Tag: power

The Four Rings of Leadership in Healthcare

I went to London a couple of weeks ago for the IHI (Institute for Health Innovation) conference in London – Quality Forum 2017. The focus was on Quality and Safety in Healthcare, with some hugely surprising and refreshing perspectives from around the world. It was absolutely great and I learnt loads. I’ve tried to distill my learning from the time into a single sheet diagram. My hope, over the next few blogs is to unpack this a bit more, but here is a very brief summary:

 

If we want to have excellent, safe and financially sustainable health systems, we need four key ingredients, with the patient and their family at the heart/centre. The most important factor in providing safe and high quality care is a CULTURE OF JOY! I love this. I love that an institute based in Harvard, with research from across the world, is able to say this so clearly. If we have happy teams, we provide the best care. It’s simple! A culture of joy has three key elements: firstly the team needs to have a sense of camaraderie (we’re in this together and we love each other and take care of each other), secondly the team needs a sense of purpose and thirdly the members of the team need to feel trusted to do their jobs.

 

Alongside this culture of joy, there needs to be a SOCIAL MOVEMENT, both within the staff and in the wider society. A social movement relies on structures in which power is ceded and personal and corporate agency (responsibility and action) can flourish. There also needs to be a sense of CONTINUOUS LEARNING, in which all partake, every voice matters and no question is too stupid. In Toyota the staff make over 2.5 million suggestions each year! No wonder they are continually improving. And fourthly, there needs to be an agreed focus on QUALITY AND SAFETY, which entails several aspects.

 

All of this depends on a new kind of leadership that is first of all humble, able to cede power and deal with significant complexity and ‘not knowing’. When financial constraints are tight, or huge savings have to be made, it can be tempting to start rationing and cut services deeply. This may balance the books, temporarily, but it destroys every thing you are trying to build, demoralises staff, ruins your culture and breaks trust with those you are trying to serve. The challenge is to begin to hold our nerve in the midst of extreme pressure and do what we know is right, backed by the best evidence available to us – and this, believe it or not, actually makes us financially sustainable. I am going to really enjoy unpacking this more and revisiting my learning over the next few blogs, but the above should hopefully fuel some thinking in the mean time.

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Building a Culture of Kindness in the NHS

My morning surgery began today with a patient of mine, who works as  Health Care Assistant (or Band 3) in our local acute hospital trust. As we find across the board in the NHS right now, there are pressures in her department with under-staffing and a very high and demanding work load. She started her day in tears, telling me about the sleepless nights, but even more so about the lack of support she is feeling in her work environment. She feels unable to understand why huge fees are paid to find locum consultants, when posts are not covered, but money cannot be found for the absence of staff at her level, when the numbers are down, leading to an increased pressure and low morale.

 

Now, this is not a criticism of the acute trust we partner with every day, because I actually know all too well the situation here, how complex it can be and just how dedicated to caring for staff the leadership of the trust are. However, when we read in the press today about sickness absence for stress among paramedics, and if I were to detail more stories about the number of cases I am currently dealing with as a GP about stress in the workplace for ALL grades of staff in the NHS and social care setting, then we have to face up to the fact that we have a problem. Stress in the workplace and low morale in our teams is not a problem we can afford to ignore. It not only causes high sickness rates, which then increases the pressure on teams, with knock on financial implications to the system; it also causes significant compassion fatigue (i.e. staff are literally less able to care about or for their patients), because they are emotionally overwhelmed, under-resourced and therefore become more numb, disengaged and unkind and this is detrimental to patient care.

 

The problem is actually really complex, but it is, in my opinion, primarily cultural, and particularly affects the lower pay-grades of staff, because they feel and are in fact less able, to influence change. If we do not develop a culture of kindness towards our own teams and have a sea-change within our working environments in terms of how we care for each other, we will only see the problems go from bad to worse. So, how do we create a culture of kindness, a culture of honour, a culture of wellbeing?

 

I would like to suggest six things (all beginning with H – the 6Hs), which are fairly simple, but make a massive difference to how teams function and therefore the morale within those teams:

 

  1. Humanity – First, we must recognise that hierarchy has the inbuilt tendency to de-humanise us. As we get higher in the pyramidal systems in which we work, we can easily lose our humility and compassion towards others as we have to cope with the greater demands from “above us” and if we’re not careful we can turn into slave drivers. Top down, controlling leadership is detrimental to good morale and stifles teams from working effectively.  There is a famous, ancient parable (told in the New Testament) about an unmerciful manager, who owed a huge amount of money to his master/CEO. The CEO called him to account and threatened to fire him. However, he begged for mercy and the master cancelled his debt and gave him a fresh chance. However, this same manager then went and found all the people who owed something to him, and instead of paying forward the mercy he had received, treated his own debtors shamefully, despite their begging and pleading for mercy. When the CEO found out about this, the manager was duly fired. I wonder how often we tolerate ‘bullying’ by managers, because they ‘run a tight ship’, without calculating the cost of this style of management on our teams and the patients we serve? Changing culture is hard. Even if the CEO sets a good culture, any one of us can bring a negative influence in the area we work. We have to make a conscious choice to keep our kindness switched on. As we climb the ladder of responsibility, we must continue to act with humanity. We must also remember that it works the other way round – we can start dehumanising those in leadership positions ‘above us’, or those who work in different teams. We make terribly unfair assumptions about people all the time. A little bit of understanding, kindness and compassion goes a HUGE way in treating each other with kindness instead of suspicion.
  2. Humility – For those in leadership, there can be a tendency to forget that when we were in in ‘lower’ positions, we often felt the same low morale and pressure from those ‘above us’. Leadership requires that we keep our love and compassion switched on towards those who we now lead. This means we must really learn to listen, and that means having the humility to recognise where we have been getting it wrong. If we are not prepared to change, then we are not really listening. It takes courage to create a culture in which we can receiving a challenge from those in our team and be able to make a change and not just use our position to squash the person who dared to speak out. It takes even more guts to admit where we have been wrong, say sorry and move forward differently.
  3. Help – one of the very worst things that can happen in any team dynamic is when we hear the words ‘it’s not my job’. I hear it so often and it makes me sad! We must never think we are above any task – whether that is cleaning up a mess, wiping a patient’s bum or picking up some litter. We must simply help each other out. But we also need the humility to admit when we are struggling and actually ask for help. We encounter terrible and unspeakable trauma at times, or may simply be going through tough personal circumstances. Sometimes, we need the humility to recognise where we are not coping, where we are struggling, when we’re not functioning and ask for help. And when we ask for help we need to have the confidence that we will encounter the humanity of those around us to help us at our time of need.
  4. Honour – Sometimes a situation may not be able to change, but in these situations the very worst thing leaders can do is close ranks, shut communication down and raise the levels of demand. No, vulnerability, openness and honesty, sharing the reality of the situation and communicating clearly why things cannot change currently at least allows the team to pull together and face the situation as one. However, there must be a very clear challenge here – Yanis Varoufakis puts it so well in his book “And The Weak Suffer What they Must” – we have to remember just how crippling powerlessness can be. Like my patient this morning, she has no access to the ‘powers’ or to the ‘purse strings’. She cannot up and leave, she simply can’t afford to, and so she works under huge pressure for very little pay, powerless to enact change, other than to put in place her own boundaries. A cultural shift towards a culture of kindness is to ensure that those with the least ‘honour’ are treated the most honourably. Leadership is about being able to take the hit, not self-protectionism at the cost of ones team. It is absolutely amazing just how far the words ‘Thank You’ can go, to keeping this sense of honour alive.
  5. Health – (by health, I mean wellbeing in its widest sense) – we have to actually care for the people around us. We have developed a culture in the NHS and social care where we will do all we can to care for our patients/clients, but will break the backs of ourselves or our teams in the process, which is actually entirely self-defeating! It is impossible to care for others well, when you are feeling exhausted and broken! I have said it on this blog before and I will say it many times again: we have to develop a sense of the health and wellbeing of the people in our teams. We need time in the craziness and business of each day to stop the mad rushing, be still and take notice/be mindful/be heartful. We all need time to get up off our chairs and stretch and be more active – #runamile every day (it only takes 15 minutes). We need time to connect with each other (do we really take time to know the people we spend an inordinate amount of time with and alongside and check they are actually doing OK?), to eat well, stay hydrated and keep learning, so we don’t feel overwhelmed. Building these as an absolute priority into our daily work routines is vital, especially as pressures increase. The tendency is that when the going gets tough, our health gets significantly worse. We must learn to protect this in the midst of our business, or we will suffer the consequences in multiple ways.
  6. Hope – there is an ancient proverb that says: “hope deferred makes the heart sick, but hope coming is a tree of life.”  Hopelessness takes root when we feel that nothing can ever change and we feel powerless to influence anything. Hope is born when we develop ways of working in which teams can work together on solutions to the problems they are encountering, rather than being dictated to from on high in a unrelational way. Hope is about being able to sense that the future is alive with possibility. It is a life line when things are tough, when the tunnel is long and dark – just a little glimpse of light – and then faith builds that together we can get there.

 

Not difficult. Actually pretty straight forward. We don’t need unkindness or low morale in our work places. We don’t want to be suffering with compassion fatigue because we are physically and emotionally drained and running on empty. We really can create the kind of culture we want to see and experience in the NHS and social care – a culture of kindness – sounds nice doesn’t it?! All it takes is for us to remember humanity, humility, help, honour, health and hope.

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A Healthier Story

So, we start 2017 with General Practice “skating on thin ice”, the NHS as a whole “creaking on the edge” and major concerns over funding and waiting times. Why don’t we step outside of that rather repetitive and boring story, and find a new one together – one that resonates far more with the ancient paths we once knew?

 

The world is changing, and not in a good way. We are becoming more separated from each other, our organisations and systems dehumanise us and we are becoming less well. The story that the ‘benevolent hand’ of the free market will work everything together for good is exposed in it’s nakedness, like the Emperor’s new clothes. The fabric of our society is unwinding as we become more disconnected from our own sense of wellbeing, our communities and the land on which we live.

 

How do we recover a sense of wellbeing? Where will we find healing for our past, present and future? How can we expand our own vision of what it means to be well, focusing not only on our physical health, but also on our mental, spiritual, social and systemic health?

 

How might the General Practice community move from being a group of health heroes, who fix people when they are unwell, to letting go of that old and unsustainable paradigm, learning instead to co-host, with others, an environment in which a community can be healthy and well? It doesn’t mean doing away with skills that have been crafted, but using them to empower others to be partakers and not only recipients. What if GPs or ICCs (Integrated Care Communities) faced up to the fact that they don’t have all the answers, nor the resources, nor the power to fix the problems in their local populations? What if they allowed themselves to become more of a part of their community, rather than separate or slightly aloof from it? What might a co-operative model look like? If every patient owned a small share of the practice and it truly ‘belonged’ to the community, just how radically might things change, without the need for huge ‘take overs’ by local hospital trusts or private healthcare firms? If we are to find a new way forward, we must all be willing to let go of what we have known and the power which we hold. We have to let go of our need to chase the money and imagine that we are like the city of Detroit, declare ourselves bankrupt, financially and spiritually and then together, break down the walls that keep us separate and find our way together.

 

When we host spaces in which communities can come together, rather than trying to be the experts who know how to fix everything, we let go of our need to be the heroes and come into a space for shared learning. As I spend time with a community of people recovering from various addictions in Morecambe, I find I don’t have the tools to fix things. However, I do find, that together there is a huge heart for a better and more healed society for everyone, so that others do not need to find themselves in the grip of addiction. We need to know less and find more corporate wisdom. We need to share our gifts and find the beauty of reciprocity – that it is in the giving and receiving of one another that we find a way forward in positive peace.

 

The future of our health and wellbeing relies far more on our interconnectedness and our community than on the systems we have built. Our systems must give way to become subservient to the longing of our hearts rather than the task masters which drive how we organise ourselves and live out our lives. Co-operative community gives us an opportunity to live something much more radically loving and kind, in which people and the planet really matter. Today is epiphany! A day in which some people with real wisdom realized that God came as a baby, weak, helpless and in need of community for health, wellbeing and development. If God is and needs community, how on earth have we become so disconnected from that story and made our whole way of being about experts and empires? Here is an epiphany for 2017. If God did not come as an imperial expert, but in weakness and humility, we need to do the same, if we are to find any hope for the future. The system will not change from the top down, it’s too invested in the broken story to be able to do so. But we, the people, can together be cogs that turn in new ways and realign ourselves with a way of being that brings better and more holistic health for everybody, everywhere.

 

 

Here is another interesting blog, from a slightly different perspective about how community really is the future of medicine – well worth a read, when you can make space for a nice cuppa and some left over Christmas cake (good for your wellbeing)!

 

The Future of Medicine is Community

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The Junior Doctors And Lady Godiva

A few months ago I wrote a blog suggesting the right approach for the junior doctors was one of subversion and submission. But I think I was wrong. It’s not that I’ve changed my mind on the power of subversion and submission, it’s just that this entire spectacle surrounding the junior doctors, the ‘7 day NHS’, the strikes and the media reporting there of actually affects us all at a profound level.

 

bmalogo14This situation exposes something far deeper than just an argument between Jeremy Hunt and the BMA and is far more important than discovering who has the strongest will power. Infact, the BMA have made a major error in targeting Jeremy Hunt so vindictively, because in the final analysis, this isn’t about Hunt at all. Jeremy Hunt can be replaced in a moment, and is likely to be succeeded by a far more robust Jeremy Hunt nhsBoris Johnson, who will simply pound his fist more visciously. To make Hunt the scape goat narrows this debate to something far too insignificant and actually strengthens the government’s ability to do exactly as they please.

 

Sadly, however, all this proves is how defunct our current system of government has always been. What the government really want is a discussion about how we can improve patient access across the weekend timeframe. However, what they did was to decide this is necessary and went ahead to try to fix what is incredibly complex. There was no discssion, no real engagement, no conversation, no asking of the deep questions. Just because we want something, doesn’t mean we can have it! Just because we think something is a good idea, doesn’t mean everyone else will agree! The entire process of enagement and change management is not understood at all. In the first8790 place, the goverment could instead have said to all the hospital trusts across the country what their hopes and intentions were and then waited to see if this was workable, in what way and how much it would cost. But you cannot simply act like Pharoah and expect the brick makers to make ever more bricks with less and less resource available – otherwise, you face an exodus!

 

What this entire debacle demonstrates is just how far free market capitalism has gone in its use of people as biopower to drive the system. The junior doctors of the NHS are nothing more than fodder to make the machine run. It doesn’t matter at all to the government that their lovely idea of a ‘7 day NHS’ is both unaffordable (due to chronic underinvestment in the health service) and unstaffable (due to a combination of under-training of staff across the board, and free market forces which work against people remaining in the UK). What this exposes in its most blatant form, is the chronic and shocking abuse of power, because of the very structures we have in place and the foundations upon which our society is built – namely violence, debt and control. And so, we see the human being reduced to what Hardt and Negri call ‘naked life’.

 

_86375024_86375023The system, to which we must all bow doesn’t care for the needs of the people who work within it. It will force them to submit. Why should doctors (many of whom work for less than the minimum wage, when on call) be allowed time to rest at weekends? Why can’t everybody have routine care through the weekend, just as from monday to friday (even though most of our top clinicians think we need better emergency care and not routine access)? Surely our economy needs this kind of health service? And actually, whilst we’re on it, isn’t it a waste of time, allowing teachers to have weekends off as well? Don’t we need our children to work harder, or at least be given some sort of babysitting service, so we can get more for our pound of flesh from their parents? If we are to have a 24/7 health service, why not a 24/7 education service? Our shops are already open practically 24/7. In this commercial world – shouldn’t everything else follow suit? No, no and NO!!

 

SolidarityThis is why we need a revolution of solidarity and resistance. We need a people movement who will stand together and be brave enough to say that there is a different way to see the world and a new way to live within it. Our naked life itself, although currently abused, can become for us our greatest power. Our naked life can expose the truth of just how abusive our systems have become. Our naked life, when combined with the indestructable force of kenotic love, becomes the very agent of change that we need.

 

So, what next for the junior doctors? Should they strike next week, including for emergency care? Are they ready for the media (who have lost the art of journalism) to turn against them? Are they ready for the storm that will ensue? Well, lives have already very sadly been lost. How many more can stand under the strain? What if the public turn against their heros?

 

It is time for something deeper to take place. It is time for solidarity. It is time for those of us in senior positions to cover shifts and show our unreserved support. It is time for the public, not just teachers, but across the board, to stand with the juniors. As my friend, Julie Tomlin showed me, we have to learn from the arab spring that one march alone will not do it. March after march after march may be needed. And singing too!! Let songs be heard on the streets! And to Lady-Godiva_DSC_9412really demonstrate the power of naked life……how about naked marches?!! (I grew up in Coventry, and so the story of Lady Godiva is in my blood – nakedness overcame oppression once before!). Or maybe the staff of the NHS should all turn up to work with no clothes on?!! How about people stripping off at least to their underwear to expose both the fragility  and the power of naked life?!

 

There is a different way for humanity. We can free ourselves from the oppressive yolk that seeks to divide and rule us. Perhaps, the Junior Doctors could be more creative and expose the deep structures of oppression that lie beneath the calls for this ‘7 day NHS’? Now is the time for subversion, for exposing just how unjust our systems are. But subversion alone will not suffice. We need solidarity and resistance. So, who will stand and march with the Junior Doctors (naked if need be?!) for an altogether different future?

 

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The Transformative Power of Listening

One of the hats I wear is to be the Clinical Lead Commissioner for Maternity Services in North Lancashire and I chair the Maternity Commissioning Group for Morecambe Bay. iu-1Over the last few years, Morecambe Bay has been under huge public and governmental scrutiny due to some sad and significant failings at UHMBFT, our acute NHS Trust. This lead to the in-depth and wide-ranging “Kirkup Review” through which we have learned together some sobering and important lessons.

 

In 2013, we carried out what is called a ‘Picker Survey’ in the Bay and had a startling reality check. 44% of the women we aimed to care for told us that they did not feel treated with kindness or respect. It was a devastating figure for us to hear. So, learning from the ‘Leeds Poverty Truth Challenge’, we learned that we needed to allow ourselves to really listen to what women were saying to us, to hear their stories and let the impact of those stories begin to change us. One of the great advocates for women, compassionate care, kind listening and careful communication in this area is Mel Gard, a Doula, who facilitates our ‘Maternity Services Liaison Committee’ (MSLC) around the Bay. The MSLC is a group of women and men who use our services, which Julia Westaway must be credited for facilitating so well. Over the last three years in particular, they have taken the time to build relationships with those of us whoiu-4 commission and provide services and in effect ‘speak truth to power’. Mel and many others have brought to us stories of times when listening and communication skills have been excellent within our maternity service and times when they have been clumsy at best and detrimental or abusive at worst. This has begun a culture change and a survey carried out in 2015 has seen this startling figure reduce to 26% (we know this is still far too high, but it is a vast improvement).

 

It is only in encountering the ‘other’ that we are really changed. Alan Alda says this, “Listening is being able to be changed by the other person.” There is no point in hearing the stories and impact of poor communication on our patients if it does not fundamentally change us and our practice. In the NHS, we’re so used to being the experts that we sometimes think we have the right to tell people what they should do, rather than really listening to them and understanding what is important to them, the person who is the expert in their own life and situation. It is partnership and not dictatorship that we need. It is a willingness to learn together rather than an arrogance that knows how to ‘fix’ things that we must develop. So, together with the MSLC we have devised an entire learning exercise for all those who work within our maternity service. We are going to allow ourselves to encounter the ‘other’, on their terms, not ours, and let the impact of their stories transform us. So, in the next couple of weeks, women from around the Bay are going to film and tell their stories in a variety of ways and this film will then be used as a learning tool for every person who works in our service around the Bay, including cleaners, the nursing auxiliary team, midwives, obstetricians of all grades etc in some wide-ranging attitudinal and communication training. Amazingly, we have just won a national grant of £65000 to help us do this really well, thanks to the exceptional work of Lindsay Lewis, our lead manager and Sascha Wells, our Head of Midwifery.

 

NAWIFUThe idea is straight forward. By hearing the real life stories from around the Bay and allowing ourselves to be impacted by them, we will then use some reflective conversations, and techniques from the ‘Art of Hosting’, to allow the power of real listening to change us and transform our practices. I am so grateful for the women and men who have been brave enough to tell their stories. I am grateful to our senior team that we have bimgreseen willing to be humble and be impacted by these stories. I am grateful for relationships and partnerships that are being established between those of us who provide services and those who use them. I am grateful for the tenacity of people who want to see our cultures change. I am grateful for ‘The Leeds Poverty Truth Challenge’ and its far reaching consequences. I am grateful for the opportunity to break down barriers and find positive ways forward. I am grateful for the transformative power of listening and the change that can happen when we really encounter another human being. Better Care Together is so much better when we work together with those we are trying to serve.

 

Stanley Hauerwas said this: “I was smart, but I had not yet learned to listen.” The NHS is full of really smart people. When we learn to listen, our ‘smartness’ will become real wisdom, and with wisdom, we can bring real, lasting change.

 

 

 

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A Co-operative Future for General Practice?

imgresIf you take the work of Steve Peters (of “The Chimp Paradox” fame) seriously, which I do, then you can see Chimps at work everywhere in the NHS right now (and I’m not taking a cheap shot at Jeremy Hunt). For those of you, who have no idea what I’m talking about, then do read the book….but a brief precis is this: each of us are two people – we are both simultaneously an emotionally driven, primal chimp and a more rational human being. When faced with difficult circumstances, our chimps all too easily take over and our behaviour is driven by our emotions, because our human also feels insecure and we lose hold of our values (the computer part of our brains) which is able to alter our chimp behaviour.

 

I’m not making a judgmental criticism, I see it in myself. I see the raw emotion of how Iimgres feel about what is happening in General Practice, Community Nursing/Therapy and indeed the NHS at large and it becomes easy to function out of raw emotion, heading into ‘rant mode’ or a strong defensive posture with the rest of my pride. But I have found it brings division. It pits my practice against another or General Practice at scale against the Hospital Trust or the government or whoever. But it doesn’t actually solve anything. It stares the problem in the face and hollers at it or throws faeces at it, and other than being cathartic (which has it’s place for a while), it doesn’t engage with a creative or collaborative process about how we face the future. The facts are right in front of us, and there is some thought about how to make General Practice strong enough to survive, be that through giant mergers or the formation of federations. Here in Morecambe Bay, we are experimenting with both those options and also trying to work in Integrated Care Communities (incorporating all our community partners) according to geographical locations.

 

However, I’m not sure we are facing up to the realities we see creatively enough. Whether we like it or not, General Practice as we have known it is unsustainable. There simply aren’t enough doctors coming through training, there aren’t enough doctors choosing to be GPs and there certainly aren’t enough GP trainees wanting to become partners.The partnership model as we have known it, is over, and the sooner we face up to this, the more creative energy we will be able to harness to find solutions. The formation of federations or the advent of the ‘super-practice’ will go some way to stop the gap, but it is the structuring of them that deserves some attention. Integrated working with community teams, be that district nursing, mental health, community therapies or social services calls for a wider and deeper system change. But here is the very difficult thing for GPs to let go of: the idea of the autonomous self, being in charge.

 

Co-Op-PrinciplesIf we are going to find solutions to the needs of the people we serve and develop together (no matter what is being shaped from the centre) a future healthcare model that works, GPs may need to let go of our power, as we have known it and embrace a different way of being. I think a possible solution lies with the co-operative movement as this would allow a truly integrative model to develop that benefits all our workers, no matter what their role, giving us the cultural environment in which innovation, excellence, learning, creativity and compassion could really flourish. Due to the nature of co-operatives and the principles at their core, a powerful force could be released which provides alternative solutions for a more equitable society.

 

What would a co-operative model be like? Well, there are different options and different imagesstyles, from John Lewis to Mondragon, or the model adopted by Jos de Blok in the Netherlands. But the reason I like it so much, is that it takes power from the few and shares it with the many. It allows for a different style of leadership and a different mode of making decisions. Collaborative conversations and compassionate care of one another in providing care to the wider community becomes the order of the day with leadership that is both clinical and managerial but modeled on financial benefits for everybody and cooperation of wider teams of people.

 

imagesThere are draw backs and co-operatives are not perfect, but they are a solution that should be seriously considered as General Practice tries to navigate itself into the future. They can be complex to set up, but I would argue that complexity is worth it when it offers a solution that lasts longer than a more straight forward quick-fix that may not make it past a decade or two.  Are we brave enough to explore solutions that dis-empower us for the sake of a better future for everyone?

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Time to Face the Music

UnknownWe 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 images-2believed 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
imagesthe 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 Unknownthis 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.

 

images-1And 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?

 

Unknown-1Truthfully, 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.

 

Unknown-2And 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 witUnknown-3h 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.

 

 

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