1) CONNECT (5 Ways to Wellbeing) – Changing the Culture of the NHS

Here is the first of a series of little video blogs about how we can change the culture of the NHS. The first cohort look at using the “5 Ways to Wellbeing” from the New Economics Forum to help us on our way. This vlog also gives a bit of an intro into the series, so is a little bit longer than the others which will follow.

 

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How Well Are You?

I have the joy of leading some health and well-being retreats with a good friend of mine, who is a life coach. The retreats look at the idea of alignment. Human beings are unique and beautiful, incredibly intricate and are made up of layers, like an onion. Some of those layers are individual and some are corporate, because no person is an island. At the core of who you are is your spirit, your unique self. Then there is your soul – that sweet mixture of emotions, thoughts, ideas, hopes, longings, memories, hurts, resentments, desires, etc. All of that is encased in a physical body, with all the complexities that the intertwining systems entail. And these 3 parts of you are constantly interacting and affecting one anoiuther. For example, physical pain caused to you by another person, may cause you to feel emotionally hurt also (soul pain) and crush your spirit. Or indeed, as I see many times in my work, emotional pain leads to a resentment, which causes a bitterness which manifests itself in a physical pain and so too your spirit is negatively affected.

But you do not just float around in a bubble. You exist in a corporate body, in a family, group of friends and community. You live in an environment of some sort, and your surroundings have an incredible amount of ability to affect your health and well-being. This is evidenced in the effect of air pollution on respiratory disease or the effect of isolation or indeed bullying on mental health. We are all aware of the sights, sounds, smells and stressors in our physical geographies. Added to this corporate body is our corporate soul. And in the corporate soul we find corporate memories, ideas and beliefs, fears and dreams, things we have been taught, world views that shape us and all of this feeds into our meta-narratives, the stories with which we align our lives, that give us some sort of meaning. Surrounding all of this? The corporate spirit. Love. God is Love, not fear, or hatred or violence or bigotry or judgment, but Love. We find time and again in our own lives and in the lives of those who come on retreat the misalignment/disalignment/nonalignment that happens so easily, not necessarily through anyone’s fault, but because life is so complex.

 

It’s not as simple as tweaking one thing and then everything falls into place. Many of us still have to live with chronic and enduring illness of various sorts, be that mental or physical and achieving images“perfect health” may not be possible. But alignment is possible and it is this that gives us a sense of well-being. So, how well are you? Do you know how much you are influenced by the corporate body and soul? What are your meta-narratives? How aligned are you? There are things we cannot change, but we can chose how we respond to them and the choices we make within them. I want to unpack this a bit more in subsequent posts, but this might just kick off some musings.

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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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Healing our Corporate Soul

In my video blog about ‘Reimagining Health’, I talked about the fact that our well being is not and cannot be an isolated, individualistic experience. The truth is that we are part of a Corporate Body (that is a community of people with a physical environment in which we live) with a Corporate Soul (a set of beliefs/mindsets/worldview) and a connection to the Corporate Spirit (which in my view is either the spirit of love aka God or the spirit of fear). These corporate experiences have a massive impact on our individual sense of health and wellbeing, and actually, as we are part of the corporate, our individual wellbeing has an impact on others around us also.

Our Corporate Soul is the issue I want to concentrate on in this post. It is complex and something to which I believe we pay little attention. However, it’s effect on our individual and corporate wellbeing is vast. Take a moment to think about the subliminal messages that come through our various forms of news and multimedia everyday.

“Your life isn’t as good as your ‘friends’ on Facebook”

“You need to be on Facebook or you are missing out on so much”

“Unemployment is being caused by Immigrants – be wary of them”

“Be afraid – people hate our country and are trying to kill us for the ‘values’ we uphold”

“The way our country does things is right and just and those who die for ‘our country’ are never to be forgotten”

“Pollution is rising – we are heading for natural disasters”

“Buy the new car – you need it, don’t worry about the pollution – live for the now”

“The chocolate industry is built on the slave trade”

“You can’t change anything, so keep on eating all the chocolate you want”

“Banks are to blame for the financial crisis”

“We have bailed out the banks with taxpayers’ money, because we need them so much.”

“Really the reason for our national debt is the poor, who claim too many benefits – we should blame them because they are lazy – we won’t bail them out”

“We all need to live longer”

“We can live however we want – our healthcare is free”

“Our children aren’t doing as well as some other children around the world when we measure them against a set of very narrow targets – therefore we need more targets and more testing”

“The only way to keep our nation really safe is to keep the nuclear deterrent – in the end, this is what makes us safe”

“Our armed forces protect us by using violent force to topple regimes which do not suit our national interest. Power vacuums are now left in those nations with untold turmoil and the rise of significant extremism of which we should be even more afraid and need to silence. We will do this with more force. The use of violence make us feel safe”

 

No wonder we are so messed up. We have some very damaging and also conflicting messages coming at us, especially through the (social) media 24/7. When do we stop to ask ourselves how healthy our worldview/beliefs/mindsets are? How much of our life is driven by fear? A fear of want? A fear of lack? A fear of the ‘other’? A fear of loss? A fear of debt? A fear of attack? And how much of this feeds our individual(istic) souls of self-protectionism?

How badly we need some conversations together that enable us to challenge some of our current core beliefs. We will not find a place of health and well-being, happiness or wholeness until we do. We have aligned our lives with the Spirit of Fear and our Corporate Soul is entirely broken as a result. We must realign ourselves with the story of Love. There is so much goodness out there. Can you see it? Only love can drive out fear. Only love can heal and awaken our souls to another holistic way of being.

 

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Well Cities and How They Can Flourish

I am someone who has many dreams – I mean the night kind of dreams….very seldom would they be a night mare, but they come with incredible detail! Maybe this is because my mind is processing, maybe it’s because I’m a bit weird or maybe it’s because I’m finally quiet and the Spirit of God can talk to me!

 

iuAnyway, one of the things I’ve been thinking about quite a bit is the ‘corporate personality’ of cities. My great friend, Martin Scott, has previously done some work on this. Just as people, with their own history and nurture form their own personality, so too does a place. Personally, I’m a fan of the Enneagram as a way of helping understand who we are, why we are, what our shadow self is like and how to become more our ‘true-selves’. I believe this can also be applied to our towns/cities/regions and nations. If we understand the personality of the place we live in, we can help it become fully flourishing and enable it to become the right kind of ‘gift’ to other places. If you don’t know anything about the enneagram, then I would recommend Richard Rohr’s excellent take on it.

 

 

iu-1Anyway, recently, I had a dream about the city of Coventry (the city where I grew up – I love it!) which I think is a type 4 personality.  In the dream, I was in the New Cathedral (one of my all time favourite buildings) and I was helping to facilitate a discussion with a diverse group of people from all over the city. The discussion took the form of a ‘world-cafe’ (a brilliant technique taught by the ‘Art of Hosting’). The underlying premise for the discussion was recognising that the 3 main ‘gifts’ of Coventry’s personality are as follows:

1) A place of peace and reconciliation

2) A place of refuge and healing

3) A place of creativity, innovation and development

 

And so the question being discussed was this:

 

If Coventry was ‘well’ how would it be flourishing in it’s primary gifts?

I wonder if we connected more with the personality of our cities and asked our selves similar questions, just how different our cities (places) could be? One of my passions is for health and wellbeing……what are the places we live in like – what do they look like, sound like, smell like, taste like, feel like, behave like, when they are healthy and well?

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UK, You’ve Had a Heart Attack – How Are You Now?

MIYou 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, they are admitted to Blackpool Victoria Hospital, where an amazing team of cardiologists literally save their life by putting stents into arteries in their heart that have become clogged up. It has been a phenomenal breakthrough in medical science in the last 15 years and has revolutionised how cardiology services are configured.

New medicines are prescribed to help keep the heart and kidneys healthy and patients are reviewed to see how they are getting on. What I always love in the initial consultation following a heart attack is how reflective a person becomes. Everything in their life gets assessed and reprioritised. Key questions are asked about how much stress they have been under, and why they were living at such a fast pace whilst forgetting about what is really important – living well, relationships, love, beauty, people and connecting with the story of who they feel they really want to be for the rest of their life. It is very rare to find a person who is desperate to get back to business as usual or someone who doesn’t ask some fundamental questions about what life is for. It is possible in some of these consultations to have some of the best coaching conversations a practitioner can ever hope to participate in. Asking some questions of the patient about what they are going to change and how they are going to do so.

And yet, in the UK (and indeed the west), we suffered a heart attack beyond all proportions with the economic crash of 2008. But we have not really reflected on the major warning sign that it was to us. We have a government and financial system intent on “getting us back on track” – and I wonder to what, exactly? It isn’t that the financial system alone, just happened to have an infarction. It’s like assuming that a heart attack happens simply because of a defect in the cardiac system itself – this simply isn’t true. The crash was only a sign of just how broken our entire body is and we would do well to reflect a great deal more about how we are living as a nation and whether it gives us any real sustainability for the future of the planet and the generations to come. Our current response is not only to “get back on track” with where we were, but  to “tighten our belts” (which means to cut benefits left right and centre without regard for the dehumanisation of people in the process). It’s like believing the correct response following an MI is to emaciate and punish yourself, without asking some fundamental questions about how healthy your whole life is.

So, what about about a national health check – let’s look at each system in turn and ask some questions – because the truth is, we haven’t faced the fact that we are in an age of transition in which answers are not obvious and we don’t have any experts who have been to the alternative future we long for. So, we have to learn together and ask open questions that provoke better conversations to help us.

Let’s start with Education. George Monbiot has written a stunning piece in the Guardian about the current health of the education system: http://www.theguardian.com/commentisfree/2015/jun/09/aspirational-parents-children-elite?CMP=share_btn_fb – well worth a read. Our education secretary, Nicky Morgan on the other hand isNicky Morgan intent on more testing of our children and has recently given a speech in which she claimed that arts and humanities subject choices close down a child’s career options and they will earn 10% more in their life if they do Maths at A level – whooppee do dah. For an alternative and altogether more inspiring approach, look to the lovely Ken Robinson:

Couldn’t education become about real learning in which our children feel inspired and find hope for the future?

Ecology – Oh dear – so far a string of broken promises on the environment from the western governments. It turns out that oil and industry is more important than the future of the planet. Is it? If not, what are we going to do?

Defence – undergirding our entire nation are three things: Money as debt (see finance), the state of the exception (see law and order) and military violence. The ultimate trust of our nation rests on nuclear warheads. How healthy is this? How much fear do we have to create as a narrative to believe this is actually a good thing? Do we want that to be the undergirding faith of our nation? And what about the change in rhetoric regarding soldiers who die in war. David Cameron recently referred to soil from the battle fields of WWI (which was brought to London) as ‘Holy Ground’ and he described those who died fighting for the ‘allied forces’ as ‘martyrs’. Is the nation state therefore the ‘saviour’? If it is, what on earth do we mean by this? If not, then is there other language we can find to use about the two world wars without creating a very dangerous worldview?

Housing – 69% of the land continues to be owned by 0.6% of the population and there is a real lack of social housing available in deprived areas. This is causing significant problems for those already under huge financial strain, given the effects of austerity measures. Who does the land belong to and why?

Justice – How many of the perpetrators of crime are victims of a system that left them with little or no other choice but to commit crime? How restorative is our justice process?

Law and Order – our prisons are full to breaking, our police force is being cut and replaced with private security firms. How effective is our law and order system? And what undergirds it? Georgio Agamben cuts through to the heart of the issue in his exquisite book ‘State of Exception’. Underneath the whole of western ‘democracy’ lies the right for the government to suspend the rule of law i.e. invoke Marshall law if deemed necessary. I look at the people movements emerging across Europe right now and wonder how far we are from the ‘state of exception’ being invoked. All it will prove, as we already know, is that democracy is a vain imagination. What is it that undoes ‘the powers’? Could a movement for positive peace, founded on love offer any realistic alternative? If so, what?

Immigration – apparently the answer to our problems is to become more fearful of the ‘other’, create a politics of fear and blame immigrants for our financial problems. We are barricading our doors Syrian Refugeesand building up our walls to ‘protect our way of life’. And while there are currently 4 million homeless Syrian refugees, the UK has welcomed 147 of them in total. Did you know that the entire world population could fit into Texas? Our concerns about lack of space and lack of jobs is really unfounded and we seem willing to ‘love our neighbours’ with great initiatives like comic relief and generous charitable giving, just as long as it doesn’t actually have to affect us and our way of life…..how loving is that? How healthy is love that does not truly cost us and change us?

Health – this whole blog is about it, but 1 in every 5 pounds spent in the NHS is due to poor lifestyle choices we are making. We can’t live imgresexactly how we want if we hope to continue with a health service that is free for everybody. How will we change the culture? Can we find innovative ways of working collaboratively within the system that breaks down the silos in order to work more effectively for the good of our national health? Is privatisation the answer? If not, what are we willing to change/protest about to keep it public?

Government – a majority with 36.4% of the vote? Deeply wrong. There continues to be profound disengagement with the system and a deep cynicism that the current style of government can bring any real lasting change. We need a new politics – what might that be like? Where are the leaders who will choose to facilitate instead of dominate?

imgresEconomy – ah yes, that old chestnut. Do we want an economy in which the gap between rich and poor continues to widen? Do we want a system in which the poor are punished whilst the rich are exonerated for their greedy crimes? The entire western economy is based on a system of debt that requires us to continually grow and expand our borders so that the debt can be serviced. We have become slaves to the economic beast. Where are the alternative experiments emerging? What can we learn from them? Are we brave enough to try something new? I have posted this before, on my other blog – www.reimaginingthefuture.org  but Charles Eisenstein is so worth watching:

The human heart provides us with a great metaphor. The health of our nation(s) is not good. We’ve had the wake up call, and if we’re not careful (this is a warning from a doctor, so take heed), the next heart attack will be even more catastrophic. We have to reflect on where we are and ask ourselves where our current trajectory will lead us. I don’t want to get back on track if it leads us to more depression, destruction and decay. I want to find the road less traveled by – the one that leads to life, hope, love, regeneration, recreation and a beautiful future for our children. So many questions. So much to learn.

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How Healthy Are You?

imgresAn NHS health check is available to all 40-74 year old citizens of the UK. The idea is to detect problems like hypertension, (pre)diabetes and the risk of heart disease early so that preventative measures – lifestyle changes and possibly medication – can be offered in good time.

 

There is plenty of debate in the public arena as to how helpful and effective they are and also questions about what is the driving force behind them. (If you’re interested you can read more by searching NHS health check evidence base).

 

There is actually some pretty good evidence that they are making a difference. They have actually been a pretty helpful resource in helping practice nurses and GPs have ‘coaching’ conversations with people about their physical health and what they could do to improve this and help them stay healthier in the future.

 

Ken WilberHowever, does a Q Risk score (something that tells you how likely you are to have a heart attack or a stroke in the next 10 years) really measure how healthy you are? What does it mean to be healthy? If we take Wilber’s work on health and well being (1997), physical health is only a part of what it means to be truly well. If we are to embrace a more holistic understanding of what it means to be healthy people, who live in healthy communities which are part of healthy towns and cities, then we need to take a much wider view of how we measure this.

 

So how healthy are you. Starting with the physical – how is your diet and exercise? How much responsibility do you take over the substances you put into your body – alcohol, cigarette smoke, recreational drugs, sugars, caffeine, toxins like aspartame……? And if you take little responsibility for your physical health, what should the response of a ‘free’ health care service be that currently spends 1 in every 5 pounds mopping up the consequences of people’s poor lifestyle choices? And what about the leaders within our cities – what will they do to tackle the fast food/alcohol/sugar/tobacco industries and the supermarkets who cream profits from product placement and advertising of hugely unhealthy foods? I could go on……

 

And what about your mental health? The fact is: the UK has some of the unhappiest children in the developed world  http://www.bbc.co.uk/news/uk-14908194 (this is always true of places where the gap between the rich and poorest is wider and where materialism is prioritised over time). Anxiety and depression are on the increase and stress continues to be a major reason for consulting the GP. Some of this is systemic and it is a challenge to policy makers to think about the impact of their decisions on the mental health of the population. Austerity and deeper benefits cuts are having a profoundly negative impact on those already struggling. But there is also a challenge to individuals about what we allow our minds to be filled with. How much time in a day do you stop to be grateful, or to be still? How much of your mind space is taken up with addictive tendencies, be that to social media or pornography? How are you at forgiving others who have hurt you? If not very good – how much is the bitterness inside you having a good effect? If the bitterness is eating you up – what are you going to do – hold on to it? How much time do you give to things like singing and volunteering which are seriously good for your mental health?

 

To take Wilber further, we must ask how well we are socially. How connected are you to the people around you? According to the Office of National Statistics (ONS), the UK is in the bottom three nations in Europe for feeling attached to our local communities and for feeling like we can ask for help from people who love us in times of need – what is that about?! How much of our time these days is given over to screens and social media instead of actually having conversations that matter with people in the same street or even the same room as us? What is the social make up of our communities like? Can we see alternative economies springing up like time-banking? What is the provision like for children and old people? Who looks after your elderly neighbour when she’s just come out of hospital with a new hip? Could there be a meal rota on your street?

 

There is one other measure to look at – our systemic health. How much do we feel empowered within society to make a difference and effect change? If not much, then we generally don’t feel very healthy. For me, it’s one of the reasons why community involvement is important so that the unheard voices are given space to speak and to be listened to. How much do leaders within cities think about the impact of their decisions on the poor and marginalised? For some truly incredible work on this, check out the Leeds Poverty Truth Challenge (https://leedspovertytruth.wordpress.com/).

 

So, how healthy are you? You as a whole person and you in the corporate sense? Do you want to be well? If so, think more holistically – think about your physical, mental, social and systemic health.

 

My health check would ask these questions:

Are you eating and exercising well?

Are you drinking responsibly?

Are you taking time to be grateful?

Are you looking other human beings in the eye and building intimacy?

Are you connected to other people in your community?

Are you choosing to forgive others when they wrong you?

Are you taking care of others around you?

Are you walking in open spaces and enjoying this beautiful earth?

Are you singing on a regular basis and taking time to be creative?

 

The challenge to us all is to learn what it is to be really well. The challenge to the health service is to work far more integratively and take a much broader, wider, richer and deeper view of what it really means to be healthy.

 

 

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