Tag: Morecambe Bay

A 3 Fold Approach to Population Health

Here in Morecambe Bay, we are trying to develop a strategy around Population Health – by that we mean we want to take a much broader view of the health needs of those who live in this area, ensuring that we try to tackle the disparities we see in the health of our population. In my opinion this needs a three fold approach.

 

Firstly, we need to get our own house in order. We know there is work

© www.stevenbarber.com – Dr David Walker

for us to do as a health system when it comes to ensuring we’re proactive with people’s health. With the resources we have available, we need to ensure that we are treating preventable conditions as well as possible and use the best evidenced-based approach to the care we are delivering. That is why, the excellent Medical Director of UHMB, Dr David Walker, with his vast experiencing in Public Health, is helping us focus on making a significant difference to preventing Strokes (CVAs – Cerebro-Vascular Accidents) across the Bay this year. We are making a concerted effort to ensure that all our patients are getting the necessary pulse checks, blood pressure checks, blood tests and appropriate medications to monitor and manage conditions which can lead to devastating consequences if left untreated or mismanaged. Within this, we are encouraging people to know more about the conditions they live with, understand them and take responsibility to ensure that they are caring for their own health.

 

Secondly, we are working with people across the Bay to live more healthy lives. We continue to see more and more children running a mile a day and hope that this will soon become the Morecambe Bay Mile, in which it becomes the norm for everyone who lives here to move a mile a day. Our sedentary lifestyles are hugely affecting our health and we’re wanting to encourage all business owners and leaders to ensure that staff have time to be active every day. On top of this we’re starting to work with schools around healthy eating and involved in projects with supermarkets to enable people to make more healthy choices in the face of fierce advertising. We’re also working with high schools around mental health issues and seeing many community initiatives springing up, run by the community for the community, which will improve the wellbeing of all. All of this is backed by our ‘Flourish’ work in our hospitals and ‘Let’s Work Well’ in the community, in which NHS staff are leading by example in changing the way that we work and live.

 

Thirdly, however, we need to dig deeper. We keep trying to put a sticky plaster over the great pus-filled abscesses that are the leading causes of ill health in our country. Traditionally we have paid much of our attention to dealing with the symptoms of ill health, and whilst thinking about the root causes, we have simply not putting anyway near enough time, energy, or resource into tackling them. The reason for this is two fold: firstly, health and social policy is directed far too much by the political cycle and the short term gains that can proven in small time windows – so we keep tackling symptoms because we can then prove how effective we are!; secondly, in truth, we don’t actually know how to tackle some of the issues and those of us in leadership roles are far too clever and proud to admit that we don’t know how to fix them and that we need to find a new way together, with the communities of which we are a part.

 

I was having a conversation with Cormac Russell the other day, via twitter, and he gave me this beautiful quote by Ivan Illich: “I believe it is time to state clearly that specific situations and circumstances are “sickening”, rather than that people themselves are sick. The symptoms which modern medicine attempts to treat often have little to do with the condition of our bodies; they are, rather, signals pointing to the disorders and presumptions of modern ways of working, playing and living.”

 

The reality is that many of the determinants of our health and especially of the health inequalities we see in our society have little to do with the availability or quality of services. No, the biggest factors affecting the health gap in this (and every) area are poverty, housing, loneliness, hopelessness and adverse childhood experiences. If we’re not careful, we end up thinking the real issues are waiting times in the ED, difficulties discharging people from hospital, breaking the 18 week target for hip and knee operations and ensuring there are enough GP appointments at weekends. We must not look at the symptoms and believe that if we tackle these surface issues then we will automatically have better health outcomes for all. Here in the Bay, we are trying to be brave enough to take off the sticky plaster and gaze into the festering wounds in our society, so that we can begin to really do some deep debridement of them and allow real healing to ensue.

 

That is why my team are focusing on hosting conversations that matter across our communities and seeking to co-create a social movement. Using the ‘Art of Hosting’ we are holding spaces open in which rich conversations can happen. “We don’t just want people to be more healthy and well – many people don’t even know what that means”, as an amazing woman called Gill, from the West End of Morecambe told us recently, “No, we want everyone to be able to experience life to the full, whatever that means for them”. We can’t do this simply by having good clinical strategies – we need something far more holistic and it will involve all of us.  We need to start our conversations together with appreciative inquiry. What is already going well? What can we learn from here? Knowing what is good, however, is not enough – we must go further, dig deeper and get to grips with some extremely difficult issues.

 

When it comes to Poverty, here in Morecambe Bay, we are trying out new economies (like time banking) and having challenging conversations. The Poverty Truth Commission is causing is to really listen to those with lived experience of poverty and learn to co-create and co-commission services, rather than presuming that the ‘experts’ know best.

 

When it comes to homelessness, inspired by the work in Alberta Canada (https://www.goodnewsnetwork.org/find-out-how-this-canadian-city-has-eliminated-homelessness/) and the Manchester Homelessness Charter (https://charter.streetsupport.net/) – we’re beginning to explore ‘housing first’ for Morecambe Bay, but imagining what it might be like with extra support in place from a caring community like ‘The Well’ in Morecambe and Barrow (https://www.thewellcommunities.co.uk/). I’m so pleased that Dave Higham is provoking this conversation for us here and I’m excited to see where a conversation between those with lived experience of homelessness, poverty and addiction, along with some of us in the public sector, might take us. There’s a challenge to all of us in society – we like the sound of these kind of things, but not in our own backyard….our values must begin to align with our actions. Love without action is not really love.

 

And what about loneliness and hopelessness? More than ever, we need connection across the generations, turning off our screens and actually being together as humans. In Morecambe we are seeing the launch of the new Morecambe Fringe in September, bringing people together around Comedy and the Arts. More Music are doing incredible work with young people. There are amazing community initiatives right around the Bay. We have loads of festivals connecting people across the district. And what is the role of business here? We need businesses to think abut what kind of enterprise we could see emerge for the youth in our area. Are there more opportunities for mentoring? We have left many of our young people to boredom and with few aspirations. With the help of Stanley’s Youth Centre and the great heart of Yak Patel, we hope to host many conversations with young people to really listen to what it is we could create together to break these problems and build community and hope.

 

What are we together going to do about the huge issue that is child abuse? We don’t have answers, but we do have questions – and we need to keep asking them. We know that the mental and physical consequences of abuse are utterly devastating and we find it hard to talk about because it affects so many of us. But our interventions are happening too little, too late, and we are missing the vast majority of cases. Our services simply cannot cope with the volume and serious case reviews tell us the same lessons nearly every time. So what? What are we going to do differently? There are definitely things that the public services can do better – but not when our resources are being stripped. What is especially terrible about the cuts to services in our most deprived areas is that ACEs cause poverty, homelessness, isolation and ill health! As a team, we take this really seriously and will be hosting discussions in our schools and local communities about how we raise happy, healthy children. Where is help needed? We’ve become so focused on grades and outcomes in schools…..but do we teach people what to do with their anger? Do we focus enough on values? Are there enough parenting (the hardest job in the world) classes – and if so, are they hitting the mark? What do we need to do differently? We know the situations in which children are more likely to suffer – so what? Have we become so focused on getting people into work that we’ve forgotten just how important parenting is? And if we know that ACE is such a massive issue, are we really making the right choices in terms of what therapies we’re making available for those who have suffered them?

 

Is it the role of those of us in healthcare to get involved in these discussions? YES! It is the role of all of us in society. Together, we must reimagine the future. We all know that prevention is better than cure, but our short-termism is stopping us from finding the kind of positive solutions that will really make a difference. In face of downward pressure from hierarchical powers, it is tough to make brave decisions to invest in the future, rather than cut our way to balancing the books. But if we really care about the health and wellbeing of our communities, then we have to stop the sticking plaster approach and clean out the gangrenous wounds in our society. We have to deal with the root and not the fruit.

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Continuously Learning Health Systems


Learning requires humility. It requires us to accept that we don’t know everything, that we get it wrong sometimes, make mistakes and need to own up to them so that we don’t do the same thing again. Learning is a vital part of all we do in health and social care, if we are to create truly safe, sustainable, compassionate and excellent services. But humility, although vital, is not enough on its own. There are things we need to put in place to ensure our organisations are continually learning, and not only so but that we actually implement our learning and incorporating it into new ways of working so that we change as a result.

The IHI and Allan Frankel have come up with a really helpful and pretty straight forward framework which enables us to do this. It requires 3 basic ingredients:

 

1) Leadership commitment

2) Individual responsibility

3) A shared learning culture for quality and safety

 

Leadership is absolutely vital in setting the right structures and support in place for learning to take place. It requires:

 

-transparency with the public, patients and staff

-vulnerability about weaknesses

-openness about what is being learned and what is changing as a result

-ensuring we are learning with and from our patients not just within our clinically teams. (Some of the most powerful learning we have done in Morecambe Bay has been from women using our maternity services. Our attitudes, communication skills and expertise have all improved dramatically as a result).

-commitment to the psychological safety of staff in developing a culture in which no question is too stupid and no concern is dismissed

-genuine care for each member of staff, creating a culture in which every person can be mentored, coached and encouraged

-time given and protected in which learning can be fostered

 

Personal Responsibility

Who are you?

In my role as a coach/mentor or trainer I have found that we have become far too obsessed with ensuring that people have the right skills but not necessarily paying too much attention to who people are, what their character is like, what their strengths and weaknesses are and how they are developing as a human being. Our medical/nursing and other clinical schools are filled with people eager to learn but who often have no idea about who they are and who, not what they would like to become. Knowing who you are as a person, hugely affects your clinical practice and we do not give it any way near enough attention. I am personally a huge fan of the Enneagram. For me it has been transformational to understand as a type 7, not only what my root need is (to avoid pain) what my root struggle is (gluttony) how I do under stress (become a falsely happy control freak) but also, what my invitation is (towards sober joy and deeper understanding), how to become a more healthy version of me and therefore a better gift to my family, my team and all the people I’m trying to serve. It has helped me to recognise when I’m doing well and when I’m not and to understand how to bring my core strengths to the fore whilst also recognising where I need discipline and boundaries to function from a more healed place. We each have a responsibility not just to be good at stuff, but to be good at being us. And  being us is more than just knowing how we function (e.g. ENFP in Myers-Briggs) but to get below the surface to the core of what makes us tick, that makes us human. Knowing who we truly are enables us to be better, kinder, more humble, genuine, compassionate people, who put aside the need to beat others down and learn to appreciate them so much more. When you really know the team you are working with, they become your friends, you understand the little idiosyncratic things about them with a whole lot more patience and you can also challenge them when they are not behaving in a way that is conducive to good care and you can also receive that challenge back when you are out of line. I wish that we were more interested in caring about who we are rather than only in what we can do. This has got to be a part of the culture of joy I have blogged about previously.

How are you?

Personal responsibility beckons us to be more honest with ourselves and others about how we’re doing emotionally/physically/mentally. It has been a transformational practice in our team to simply check-in with each other and talk about where we’re at. In this way, we can carry each other when needed and treat each other with kindness and compassion. But our individual agency, must also cause us to recognise when we are at a wall/ceiling/limit personally or professionally. We must simply own up when we don’t know something or are out of our depth or need help. We cannot pretend to be able to have a competency that we don’t have. We need to be self-aware and humble enough to accept when we don’t know something or have become unwell and ensure that we take it upon ourselves to find out or get the help we need. This is learning to have an internal, rather than an external locus of control. An external locus, always looks elsewhere for the answer. An internal locus takes responsibility to find out and keep learning. We need to develop a core value, that learning is really really important and we will prioritise ensuring that we keep making time to do so, through whatever form that takes, especially reflective practice. Yes there is some dependency on supportive structures and time being given, but there is also that sense of motivation that comes from within that we take ourselves and our roles seriously. It’s one of the reasons why I’m such a fan of a combination of problem-based learning and a solutions-focussed approach. If we do this ourselves and foster it in our teams, the care we provide will be beyond stellar!

Why are you Here?

We talk about the law of two feet in our team. You are responsible to know why you are here, or if you need to be somewhere else. That might even mean a job change, but more often than not it means having some good boundaries, knowing whether or not you really need to be at a certain meeting or somewhere else, if you should be doing what you are or if you need to ensure other things get the right focus. And what about yourself? Have you taken time to eat well, stay well hydrated, exercise, sleep well, maintain health in your relationships? In teams that care for each other we need to help each other to know why we are there and why we are important.

 

A Shared Learning Culture

 

It’s amazing to me that so many of our learning environments are still so teacher-based. Adult education is so much more empowering than this and it’s high time our clinical learning environments (both preclinical and in every day life) reflect this. They should also be more inclusive and we should be learning with and from our patients far more than we do. Although the above graphic applies to classroom settings, it contains many lessons for us.

 

With leadership and personal agency holding true, a culture then develops in which continuous learning is the norm. Learning environments, fuelled by kenotic power create a space in which an organisation can begin to truly flourish. It creates a net of accountability, teamwork, improvement and measurement, making the entire system more reliable. It is vital that we create this as one of the core principles upon which we build our future health and social care systems.

 

 

 

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Social Movements and the Future of Healthcare


As the crisis in the Western World deepens, and the growing reality sets in that business as usual simply can no longer continue nor solve our problems, our systems must change the way they view, deal with and hold onto power. The NHS is no exception. If we want a health and social care system that is of the highest quality, safe, sustainable and economically viable for the future, we need to understand the power of social movements, both within our systems and through the wider society. This is something we are really committed to in Morecambe Bay and so it was with great delight that I listened to the excellent Helen Bevan, talk about just how vital social movements are for the NHS and healthcare, worldwide at the recent IHI conference in London, Quality 2017. This blog will be an amalgamation of what Helen shared and my own thoughts about our early experiences with social movements.

 

 

A social movement in health and social care involves us all learning to connect, collaborate, cooperate, cocreate and coproduce at a level we have never done so, until now. But our circumstances are forcing us to reconsider the ways in which we work. We need the creative substance that is within our teams to be heard and harnessed so that we cut our waste and work more effectively together. The issues we face, need facing by us all, together; not by some board in an isolated room, making decisions based on diktats from on high, on behalf of us all.  But even this will not be enough. Those of us stuck in the system have become too homogenized in our thinking for us to do this exclusively from within. We need our citizens to help us re-imagine what it means for us to be healthy and well. We must stop designing things for our communities or doing things to them, instead we must design and do things with them. We must analyse, create and enact together and to do this, we must learn to solve the issues of power.

 

Helen Bevan, with her background in social science, demonstrates the great debate about the interplay between our organisational structures (rules) and agency (freedom) when it comes to effecting change. Where does the “permission” come from to enact the change we need to see? Is it externally generated by those in positions of power, or is it internally generated by a personal motivation? Our experience in Carnforth and Morecambe in community conversations has been a bit of both. There are many people of incredible heart and goodness, waiting to do something new and good that will positively affect the health and wellbeing of society, but are perhaps waiting for that sense of community backing, support, encouragement or indeed permission. With a bit of coaching or spurring on, we have seen some amazing initiatives begin that are bringing transformational work into our area and causing us all think differently. We need both individual agency AND corporate agency. Helen describes individual agency as being when people get more power and control in their lives – we see this in patient activation, shared-decision making and self-care – a greater sense of autonomy and responsibility. Collective agency, on the other hand, is where we see people act together, united by a common cause, harnessing the power and influence of the group whilst building mutual trust.

 

 

We have seen this used powerfully, in just one example by our maternity liaison service committee, who together have challenged our system to think more carefully about how we communicate to women, especially at key or stressful moments of their obstetric care. These stories are now a compulsory part of training for all who work in our maternity service and have significantly improved both our skill mix and ability to provide excellent care.
What is absolutely vital to understand is that we do not become transformed alone. We are transformed when we are in relationship with others (Hahrie Han). The problem is that we don’t really encounter the “other” enough to be changed. However,  when we let go of the kind of power that is held by the few, pushes others down, uses command and control, that is closed and transactional, and instead embrace a power that is held by the many, shared, open and relational, then we can begin to see the change we need (Hirschman and Ganz).

David Holzmer says that we are witnessing the collapse of expertise and the rise of collaborative sense-making. I would suggest that this has been going on for some time, but our systems have been incredibly slow at catching onto the change around us.

 

Now, what is hugely encouraging is this: research by Kollectif shows that you only need 3% of people in an organisation/society to drive the conversations with 90% of other people. In other words, you don’t have to get everyone on board from the word go. You find your passionate people with a sense of agency, infect them with the virus and watch it spread. These people need to be a mixture of ‘lone wolves’, mobilisers and organisers. Lone wolves are people who have been trying to help change happen for a long time but can sometimes feel like an annoyance to the system, so they are given tokenistic positions, patted on the head and patronised into exhaustion. Mobilisers build power by calling large numbers of people to contribute, engage in change and take action. Organisers build power by growing leaders in a distributed network, building a community and protecting its strength. We need all of them, though mobilisers and organisers will be the most effective in creating agency and bringing about lasting change  (Hahrie Han).

Joe Simpson says that ” great social movements get their energy by growing a distributed leadership.” The cult of celebrity can be powerful, but is not effective. The beautiful thing about a social movement is that is depends not on money, materials and technology but on relationships, commitment and community, and as the movement grows, these resources increase, rather than diminish. The problem, as Don Berwick puts it, is that leaders in position of strategic influence, are simply not seeing the resources available to the biggest problems we are facing.

 

Jason Leitch and Derek Feeley have powerfully shown that performance management (keeping the power), based on targets, sanctions and inspections can only get us so far. Quality improvement (sharing the power) gets us a little further, but mobilising social action, or co-production (ceding power) has a far greater potential to bring lasting change and far better outcomes for all.

 

So, how do we catalyze a social movement and how would we know if the movement was being “successful”? Well, our experience in Morecambe Bay is that you start with the 3%. You start with those who are drawn to the conversation, who recognise the need for change and who want to be part of it. You start with transparency, with openness, honesty and vulnerability about the mess we find ourselves in and the truth that we no longer have what it takes to solve the problem. And you start with really good questions and then deeply listen to the conversation which is emerging so that we ourselves are changed and can therefore be part of the emergence of something new, which operates on an entirely different kind of power.

You might call this a re-humanisation of our systems based on love, trust and the hope of a positive peace for all. But this social movement is not aiming for some kind of hippy experience in which we are all sat round camp fires, singing kum-ba-yah! This social movement is looking to cause our communities to flourish with a sense of health and wellbeing, to have a health and social care movement that is safe, sustainable, socially just and truly excellent, serving the needs of the wider community to grow stronger with individuals learning, growing and developing in their capacity to live well. That is what we must measure!
And so we need disruptive co-creation, which breaks through the top-town/bottom-up approach and causes us to see and hear like we have never done before. It is hugely exciting and enables managers to stop feeling like they have to extract as much performance as possible from the system, flogging the workforce, blocking change and innovation and inadvertently driving down the quality of care in the process.

The invitation is instead to become part of the change that we all long for. If we’re going to have an NHS in the future, we have to give it back to the people and work with them. In order to do this, we have to deal with and change our relationship with the very notion of power – something I will turn my attention to on the next blog!

 

 

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Turning To Each Other

Here are some excerpts from a speech I gave recently at Lancaster City Hall about how in a time of crisis, we can either turn on each other, or turn to each other (my friend Mike Love gave me that line!). When we turn to each other, unimagined possibilities become the fuel of hope for a better future for us all. I broke the 20 minute speech into just over 6 minutes – sorry if it’s a bit clunky, but I hope you get the gist!

 

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Why Are We So Inactive in the North West?

So, I was interviewed on BBC News 24 on Monday evening (sorry for the poor visual quality), to talk about why it is that we are so inactive in the North West (worst in the country, apparently at 47% being inactive).

We have also pretty much the worst health outcomes, with high rates of obesity, heart disease and Type II Diabetes. Maybe we can muster our Northern Spirit and do something about this together? We may have the odds stacked against us with the weather (!), our work-life balance, long working hours and various other factors, but being active is so good for us and helps our health in so many ways – let’s cut the excuses eh? Maybe it’s time for a cultural shift?! Time for healthier workplaces.

 

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The Morecambe Bay Mile A Day!

Every day in Morecambe Bay 2000 children aged 4-11 run a mile a day (how fantastic is that?!). Inspired initially by the story from Stirling, the word  is spreading and we now have another 3000 children starting across Lancashire. Our early data shows that there has been a dramatic improvement in the children’s health, from a physical, mental and educational perspective. 15 minutes a day for a healthier, happier child who is able to sleep better and concentrate more in class – it’s an absolute no brainer. And what is more – if it’s good for the kids, then it’s good for us all. We will all be more physically healthy, more mentally well and be more productive in our work if we just take a break (especially in that post-lunch lull) and do some exercise! Who amongst can’t spare 15 minutes a day? And for those who can’t run, there are other alternatives. Some of our kids here are cycling or walking or even using hand bikes according to their physical ability, but everyone is taking part. Even on rainy days, they just get out there, or if it’s especially vile, they do some aerobics or zumba in the classroom.

 

The challenge is this: if kids 4-11 can move a mile a day…..can’t we all? What if it became part of our culture, here in Morecambe Bay and further afield that everyone is given space in their educational or working day to run or move one mile each day? One mile – 15 minutes – easy!

 

Today, Simon Stevens, head of the NHS, will highlight that we are now half way through the 5 year period he launched to help transform the NHS. Across the UK, there are now 44 STPs (these stand for Sustainability and Transformation Plans). In order for the NHS to be sustainable in the future, there needs to be some transformation – it’s simple really. There are plenty of conversations happening about how the system itself can work more efficiently and many new ways of working are being trialled and forged. However, we all also need to transform the way we are living, as our current lifestyles are making the NHS have to deal with pressures it simply can’t cope with anymore. Part of our work as an STP in Lancashire is to work with our population to encourage us all to be more healthy and well in our daily lives. It isn’t rocket science. Simple, small steps go a long way to making significant changes to our health. The 4-11 year olds have laid down the gauntlet – one mile a day – a simple first step that packs a real punch. The NHS and City Council will be following in their wake. One of our headteachers lost 3 stone in 6 months just by following their lead…….let’s get moving, let’s be healthier and let’s have an NHS that is therefore more sustainable for the future. The Morecambe Bay Mile a Day could easily become the UK Mile a Day. (Also see The Daily Mile Foundation).

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How do You Solve a Problem Like………..£50,000,000?!!

On Friday night, watching comic relief, I got quite excited as the total neared £50 million – I turned to my lovely wife and said – ha – there now, we can plug the gap in our local health economy for next year! (Obviously the money is desperately needed in many situations across the UK and Africa, so I wasn’t being flippant), but – that’s the target we’ve been set by the government in Morecambe Bay – save £50 million pounds – one tenth of our budget in 1 year!! Sure thing! The public just love to hear about cuts! Comic relief – you have to laugh, or you’d cry……..but the situation isn’t really very funny and yet, if we don’t head into the fray with some joy and hope in our hearts, we will become wearied very quickly.

 

Let me frame this problem by stating something we must then put to one side. Professor Don Berwick, health advisor to Barack Obama, and president of the IHI (Institute for Health Innovation at Harvard – a clever man by all accounts) recently stated very clearly to the Department of Health that it is quite simply not possibly to continue having a National Health Service run on only 8% of GDP (the lowest spend on healthcare of almost any OECD nation). We must also put to one side the recent publication by the King’s Fund, the independent think tank, that states quite clearly that the government are not investing anywhere near what they promised they would  in the NHS. It also demonstrates that the NHS is not a bottomless pit, as some of the media would have us believe. Read it in more depth here:

(https://www.kingsfund.org.uk/topics/productivity-and-finance/nhs-myth-busters)

 

We know we need more funding. We know there is much negativity in the press about the crisis we are facing, we know about the recruitment issues and we know about the low morale of staff and high strain on the service.

 

Having put all of that to one side and accepting that the NHS remains a political football, currently being given a good kicking, we do need to have a sensible conversation. Whether we like it or not, as we look into the future, it is unsustainable for the health and social care system to have to allocate 1/5th of its budget as a direct result of our lifestyles, 1/10th of its budget on diabetes (the vast majority relating to type II, which is hugely preventable and reversible) or to double pay for beds in nursing homes and hospitals because of unnecessary admissions. So…..what are we to do? Simon Stevens, the head of the NHS will, this week give a major speech on the direction the health service and the progress of the Sustainability and Transformation Plans (STPs), of which there are 44 across England – they have little chance of success if we do not believe that we are all in this together.

 

It truly involves all of us! We, the people, together must face this problem head on. We do not have to turn on each other in a time of crisis, we can turn to each other and use our collective wisdom and gifts to find a way through. This does not have to mean doom and gloom. It could mean better community cohesion, a more positive way of working together across the system, organisations working collaboratively in a way that makes more sense for those who need help and all of us taking a bit more responsibility for our own health and wellbeing. We must learn to rebuild the very fabric of society, based on love and trust, de-professionalise the public and civic space (as per Cormac Russell) and reconnect as human beings who care for each other and want to have systems that serve our needs. This will be made possible through multiple, small and large conversations in which we take time to ask some really deep and important questions, holding the space through the process of frustration as we wrestle together for solutions that we can all work with.We don’t leave our brains and expertise at the door, but nor do we behave in archaic hierarchical ways or hide behind our name badges and lanyards.  Here in Morecambe Bay we have started this very process, using a set of values from ‘the art of hosting and harvesting conversations that matter’ – here is a link to one of our conversations in Morecambe:

http://aohhealthandwellbeingmorecombe.weebly.com

 

Over the next two years, our team will be working with communities right around this Bay to ask and explore some important questions, such as these:

 

  1. How do we begin well? Put another way – How do we enable our children to have the very best start in life? (This may include areas like breast feeding, bonding, parenting, healthy food, exercise and the massive public health issue that is child abuse – or adverse childhood experiences, or maybe issues like indoor vs outdoor learning, music, arts, sports, targets, sex, screen time, social media etc) – what are we going to do about this as a society?
  2. How do we live well? How do we face some of the issues we are now having to tackle? How do we square up to some of the nonsensical adverts, learn to laugh at them, rather than be sucked in by them and change the message?! How do we reconnect, heal our divides and learn to live well alongside each other? How do we heal our past traumas that have such a huge impact on our health and wellbeing now? How might we build the kind of economy that cares about people and the planet? How might we live in an altogether more healthy way? How do we become less dependent on a medical model to fix our problems and take a more holistic view of what it means to be well?
  3. How do we work well? How do we create work that cares for the future and sustainability of the planet? How do we work in ways that are beneficial to our health and by doing so actually help us to be more effective and efficient? How do we create a culture of kindness and compassion in our workplaces?
  4. How do we age well? How do face retirement, without it becoming  only a selection of cruises and alcohol (biggest problem drinking now in women over 60)? How do we connect three generations back to each other and enjoy life more fully together? How do we live well with increasing frailty and health issues? How do we understand the conditions we live with and learn how to manage them ourselves (self-care) as effectively as possible? How do we create the kind of social care that is compassionate, caring and serves to create community?
  5. How do we die with dignity? We must ask ourselves some difficult questions here. Why do we admit so many people to hospital from nursing and residential homes, when there is little evidence that they get better any faster and then end up blocking the beds? Why are we not more radically reallocating resources out into the community to care for people in these settings and in their own homes? Why are we so afraid of our own mortality and allowing people to die well in environments that are familiar to them, surrounded, where possible, by people who know them and love them? How can we face our own deaths well and plan for them in a way that makes the end of our lives better for us and those around us?

 

If we take each of those questions in turn (as we plan to do) and really talk together about how we make society and therefore our health and wellbeing better for everyone, rather than leaving it to others to make those decisions from on high for us, then I think we will achieve more than we could ever imagine possible. It is in discovering one another, in encountering the other that we can be transformed and find new ways forward together.

 

A people movement or social movement such as this will invigorate and create space for those within the systems not only to reconnect with our own humanity but enable us also to have braver conversations about how we can share our resources more effectively, work together more creatively and reimagine how we can provide the kind of health and social care that makes sense for the needs of the people we serve. We might not save £50 million, but we can’t continue with things as they are and if we talk and work together, we could make a really difference.

 

 

 

 

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The Art of Hosting Good Conversations – Morecambe

Here is a video about a brilliant couple of days a bunch of us had in Morecambe, talking about how we discover what it is to be healthy and be part of a social movement to improve the health and wellbeing of everyone:

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Doing the Impossible – Turning the Tide!

It’s time to do the impossible. It’s time to turn the tide.

imgres.jpgIn my last blog, I talked about the exponential potential of what could be possible if clinicians worked together in a more collaborative way. However, far more can be achieved if we work together in and with our communities to create a social movement together around being more healthy and well. I’ve talked previously about the “battle royale” that occurred between Béchamp and Pasteur over whether we should promote health or fight disease. The answer is, of course, that we need to do both, but the clinical community is not equipped with the resource or power to do it alone.

What we cannot accept, though, is our current apathy or malaise that some of the health imgres.jpgcrises we now face are too much for us to do anything about. We are in the midst of a battle, which we are currently losing and it is time to gird our loins for a turning of the tide. Here in Morecambe Bay, we have started a conversation, not just among the Clinical Community but with the wider population about how we might become the healthiest place in the UK. Yes, we mean this in a very holistic way, but there are also some specific foci we have so we can together reverse some of the appalling health statistics we are facing.

For too long, we have simply laid down and allowed exercise to be taken out of schools, whilst our kids consume a bath full of sugar every year. All the time our own work and eating habits have become significantly unhealthy. We have relied on expensive drugs to fix our problems, rather than tackling the root causes of our excesses. It has lead to 1 in every 5 pounds in the NHS being spent as a direct result of our lifestyles and 1 in 11 pounds being spent on diabetes. We say we value the NHS above anything else as a nation (maybe an issue in it’s own right…..) but we do not behave in ways that show this value to be true. We have not been brave enough to challenge the status quo and together make a wholesale change both about how we promote health and look to aggressively reverse it when things begin to go wrong.

images.jpgI suggest that within a generation, if we wanted to, we could render Type 2 Diabetes a rare diagnosis. We can do this through encouraging far more healthy lifestyles in our children and young people now, like running a mile a day and learning to eat food that doesn’t actually harm them! I believe we could significantly reduce the need for so many people to be taking medication for hypertension and diabetes now, prevent many strokes and heart attacks, by being violent towards these conditions with major changes in lifestyle, though diet and exercise, rather than the prescription of drugs, using coaching, peer support and local champions to give psychological motivation and encouragement. We are beginning to have some excellent discussions and develop some exciting plans around this.

Our NHS health checks should serve as a major motivational opportunity for someone toimgres.jpg pull themselves back from the brink of a lifetime of medication and we should use all medication reviews as a chance to help people adopt lifestyles that might reverse the need for such drugs. In the process, we would also significantly reverse our number of cancer diagnoses – many of which are linked to our lifestyle choices. We simply can’t afford for our current and failing approach to continue. We need to be braver together! And this means the NHS must be willing to partner in new ways, not only with local people, but also with businesses like the major supermarkets to help reverse our current direction towards the abyss, in which there is no longer a healthcare system that serves the needs of everyone, no matter where they come from or how much they do or don’t earn.

Don’t get me wrong! We should absolutely use medication to its fullest use for those who are at risk and have not responded to major lifestyle changes. For example, we can wage war on Atrial Fibrillation, ensuring far more appropriate use of anticoagulation, in the most cost effective and safest way, therefore preventing many life-changing strokes in the mean time. And for those who, despite lifestyle measures, still have a high blood pressure or continue with diabetes, we should not withhold medication that would prevent major issues later on. It’s just at the moment, we’re reaching for the prescription pad too readily and not looking to reverse conditions completely before they set in. We need more education out there around the early signs of cancer, so we can hit it early and reverse it’s effects when we have a better chance. Respiratory disease is another area where we could seriously make a change. We need to think of ourselves as one big respiratory team, tackling smoking, housing damp and carpeting, whilst ensuring every person has an understanding of their condition, how to use their medication effectively and what to do when things flare up. A cohesive clinical community really could deliver something special in each of these disease areas.

We could also be a great deal more effective in how we care for the frail elderly. We don’t need anywhere near as many hospital beds. We can provide care in residential and nursing homes, avoiding double payment for beds, by shifting resource out of our acute hospitals and into the community. We need to have a far more grown up conversation about why we admit people to hospital when there is very little proven benefit of doing so.

Taking a strategic shift towards a social movement for health, significant lifestyle changes and treatment only after these things have been given serious attention, but unapologetically so once they have, we can turn back this battle at the gates and change the health of this nation for generations to come. We can undo the unaffordable situation we find ourselves in and discover together a much more healthy future.

images.pngWe can absolutely do this!! It’s going to take some serious resolve and we’re going to have to withstand the fear and pressure of some pretty powerful lobbies, like the sugar, alcohol, tobacco and pharmaceutical giants, and perhaps even the government itself, but it is time for us to do the impossible. With love, hope and faith, we can do this! Yes we need to focus on schools and work places. Yes, we need to partner with organisations we’ve never worked with before. Yes, we need a far more effective media strategy and yes, we need to allow clinicians to work very differently. But we cannot do nothing. So let’s try something a whole lot more radical. That’s what we’re going for in Morecambe Bay – not just better care together, but better health together – you can watch and wait, and see if we sink or swim, or you can join us!

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Solutions Focused Thinking in Population Health

My last blog focused on how we can think about solutions instead of problems in the NHS. Well the same is true in thinking about the health of our whole population. Yes there are some problems! We have growing health concerns with obesity and diabetes. We imageshave huge health inequalities. There are major issues with housing, economic policies that are not working for huge swathes of our population, with more people having to use food banks, struggling with fuel poverty, living in damp houses and unable to make ends meet. Yes, our kids are spending more time on screens and less time in activity. Yes, the sugar lobby, alcohol lobby and advertising giants have far too much power. Supermarkets are designed deliberately so that we buy things that are bad for us. And sometimes, we just make poor choices (if you can call them choices, which for some people, they aren’t always) – we do not all live as healthily as we could – we eat the wrong stuff, work highly stressful jobs, and exercise less than we are recommended to. Mental health issues are on the rise, especially for teenagers, due to crazy targets and league tables, with all the pressures they face. We are less happy and more separated than we ever used to be, despite the rise in social media…..(or maybe because of it……)…..Man, I can paint a negative picture – it’s like storm clouds and darkness everywhere……..

 

imagesBut what if it wasn’t that way? What if we got a bit angry about it, but instead of finding someone to blame and pointing the finger; instead of getting all tribal and throwing stones at others, we chose to use our energies creatively to find solutions, to work together and make positive changes?! Let’s put away our pointing fingers and our ranting tongues and let’s work together for a better future for everyone! Doesn’t that sound good?! It’s what we’re trying here in Morecambe Bay, and I’m hoping it spreads like wild fire so that we can become a place where health abounds and beauty surrounds (that’s the motto of this place!). That doesn’t mean we stop speaking truth to power, but we also let our actions (and maybe our votes) speak louder than ever before.

 

imgresWe’re talking together, taking time to dream about what it would be like if we were the healthiest area in the UK. We’re training up many people to host conversations, so that we break down walls and learn to collaborate for the sake of everyone. We’re not just dreaming about physical health, but mental, social and systemic health as well. We’re encouraging those who want to rise up and take some leadership, to be pioneers in the stuff they are passionate about. Even in my little town, we now have a mental health cafe that is literally saving people’s lives, because a lady called Jane wanted to make a difference. We have a cafe for all the people who have circulation problems because one of our nurses wanted to break people’s isolation and improve their healing rates at the same time. imagesWe’ve got a carers cafe, a dementia cafe and will soon have a breathing cafe for those who have severe COPD, sharing ideas and diminishing anxiety. We’ve got exercise classes to help with pain, a community choir, dog poo wardens to help us take more pride when we walk down the street and food banks to help those who can no longer afford to eat.

 

image[1]We have 2000 kids aged 4-11 running a mile a day at school with staggering results for our children here in terms of physical, mental and educational health. We’re hoping over time, this becomes the Morecambe Bay Mile, part of a cultural shift towards being more active. We are working with local chefs and supermarkets to enable people with pre-diabetes or weight struggles to eat more healthily.  We’re choosing to lead by example in the NHS to work well and flourish in our work places. We’ve made a commitment to see the 5 ways to wellbeing in every NHS organisation and we’re hoping many other systems and businesses will follow us in this. We’re finding radical ways to help people who are struggling with alcohol and drug addiction, get free and stay free with amazing results. We’re helping people live well with and beyond cancer.015c74b06779fe8d8496d585fb9865ea We’re changing the way consultations happen in the NHS to enable people to make more informed and better choices about their own health and conditions, so they feel empowered to make changes that work for them rather than beaten up when they go for an appointment! We’re launching the Morecambe Bay Poverty Truth challenge, learning from those who are lived NAWIFUexperts in poverty to help us work together and care better for those most struggling in our society. We’re having difficult conversations about death to help people be prepared for every eventuality.

 

All of this has started in the last year! What else might be possible? What other dreamsimages will be awakened? What other partnerships, collaborations and relationships might be formed? Being all tribal and accusatory of others saps our energy and stops us being creative. Mud slinging and blame will achieve little. We have to work from where we are. We have to build bridges and work together. We have to build a future of positive peace and that means binary thinking is over! The future doesn’t have to be full of doom and gloom. It is alive with hope! What resources might  we find? What talents might we discover? What might we see develop over the next 12 months/years/decades as we look for solutions together for a better future for everybody? Don’t you feel just a little bit excited?

 

 

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