In my last vlog, I started looking at how we might use the 5 Ways to Well-being to help build resilience and promote health, particularly for those who work within the NHS (though it can apply to anyone). This second vlog takes a look at the being active and how it can improve health and well-being.
We have yet to really face up to the crisis we are in. We keep on pretending that by making a few alterations here and some adjustments there to how we deliver health and social care, we might be able to save the NHS. But this simply isn’t true. Last weekend saw a crisis conference for GPs nationally as 38% think they will be forced to leave the profession in the next 5 years due to severe under-resourcing and increased stress (that would be a loss of 10000 GPs throughout England, with government plans to recruit only 5000 by 2020). Yet again our Emergency Departments are at breaking point, Junior Doctors are staging further strikes, Public Health Services have been decimated and although new partnerships are being forged with social services and (to some extent) the education system, deep cuts in both those areas mean there is little time or energy left to find new ways of working for the future health of our population. Throw into the mix a need to save £22 billion through “efficiencies” and couple that with the crippling debt caused through programs like PFIs in our acute hospital trusts and we really do have a problem.
Complicating this picture is the stark reality that 1 in every 5 pounds spent in the NHS is as a direct result of our current lifestyle choices and we have 
believed a lie that the NHS is “free” and therefore we can treat it however we like and live however we want and it will somehow magically sort us out. On top of this we have an ageing population with increasingly complex health needs and an ongoing under funding of the entire system (only 8.9% of GDP).
And we cannot we forget the financial crash of a few years ago which was a major warning sign to us that we are living in a broken system and the god that is
the Nation State is beginning to crumble all around us. Let me just repeat that difficult statement in another way. The grandfather that is the Nation State is now utterly riddled with a cancer and it is dying. The cancer, like all cancers needs ever increasing growth in order to sustain it’s life and our economy is set up to feed it, but even built on the pyramid of power, control and debt, it can no longer survive. Like any dying man, it is holding on for dear life and as it does so, it puts the squeeze ever tighter on to health, education and other public services, pretending it is still powerful, controlling public services through the slashing of budgets and ever tighter and undeliverable targets whilst not actually dealing with it’s debt issue at all, but telling us all a story that it is. And the mouth of 
this dying beast, the media that has become utterly complicit with it all, spouts out tale upon tale of how mighty the State remains, “punching above it’s weight” on an International scale (using violence and threat where necessary to do so), but tightening it’s belt to ensure economic sustainability. Am I being dramatic? Listen, when 85 people now have more accumulative wealth than half the world and when the 50 richest global corporations are richer than the 50 richest Nation States (and are therefore powerful enough to tell them what to do), the facades must come down. The Emperor has no clothes on.
And so it is time to face the music. Once we realize that the centre cannot hold, we can permission ourselves to find new ways of being. There really are alternatives to what we have now. there are other ways of being. Life will go on. We can learn to dance to a different tune, we can sing a new song and begin to reimagine a different kind of future. We can learn to live differently. There are some tough conversations to be had. But, as the old systems begin to pass away, what might emerge instead? What brave or holy experiments might we try without letting go of the wisdom we have learned? What might it be like if politics and economics were just part of a collaborative and cooperative world rather than assuming the role of dominant sovereignty over every other sphere of society? What if we can’t have everything we want right now, learning some new and more effective boundaries around the ways we live? What might we prioritise? How might we move towards a more peaceful world? How are we going to live in a way that is sustainable and leaves the environment as a gift rather than a burden for the generations to come? How might we develop an economics of equilibrium (the state of a healthy body) rather than one of continual growth which requires us to feed its ever hungry belly with our own lives? What might we recover in education? How could we shape regional wellness services? How might cities and regions gift their expertise to one another? How might we choose to protect the most vulnerable in society and provide for the most deprived, keeping love at our core over self-preservation, greed, fear or hate?
Truthfully, we can no longer afford to avoid these conversations or hide away in our business. If we want things to remain exactly as they are, then so be it, but what will we leave for our children’s children? In the NHS we spend our lives trying to preserve and prolong life at all costs. But we must learn to face death, because there is life the other side of it. There is life the other side of the Nation State as we have known it. There is still ethical, free, safe, sustainable and accessible healthcare for all the other side of the NHS in its current form. It might become a National Wellbeing Service. Or it might be more regional and cooperative. It will mean some different lifestyle choices and some more effective partnerships. It will mean changing our attitude towards how and where care is provided. But I’m sorry to say that unless we make some radical choices to either pay a lot more tax or not renew trident and spend all of that money on healthcare, there are some deep cuts to be made in the mean time. It is going to be a very painful few years ahead. We must not imbibe ideologies that protect the rich and punish the poor. But we have to be brave enough to let go of the good we have known in order to embrace a future that is better for everybody together.
And that calls for a different kind of kenarchic leadership. We need leaders who will serve and collaborate with communities in open and honest conversations, so that cuts do not happen in an isolated boardroom, but wit
h and among the communities most affected. Leaders must learn to ‘hold the space open’ for the new to emerge. It will mean understanding that we must make choices about which targets we do and don’t decide to meet, prioritising some services over others and taking better care of ourselves individually and in community. But it is not a time to lose hope! There is much goodness to come, much rediscovering to take place. Much creative reimagining to enjoy. Many songs to be sung. So, let’s face the music and dance.
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.
If we were to view the NHS as a person instead of a mechanical system, then we would have to conclude that she is the most used and abused person in our history. She is someone with a great heart, incredible talents for healing people and who wants to do the right things for people, but she has completely lost any sense of boundaries or the ability to say ‘no’. Therefore, she is walked over and treated as a state-sponsored prostitute for anyone to come and do with exactly as they want, as if there were no consequences. However, as a result of this behaviour, the cells which make her up have become damaged and infected, her tissues are breaking down and she is dying. It is not too late for her to be mended and revived, but she must learn that she cannot say ‘yes’ to everybody and everything that is demanded of her and as she learns more appropriate boundaries, she will help others amend their own behaviour to create a loving, sustainable and mutual relationship that can last long into the future.
Black Friday demonstrates just how utterly consumerist we have become as a nation and we treat the NHS as if she were a commodity to be ‘had’. There is little sense of personal responsibility with diet, alcohol, drugs, exercise, maintaining healthy relationships and managing stress and yet we have a developed a meta-narrative that we can live exactly as we please because in the end the NHS will fix it. We give little thought to developing our personal and corporate well-being and why should we, because when we fall apart the NHS will fix it?!
We can be utterly disorganized and forget to renew our prescriptions and then shout and scream at our GPs receptionist to ensure we get our tablets (that we might not have needed to be on, had we taken more care of ourselves) turned around in a 24 hour period, as if it was someone else’s fault that we forgot we were running out of our own medications. We can fail to 
turn up to appointments when there are already long waiting lists, because who cares if the appointments are wasted – they are ours to waste after all! We can run to the A&E when we fall over drunk and hit our head, or get into a fight with someone we’ve never met whilst under the influence because we haven’t bothered to learn any healthy patterns of processing the anger we feel. We can go to the walk in centre with a 3 hour old sore throat, demanding treatment, instead of trusting our incredible immune systems. We can continue to eat far too much meat, over injected with antibiotics, whilst we head towards the super-bug apocalypse. We can drive too fast and cause near fatal accidents (if it wasn’t for the seat-belt and airbags) and some clever surgeon will put us back together. We can smoke our lungs into a tar filled bog or stuff our arteries full of cholesterol and sugar crystals because there is medication (that is super expensive by the way, but subsidized so we don’t care) that will fix our ill-behaviour. We can experience the love, kindness and generosity of our elderly relatives, but dump them into hospital for Christmas, when they might spoil our fun. We can stuff ourselves with food, until our joints can’t take it because then we’ll either get new ones, or a bariatric surgeon will half the size of our stomach for us.
OH THE GOOD OLD NHS!! She will sort out all our problems……except that we are killing her. We have believed a lie that we can live exactly how we please as if there were no consequences. If we love the NHS and she loves us, then she is going to have to learn some boundaries and we are going to have to change our behaviour……..
The NHS is a national treasure. And we all know, (because the media tells us again and again) that it is failing and our metanarrative is becoming one of crisis, inaffordablity and criticism of poor care. We want to keep it, save it and make it sustainable for the future. But there is a major problem. We simply cannot agree from our differing political positions how to make this happen. And no one perspective can be the whole truth and nothing but the truth and yet each ideology is so entrenched that rather than working creatively to find solutions together (as was called for again this week by MPs of 3 different parties), there is an ever more pathetic mud-slinging match and deepening suspicion of the ‘other’, which will do nothing to help us collaborate in creating a truly amazing, sustainable, affordable and accessible health and social care service for the generations to come.
I am about to caricature and overstate the various positions.
The Tories believe in a small state and the devolution of powers. They would see the NHS being broken up into regions which might be able to work more effectively in networks. They believe in order to have a strong NHS, we must have a strong economy. In order to have a strong economy, we must create wealth through private business, have low taxes, increase austerity and shrink the public sector. Ideologically they believe in a free trade market and that the NHS should be subject to the same free market forces as any other kind of business, which is why they like the TTIP. They believe that the NHS is only sustainable if run by private companies, who they think will do a more ‘efficient’ job than the current management structures – and yet they can point to shining examples of those who do it extremely well under the current operational system, like Salford Royal. They believe competition drives up excellence. They believe in personal responsibility in determining ones own health. They believe that clinicians should have more leadership in the NHS. In order to make the NHS sustainable, however, they want to invest £8 billion over 5 years whilst making efficiency savings (which are different to cuts, you understand) of £12 billion.
Labour (of which I confess to being a member) is currently more split ideologically. Some veer more to the centre ground arguing for a mixture of public and private provision of services, whereas others believe it must all remain public at any cost. There is huge suspicion of the private sector which is thought not to be compatible with delivering healthcare in a caring or compassionate way as it cares more about profit than people. Labour love targets and management structures to monitor everything that happens, which the Tories say is a waste of money. In order to fund the NHS, Labour believe in higher taxes, especially of big business and the rich.
The Greens and the SNP would also sit to the left side of healthcare provision whilst the Liberals are a bit of a pick and mix bag and partnered with the Tories in the top-down reorganisation we were promised wouldn’t happen but ideologically are probably closer to Labour! They do place more emphasis than anyone else on improving mental health services.
There are also outside forces at work – the Royal Colleges, the Research Networks and NICE all prescribing, in their own ways, the kind of healthcare that needs to be provided in order to meet standards of excellence – all of which has huge implications on the structuring and affordability of certain models of care. Then of course are the other nettles no-one is really ready to grasp. Tobacco has been tackled to some extent, but when it comes to alcohol, sugar, fast food, exercise in school and some people’s complete abuse of the system, they haven’t played ball. Nor is there a clear plan about what to do about the staffing crisis and the fact that in a free market, if you’re not competitive, some of your workers will move to areas where they get paid a lot more money for less work and less stress. And then there are the cultural issues, general chaos and shoddy systems rampant throughout the NHS and Social Care that requires an altogether different kind of leadership for them to be addressed. Oh yeah – plus it’s really expensive, but we still invest less of our GDP into our health system than most other OECD countries.
Yikes! What shall we do? Who’s right? Who’s wrong? What pearls of wisdom can we draw on from each perspective to find a way through? We probably do need devolution to the regions, so that we avoid the trap of a London-centric or South-favoured economy, whilst maintaining some accountability, especially for appropriate provision and distribution of resource with the Secretary of State. We do need to encourage more personal and social responsibility whilst ensuring we protect services for the most vulnerable and deprived populations. WE need to provide fare more resource into mental health services. We need to work with the high standards of research and be pragmatic in our approach to delivering them in reality.
The NHS, the largest of all political footballs, must somehow be de-politicised (in the sense of the old politics). Each new government with its successive and extremely costly reorganisations disrupts and destroys the excellent work done in the preceding 5 year cycle. If the NHS is ever going to work and be affordable, collaboration and not competition is the only way.
There isn’t a perfect model, but we need to keep aligning to the vision.
The vision is to deliver continuously improving, high quality and compassionate health and social care to all in our communities. We really are going to have to collaborate together, taking the best of all our ideas in order to make this happen. This isn’t about winning a political argument. This is about being real and pragmatic together in finding a way through the current dross of all our fallings out for the sake of a future health and social care system that works for everybody.
There is one of the beatitudes I’ve been thinking a lot about recently: “You are
blessed when you can show people how to cooperate instead of compete or fight.” We have to learn a new style of politics over the NHS that is about co-operation. One that operates out of a different kind of spirit. Humility, kindness and compassion are our keys in learning this new way together.
A few months ago, I was moved by the Syrian Refugee crisis to write a song. I sat at my piano and played some chords and imagined what it must feel like to have to flee the place you call home and to throw yourself on the mercy of strangers. I let myself feel the pain that many Syrian people must feel as they see the walls being built around the borders of Europe, a continent which only a few decades ago was tearing down the Berlin Wall but is now erecting barbed wire fences.
So, this song emerged. I recorded a little youtube clip. A friend of mine, Claire Askew (who plays drums on the track) heard it, played it to some
p
roducers (Sugarhouse uk) who generously offered to record the track for free. The amazing charity that is World Vision then heard it and it was agreed that we would release this single as a way of raising money (100% of all the money from singles sold will go to World Vision) for Syrian Refugees this Christmas.
I don’t know if there is a better narrative for a song in this season. The song of a refugee, fleeing home due to powers beyond their control, only to find there is no room for them…..
On one level, I would love the NHS to get to the number 1 spot for Christmas; I definitely don’t want x-factor to get the spot! But, what if this Christmas, we decided to spread the word as far and wide as possible and help World Vision raise a huge amount of money to help those stranded, cold and homeless. The single only costs 99p – less than most of the bottled drinks we will consume this Christmas. I have no power at all to make this happen, but it would be amazing if the Syrian Refugees could be this year’s Christmas Number 1!
So here it is. “Will You Love Me?”
https://itunes.apple.com/gb/album/will-you-love-me-feat.-claire/id1063998040?i=1063998267
There is a lie that has been told, to clinicians in particular, that it is wrong to get too close to patients. One is told to keep a healthy
separation, perhaps to make the tragedy we often deal with somewhat more bearable. We have shaped medical ethics around the four core principles of beneficence (do good), non-maleficence (don’t do harm), autonomy (respect a person’s own wishes) and justice (treat everyone the same). But as the black eyed peas would ask us (!), 
where is the love? Where is the love and compassion that makes us human and deeply connects us to the ‘other’ and even the ‘other, other’ (someone so different to us that we find it almost impossible to connect to them)?
I was involved in a conversation recently with Phil Cass, a psychologist and CEO of a healthcare company, from Ohio, about this very subject. He told me some very stark facts. In the USA, the highest suicide rate is now amongst physicians and 67% of medics suffer with depression. Studies found that although these people were motivated by love, they found it very hard to receive love back from those they were giving love to.
We have made the clinician-patient relationship a one way system, and we shut down the reciprocity of the love we give in the name of ethics and professionalism. But this is to our great detriment. Patients love and trust their doctors, nurses and therapists and this love could be a huge source of resilience, courage, support and hope. We must let down our guard and receive back the gift that we give in order to
become more healed ourselves. It will allow us to enjoy our work more, reconnect with the core motivation inside us and encourage us, because when we give and receive love it spurs us on to keep going when the system feel like it is against us.
There 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 
together 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 
organism, 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 
had 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’ here
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.
Over the last few weeks we have seen the unfolding story of a health secretary in a battle with Junior Doctors (of which there are 53,000). Under-girding the entire debate is a manifesto promise made by the Conservative government that they will deliver a 7/7 NHS. There has been a misuse of statistical evidence by the government to inform this position and indeed we do already have a 7/7 NHS.
In order for this promise to become a reality, the government must face up to certain facts, which are obvious for all to see. Firstly, the NHS is underfunded and rearranging pay agreements with junior doctors who are already underpaid is grossly unfair and will not achieve the desired affordability. Secondly, the NHS is understaffed (we already have one of the lowest doctor to patient ratios in the EU). Thirdly, morale among NHS staff is low, and much of this is due to staff being used as fodder to drive the system, rather than cultivating a system in which they are cared for, can flourish and can influence change in the system where it doesn’t work. Pushing more work for less pay will not drive up morale! Fourthly, the slashing of local government budgets is causing a social care crisis that has huge implications on the ability of the NHS to function. Fifthly, public health budgets have been reduced to a bear minimum at a time when we know we need to have wider conversations with the citizens of the UK about how to take greater care of their own health and the health of their communities in order to make the NHS sustainable. Sixthly, the problems with weekend care in our hospital systems are a result of a lack of support staff and services available over weekends and a crumbling social sector which blocks up hospital beds. Needless to say, the situation is complex.
And so, given such a complex problem, how should the system be lead and managed? With an iron rod? With bullying, top down hierarchy? With “visionary” leadership that knows how to do the “right thing”? With the defeat o
f the ‘militant’ junior doctors? What kind of system is the NHS? It is not a linear, predictable system, but rather something far more akin to a human body, a living, organic system. Meg Wheatley in her book, “Leadership and the New Science” writes powerfully about the folly of trying to manage complex systems as though they respond to the theories of Descartes and Newton – they simply don’t behave that way. And so, this kind of system cannot and will not respond best to competition, targets, inspections and beating its members into submission. No, it will respond best to collaboration, to the right environment in which people can thrive. It requires the kind of leadership that will listen, that will work in partnership, that will host good conversations and find a way through together. I do not see that kind of leadership from the department of health.
The NHS is a national treasure. Yet, this government, with only 36% of the national vote, from an antiquated and unjust ‘first-past-the-post’ voting system, is driving through ideological changes that it has no true mandate from the people to execute. This kind of political behaviour exposes more than ever the abuse of sovereign power and the need for something totally different. We need leadership, but we need a new kind of leadership, a leadership that is loving, compassionate and kind, collaborative, listening 
and releasing, a leadership that believes for the best and a leadership that invests in the kind of health service we need to deal with the health inequalities we see. We need that kind of leadership now. We need a different kind of government and a different kind of politics now. It is emerging in the margins, but we need leaders at the centre with a new kind of heart.
This week the health secretary, Jeremy hunt, tweeted this: “Moderate doctors must defeat the militants”.
Here is a man I truly admire speaking some (slightly rude) truth to power. Sir Sam Everington knows a thing or two about the power of protest.
 BE ACTIVE (Changing the culture of the NHS)){kind=link}
 CONNECT (5 Ways to Wellbeing) – Changing the Culture of the NHS){kind=link}
