It’s Time to Say #EnoughNow to Adverse Childhood Experiences

Last week, I had the utter privilege of co-hosting a conference with my good friend, Siobhan Collingwood, the head teacher at Morecambe Bay Community Primary School on Adverse Childhood Experiences (ACEs), at the Globe Arena. We both know the reality of ACEs every day in our communities (see my previous blog) and so wanted to bring people together from across our amazing community in North Lancashire, working in the public  and community sector, or simply with a passion to see change, to explore how we can begin to say “Enough Now” to ACEs. (Huge thanks to the incredible Jon Dorsett for his graphic art).

 

As part of the day, my friends, Ian Cooper (Chief Inspector of Police) and Nick Howard (who leads the team at the city council on housing and planning) hosted a 135 minute conversation for all 180 participants around this theme: ‘Together, what can we do to transform the experience of childhood for good?’ There was such a buzz as people from different backgrounds and perspectives, collaborated and challenged each other to break out of our boxes and find new ways to bring transformation. The ideas generated were incredible and each person left the room with a clear commitment and next step for what they needed to do in their place of work or neighbourhood. Already we are hearing amazing stories and initiatives which are beginning as a result and we are building networks together.

 

We had fantastic input from Prof Warren Larkin, Sue Irwin (and her excellent work with EmBRACE), and host of other brilliant people working across many sectors, lending their expertise to further the conversations in interactive seminars – the feedback on each one has been incredible!

 

So – there is a huge challenge to the English Government (Scotland, Wales and Northern Ireland are already streaks ahead) as to why they are not taking the vast evidence base seriously and playing their part in breaking this devastating cycle. If we are to tackle this enormous issue of ACEs, it means vast changes to the ways we are delivering and measuring education in our schools and a serious reassessment of cuts of funding to children’s centres, midwives and health visitors, removing target-driven outcomes and finding ways to put relationship back into the heart of our modus operandi. It will take a people movement to bring the shifts that are needed, but given just how devastating ACEs are to physical, mental, emotional and social wellbeing and the huge cost burden they are to our public services and society, we have to give ourselves to drawing a line in the sand, saying enough now and reimagining the future together.

 

Here in Morecambe Bay, and across Lancashire, we are taking this issue really seriously and believe it to be one of THE most important population health issues of our time. A few of us have co-authored a ‘Little Book of ACEs’ together, in conjunction with Lancaster University – available very soon (!) which you might find helpful. My section expands a little on a previous blog post I have written here.

 

This whole area of ACEs is so sensitive, it takes compassion, kindness, bravery and wisdom. We cannot face it alone in silos, but together we can! Together, we can bring healing to our communities and freedom for the generations to come. We have to be willing to be those, who life Gandalf, in ‘The Lord of the Rings’ take our staff and say to this Balrog, which has devoured too many lives – “you shall not pass!” We have to give ourselves to drawing a line in the sand, saying “enough now” and step into a reimagined future of childhood, together.

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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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Population Health and the NHS 10 Year Plan

Tweet https://www.kingsfund.org.uk/publications/nhs-10-year-plan   This is an excellent blog from Sir Chris Ham and Richard Murray at the Kingsfund and highlights some important issues that deserve real consideration and debate. Get a cup of tea, reflect on it and then join the discussion. Here are my reflections on it.   Improving population health and closing the [Continue Reading …]

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Facing Our Past, Finding a Better Future – Adverse Childhood Experiences

Tweet This week I had the privilege of listening to Prof Warren Larkin, advisor to the Department of Health on Adverse Childhood Experiences. This is something I’ve written about on this blog before and Warren has made me more determined than ever to keep talking about this profoundly important issue. This blog draws on his [Continue Reading …]

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Healthy Schools

Tweet 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. [Continue Reading …]

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Reimagining Medical Education

Tweet We’ve got a problem (well 4 actually), when it comes to medical education! The first is this: Jeremy Hunt is promising loads of new places at medical school – I know this doesn’t sound like a problem, it sounds like a solution. But the truth is, once you actually do some number crunching, the [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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UK, You’ve Had a Heart Attack – How Are You Now?

Tweet You might want a cup of tea whilst you read this! I often see patients a week or two after they have been discharged from hospital with a Myocardial Infarction (what we often refer to as a heart attack). In this part of my home county, once someone is diagnosed with having a MI, [Continue Reading …]

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