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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Wisdom From My Nanna

Last week, I was on the closing plenary panel at The Kings Fund, as we reflected on what we had learned together about ‘PopulationHealth’ across the UK. There were some really excellent contributions throughout the day.

 

Councillor Matthew Brown, leader of Preston City Council, talked powerfully about the new economic models they are using there and the incredible regeneration they are seeing. Councillor Becky Charlwood, spoke about the great work being done across the city of Leeds and how strong relationships enable them to flex around complex legislation. Mayor Andy Burnham spoke with humility and realism about the power of devolution and the challenges they face as a city in Manchester in giving kids a great start in life and ending homelessness. Liz Gaulton, Director of Public Health in Coventry, spoke about how the Marmot principles are radically shaping the future plans of the city in thinking about inequalities and how they face them together. Prof Kate Ardern, from Wigan, talked about how we need to change our relationship with power and work radically differently with our communities. Prof Dominic Harrison from Blackburn brought his wisdom on how we face up to multiple unhealthy risk factors. Perhaps the most important contributions from my perspective were from Carina Crawford-Khan, lead organiser of Citizens UK and Dr Charlotte Augst, CEO of National Voices who asked us to reflect on how “Powerlessness leads to ill health” – that’s a statement worthy of pause and much reflection. Power is the ability to act. Anger without power leads to rage. So, if we don’t radically change our relationship with power, we can never see true population health – rather we have disempowered people who feel angry and unable to be part of the change we need to see.

 

The reality is that all of the things we long to see in society will not happen unless we ourselves are willing to change. In all the uncertainties we face and admidst the brokenness of our political and economic models, how do we stand firm and find a new way through to a way of being together that is socially just for humanity and sustainable for the future? In reflecting on all of this in the final panel, I drew on the wisdom of my Nanna.

 

My Nanna, Joyce, who is 97 years old this year and who still wakes every morning to play Mozart and Chopin on her beloved piano, has always been one of the most important people in my life. In our family, we call her “Yoda”, because she is strong in the force and exceedingly wise! This 5ft tall lady, who taught me to bake, spent hours helping me with my music and can still whip my butt at scrabble and rummikub, is a truly remarkable woman.

 

When I was a boy, we used to talk to each other whilst making ginger biscuits. My Nanna is a deeply spiritual woman and she used to tell me about her favourite bible verses, one of which is from the book of the Prophet Micah, Chapter 6 and verse 8. That verse says – “God has shown you the best way to live – act justly, love mercy and walk humbly with your God”. I think those three statements hold profound and ancient wisdom that we need to draw on in the complexities of what we face together now. What does that actually mean for us in practice, as we try and transform culture, relationships and behaviours? I suppose I think it’s pretty simple.

 

Firstly, as leaders and as people who want to see change, we must act with justice. We must care deeply about issues of injustice in our society and be willing to challenge it whenever we see it. But we must not just care, we must act. We have to be willing to put justice into practice in what we build. We’re beginning to see this, and it’s exciting!

 

Secondly, we must love mercy. I think that means we have to love the principle of mercy and therefore we have to love people with mercy, or as I put it at The Kings Fund, with real kindness. I love what Prof Micheal West says, when he talks about looking at people with kind and fascinated eyes. We did a lot of thinking about the need for a different kind of power. I think we need to unashamedly talk much more about love and the transformative power it holds. MLK said that love on it’s own is anaemic – it certainly can be. Power alone is destructive. But power and love together is a force to be reckoned with! We need this kind of love in the power that we hold to keep mercy at the fore and kindness as our way of being.

 

Thirdly, we need to walk in humility WITH our communities. I replace the word God here, with communities, not because I don’t believe in God (I do), but then Nanna and I used to talk, she would tell me that walking humbly with God means walking humbly with other people – with your community. It is worked out in the practice of every day life and being willing to interact with and be changed by the person you most look down on or despise. Nanna isn’t a fan of people getting too big for their boots. She sticks her tongue out at arrogance and blows raspberries at pride. She’s not into titles or pretensions. As a true elder, she knows humility and walks in it. I have learned so much from her and it has shaped so much of who I am and how I choose to spend my time. We must learn to sit with, be with, learn with and create the future with our communities. We don’t have the right to dream up plans and do them to people. Together with, is the kind of humble, mercy-loving, justice-acting way that we so badly need. Without those under-girding, foundational truths, we will never see true population health. Our guiding principles and undergirding culture will shape what we become together.

 

In a time of so much uncertainty and complexity, we do well to stop and draw on the wisdom of the elders. And so I offer that of my lovely Nanna – in all you do, make sure you act with justice, love with kindness and walk in humility with your community. 

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The Black Swan Podcast

Tweet I’m super excited to announce the launch of a new podcast: “Black Swan Podcast”   Until 1791, people in the UK assumed all swans were white. Then a black swan was brought to these shores and so perspectives and previously held beliefs and opinions had to change. Sometimes anomalies cause us to stop and [Continue Reading …]

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Truth about Poverty

Tweet One of the best things I have been involved in over the last few years, is the Poverty Truth Commission and it has helped me to learn just how utterly complex and wicked poverty is as an issue. I’m currently reading an absolutely brilliant book by the theologian Samuel Wells, called ‘The Nazareth Manifesto’. [Continue Reading …]

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A Fallow Year

Tweet This coming year of 2019, I am letting my garden have a rest – letting the ground be fallow. It gives space for the soil to replenish and to have its nutrients restored.   I am personally trying to allow much more space this year for contemplation, silence, reflection and the deeper work of stillness. [Continue Reading …]

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To Hull and Back

Tweet Last week I had the complete joy (except for the awfulness that is the M6 and M62!) of heading over to Hull to speak at a gathering of Public Health and Public Sector people from across Yorkshire, The Humber and The East Riding, called “Minding the Gap”, hosted by the amazing Ian Copley. In [Continue Reading …]

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Goldfish and What They Teach Us!

Tweet Last week, I had the privilege of listening to Prof Sandro Galea, from Boston State University talking on the subject: “What do guns, obesity and opiates have in common?!” It was an amazing walk through the world of epidemiology – and the answer? Well – all three things are hugely important problems, they are [Continue Reading …]

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Solutions for the NHS Workforce Crisis

Tweet This week, the Kingsfund, one of the most respected think-tanks on health and social care in the UK declared that the current NHS staffing levels are becoming a ‘national emergency’.   The latest figures have been published by the regulator, NHS Improvement, for the April to June period.   They showed: ■   11.8% [Continue Reading …]

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Health and Society – Can we make a Difference? Part 1 – Economics

Tweet If we want to make a difference to health and wellbeing in society, tackling health inequalities, whilst protecting the health and wellbeing of the environment and creating a fair and just save for humanity…..we have to ask ourselves some searching questions about whether or not our current economic models are really fit for purpose. [Continue Reading …]

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Creating a Great Culture – Part 1

Tweet I’ve recently finished reading the extraordinary book, “Legacy”, by James Kerr. It is a book about the culture of The All Blacks, the most “successful” sports team in the world. If you are involved in leadership, at any level, especially if you are passionate about developing the culture of your team, I would heartily [Continue Reading …]

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