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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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.

 

 

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