people who live here and that is environmentally sustainable for the future? In other words, how do we ensure we have an economy that is distributive and regenerative by design? Secondly, we drew on the important work of Sandro Galea (Professor of Epidemiology at Boston State) and his concept of the Goldfish bowl as a way of thinking about ‘Population Health’ or Epidemiology (see my last blog). Politics IS health, according to Galea.

 

One of my favourite quotes is from Einstein, when he said that “If I had 60 minutes to save the world, I would spend 55 minutes trying to find the right question and then I could solve the problem in 5 minutes.” It turns out that the question we used itself is problematic at a few levels! Here are some of the questions we found ourselves wrestling with: Do we need to build the city, when it is already here?! What do we really mean by ‘the city’ – is it people and communities or more than that? What do we mean by ‘works for’? That felt to some like we were settling for something that was just enough, maybe scraping by, rather than thriving! And who do we mean by everyone?! This didn’t stop us having a a great discussion, but highlights how powerful the perspectives and biases we bring into the room can be!

 

Despite not having a perfect question, (and hopefully, by the time we host 3 much bigger conversations across the city during 2019, we may have honed something more helpful!), some key themes emerged, through our generative conversation. 

 

  1. Relationships are vital! We want to live in a city which really does “work” for everyone. So, we want to give value to the currently unheard voices and we want to value diversity and inclusivity. Taking time to get to know neighbours and colleagues grows a richness of community. We want to live in a city that values love and kindness in how we treat ourselves and other people.
  2. We need to build on the amazing assets and skills that we already have in the city. If we made space and time to discover and share these skills with each other more, we would develop a richer life experience within our communities. This is an expression of ‘gift economy’ and ‘reciprocity’, which Charles Eisenstein writes powerfully about in his book ‘Sacred Economics’). It builds on voluntary power, and may require a reimagining of how we work and what we value in how we invest our time, energy and resources. We also have so many incredible physical assets in this area, which we don’t tap into enough or perhaps make fully accessible for all who live in the city.
  3. People want to be part of the change, not have change happen to them! This requires much better engagement and democratic discussion about how budgets are spent, for example or how land is developed. Somehow, there needs to be a better safeguarding against ‘invested interests’ and ‘dodgy deals’ with far more transparency about how decisions are made. Such a process, it is believed, would enable far better personal and corporate responsibility when it comes to caring for the fabric of the city and the people who live here, similar to what has been developed in Wigan. There was a recognition that when we talk about personal choice and responsibility that this is much more possible for some people and communities than others. However, it was felt that increasing self-esteem and a sense of belonging would enable more personal responsibility and choice.
  4. Housing really matters. The physical environment is actually causing fragmentation and silos. There were many more questions than answers here – but that’s ok – this is an iterative process, and we don’t have to solve everything in one go. So…how do we create really good social housing? How could we redesign the spaces of the city to encourage togetherness and community? How do protect green spaces in the process and take care of the city’s drainage (strong memories of the recent floods)? How could we ensure that everyone has a home to live in, and what might that mean for both the homeless and also for single people?
  5. We want an education system that really values the unique beauty of each child, treats each one with compassion, mindful of what traumas they may be experiencing and values creativity and activity in education just as much as academic outcomes. We care about who our children become, not just about what exams they pass. So we recognise that we have a measurement problem but we’re not quite sure yet what to do about it! 
  6. We need to invest in our children and young people by providing physical spaces in which our young people can feel safe and not bored! Many have been affected by the closure of children’s and youth centres. If we are to really invest in our children and young people, there was a sense that we also need to provide parenting classes across the board to pregnant couples and through ‘family centres’ and schools across the district.
  7. We want to create a greater sense of value for our older citizens. There were many people present who felt they have things to offer, but don’t have an obvious outlet. Involving those retired from paid work more in the life of the city would break isolation and feed the gift economy. 
  8. Business needs to thrive in a way that really values entrepreneurial gift and allows it to flourish, whilst holding it true to the ideas and principles of the doughnut and the goldfish! How could the business community serve the needs of the city and how can the city enable business to really thrive, creating jobs, whilst caring for the environment and the needs of the people who live here? Kate Raworth’s work could really help us!
  9. Transport systems need to be redesigned to encourage more cycling and walking or the use of green public transport alternatives. Transport routes also need to join up our communities more effectively to improve opportunities for those who live in areas that are currently more financially deprived. 
  10. If we are to really improve health and wellbeing and care for the environment, then we need to see this written into EVERY policy decision. If politics IS health, as per Sandro Galea, then we need to take this seriously and stop making policies which do not care for these things.
  11. We want to be part of city that does welfare well! We think there are many possible new ways of doing things more effectively, as described in Hilary Cottam’s book, ‘Radical Help – Reimagining the Welfare State’. One of the things felt to be important is increasing skills in money management (85% of people living in social housing in this district are in debt to the city council -though this is certainly not only due to poor money management , but an unjust system that isn’t working for the majority). Morecambe Bay Credit Union offers an alternative economy as a way of using micro finance in our local geography.
  12. We need better ways to communicate and connect people together. There is smart, digital technology that could help us here….perhaps a Lancaster portal, that connects us together more effectively and helps facilitate the sharing of our assets and gifts.

 

Wowsers! Not bad for 2 conversations of 90 minutes each! Just imagine what a phenomenal city Lancaster might become over the next 10-20 years, if we set out on a journey together to build this kind of city! What is stopping us, I wonder?! #enoughnow #togetherwecan

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Inconsistent and Incongruent Messages

Tweet 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 [Continue Reading …]

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What Next for General Practice?

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Engage Well

Tweet I spoke at the NHS innovation agency north west yesterday about using video in engagement. Here is a 2 minute summary of some of what I shared! Share This:

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Wake Up to Our Health Crisis

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Solutions Focused Thinking in Population Health

Tweet 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 have huge health inequalities. There are major issues [Continue Reading …]

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Healthy Conversations

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

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The Junior Doctors And Lady Godiva

Tweet A few months ago I wrote a blog suggesting the right approach for the junior doctors was one of subversion and submission. But I think I was wrong. It’s not that I’ve changed my mind on the power of subversion and submission, it’s just that this entire spectacle surrounding the junior doctors, the ‘7 [Continue Reading …]

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