To Hull and Back

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 my next blog, I will give the podcast of what I said and written piece, for those who prefer that format, about Population Health and the realities we are currently facing.

 

However, I thought it just worth reflecting on a really interesting lecture I heard by Prof Franco Bianchini from Hull University (https://www.hull.ac.uk/work-with-us/research/institutes/culture-place-and-policy-institute/culture-place-and-policy-institute.aspx) on the impact of Hull being European City of Culture 2017. It was amazing to see this little video, presented by the excellent Director of Public Health, Julia Weldon (https://www.yhphnetwork.co.uk/about-us/julia-weldon/), and to hear of so many wonderful, creative, life-giving, community-building initiatives that happened all over the City and the beautiful stories of people celebrating the history and many facets of this place. 

 

The sense of wellbeing and happiness in the City increased significantly during that year (not much of a surprise) and the injection of finance into Hull gave opportunity for some creative regeneration and fantastic projects. Unfortunately, since 2017, the overall sense of Wellbeing and happiness has now fallen to below what it was in the years preceding Hull as the City of Culture. What a shame! And interestingly, if you study other Cities that host Olympics, Commonwealth Games, or have other similar initiatives, you see the same pattern over and over. The hype wanes, the carnival moves on and what is left?

 

There is so much we can learn from this, if we want to. Firstly, if we only plan for an event and do not think about it as an agent of transformation for the future, then we risk sowing huge promise and then once the event finishes, things just go back to being the same old, breeding disappointment and disillusionment. This must be taken into account in the planning. Becoming a City of Culture gives the opportunity for a City to come together, not only for an event, but to turn the future of the city, releasing dreams of what it can become. This requires much wider ownership and community conversations about keeping the momentum and building on it. Secondly, leaders across the city need to own the future and hold true to the principles, especially once the funding is withdrawn. It’s really sad that the vast majority of schools have not felt able to continue the great initiatives in the creative arts or sports, which began and were having a great effect on children and young people’s physical and mental health, due to the pressures they feel around delivery of the curriculum. Surely there was an opportunity to reimagine the whole realm of what education might look like in the City of Hull, aligned to the values of the City and its hope for the future?

 

In the Jewish tradition, at certain points along their journey from Egypt to Israel, the people would build an ‘Ebenezer’. It was a pile of stones to mark a certain point on their journey that would help them remember what was past and what they were looking forward to. It was more than a monument. It was a stake in the ground which called to memory where they had come from, what they had been through but also opened up an altogether different future. My hope for Hull, is that 2017 City of Culture becomes an Ebenezer for the city, something they can look back on and say – “that’s when things really began to change, that’s when we celebrated our past but began to build a new future together, a city that really works for everyone and the environment we live in!” I fear, however, that the opposite will be true….a temporary flash in the pan and then back to the same old, same old……

 

I hope with all my heart that it isn’t too late for Hull to regain this momentum and despite the lack of funding (although this begs whole new questions about devolution) for the city to take hold of the promise of what could be. I also really hope that Coventry (the city of my birth) really hears and learns from the lessons of Hull and begins now to think of being the City of Culture 2021 to springboard into a new future for the city, rather than have yet another event that feels good in the moment, but does not bring the transformation of the City that is so desperately needed. Now is the time for Coventry to dream and to think creatively about what this opportunity really might become. 

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Lessons From Helsinkii

I’m just returning from 36 hours with the Coalition of Partners for Europe, as part of the World Health Organisation. There were a further 2 days of conversations to occur, but I needed to get back to Morecambe Bay. I have learned so much during my short time with this amazing group of people, some new things and other things learning at a new depth or from a different perspective. I am again bowled over by how using tools from the Art of Hosting can bring a diverse group of people, across languages and cultures together to have really important conversations. Rather than write this in long paragraphs, I’m simply going to bullet my learnings, some of them personal, some more corporate, some amusing, some difficult. One thing is for sure: I know much less than I thought I knew!

1) Finland is 100 years old this year. It has a fascinating history. They also have one of the best Public Health systems in the world and are huge at tackling the social determinants of health. We have much to learn from them and their Scandinavian neighbours.

2) People LOVE the idea of a Culture of Joy! There is a tiredness to the WHO but a recognition across the board that there is a need for cultural change and that culture determines an enormous amount in terms of how well organisations function. Remember a culture of joy is built on good, honest, open, encouraging, kind, approachable and vulnerable leadership, with team members feeling a) that they belong and are loved/valued b) that they are trusted to do their work and c) they share a strong sense of vision.

3) There is wide recognition that Social Movements are vital if we are going to break down health inequalities and see the health and wellbeing of all people improve. We simply cannot come up with ideas in board rooms and ‘do them’ to communities. However, there is also fantastic data and learning available to communtities, which can fuel the social movement. Public Health and Primary care must not sit as separate to or aloof from this emerging movement, but must be a key player and protagonist.

4) When dealing with complex systems, it is good to think of them as gardens instead of machines. To whom does the garden of public health belong? Public Health belongs to the public – it is part of the commons. Therefore communities need to be more involved. There are some great examples of community engagement from across Europe. However, we must move from consultancy to co-production and co-design.

5) Helping people live longer at a poorer quality of life is a pointless goal. The league tables and goals we develop must be co-designed with communities. Our markers of health and wellbeing need some reassessment.

6) People everywhere in the Western world are scared of talking about death and this has huge implications for how we spend money in our health systems.

7)  Our European history is so fragile. This causes its own complexities when European people meet together – it all comes into the room with us and requires grace and kindness as we communicate. The quality of relationships within the coalition is fantastic, but more time is needed to develop this.

8) When trying to drink a yoghurt in a taxi, it is important to seal your lips around it well, otherwise you spill it all down your front and look like an idiot.

9) Public health and Primary Care are the bedrock of any health system. I knew this already, but the evidence from around the World is staggering. If these two foundation stones fail, and the staff who deliver these services are not cared for, the entire system collapses.

10) The UK has some of the best public health systems of anywhere in the world. However, the world is watching the decimation of our public health services with dismay. The vital role of prevention and protection that public health has must never be underestimated. If we do not invest in prevention, the consequences for the health system is devastating. The reorganisation of Public Health into our county councils has seen profound cuts to the budgets, as councils have removed the ring fenced budgets. This will almost certainly have detrimental consequences, especially when it comes to tackling our most difficult health and wellbeing issues.

11) When people tell you that all saunas are naked, this may not actually be true and you might end up feeling pretty awkward!

12)  We have much to learn from other areas and nations. Shared learning is key. We can do this without competition, hierarchy or lording it over each other.

13)  Building good relationships is everything.

14) There is a new generation of leaders emerging who are able to deal with complexity, refusing old silos, borders and hierarchies and finding ways to collaborate through good, honest and vulnerable relationships.

15) We need to learn to hold expertise in one hand and humility in the other. The expertise in epidemiology and the mapping of our health and social issues is vital, if we are going to close the health inequality gaps.

16) Public health is dependent on building partnerships. The wider social determinants of health (poverty, housing, adverse childhood experiences, loneliness, education, environmental issues etc) cannot be tackled by the meagre Public Health budgets. Coalition, collaboration and cooperation across many sectors are necessary for us to begin to tackle these hugely complex social justice issues.

17) Due to public health being underfunded, it leaves it wide open to abuse from those who hold the money strings. Lobbies, donors and national governments hold huge power in determining what does and does not receive funding, often despite the evidence.

18) We need leaders who understand the importance of gift economy and making investments into areas which will not serve their ego nor their profile, but will cause huge benefit to many people.

19) Collecting really good data is important. We need to learn to use it well to shape the conversations and change policy and legislation.

20) Public health holds a hugely important voice in calling governments to account for policy decisions that are to the detriment of a nations health. There is now clear evidence that austerity economics is really bad for people’s physical and mental health and is actually causing people to die. Theory must be challenged hard when evidence does not support it.

21)  The poverty truth commission has so much to teach us. No decision about me, without me is for me. this statement made a profound impact on some of the delegates.

22) Doughnut Economics has caught the attention of the coalition.

23) Fazer chocolate is delicious.

24) One of the most challenging truths I learned is that it is often public health workers and doctors/clinicians working on the front line, who are the biggest barriers to working differently with communities and ironically get in the way of the very thing they would love to see happen. This has more to do with the ways we train people to think and work than anything else.

25) Although my talk went well and was hugely well received, I am learning more about the power of story and how to tell our story more effectively.

26) I am grateful that the coalition of partners does not depend on membership of the EU but I am more aware of the pain that Brexit is causing both for me personally and for many friends across Europe.
I understand that Brexit is happening, but day by day it feels to be one of the worst decisions we have ever made as a nation. It is going to cost us over £50 billion to leave, cause untold issues for our ability to trade, decimate the 3rd sector (which btw is the only thing right now stopping our public services from completely collapsing), undo so much great work built through the partnership of our nations and not deliver on any of the false promises made around extra money for our health system or solve our ‘migration issue’. Yes, the EU needs to change, but we have made a monumental error in leaving, rather than reforming it and I still feel we should just apologise and rebuild our bridges rather than burn them.

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3 Keys for the Future of Healthcare

Tweet This week I traveled to London for an interview. The lovely team that I work with have nominated me for the HSJ Clinical Leader of the Year award. Unbeknownst to me, this meant presenting myself before a panel of experts and leaders in the field of healthcare to talk about the work we have been [Continue Reading …]

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