Apocalypse Now?

It’s a while since I last wrote a blog. That’s because I’ve been concentrating on finishing my first book and there are only so many hours in a day! It is called ‘Sick Society’ and will hopefully be out soon.

 

However, now that it’s done, I will hopefully have a bit more time for blogging again.

 

Last night, I awoke from a disturbing dream at around 0350h and wasn’t able to go back to sleep. I’ve had many troubling dreams of late – maybe I’m just processing. There have been plenty of tough situations to deal with at work recently, plus the backdrop of what feels like chaos. But I have learned over years to tune into my dreams, following the thread of them.

 

My dream last night consisted of two things: very rough, rising seas buffeting against the coast where I live and multitudes of people in refugee camps. I know exactly why I dreamt about them. Before bed last night, I listened, whilst my wife watched Episode 6 of Frozen Planet 2. A glaciologist, whom we both know, fairly well, was talking about his work. He is studying how the ice caps are melting at an alarming rate. I also read just before going to bed, an article about Greece and Turkey trading insults over the plight of 92 naked refugees, who had suffered utterly degrading treatment. My night was full of the angst of these two realities.

 

We find ourselves in an apocalyptic moment. An apocalypse is often thought to speak of the end of all things. Rather, in its truest sense, the word apocalypse simply means ‘to pull the lid off something’, or to reveal things for what they are. We live in a moment when perhaps more clearly than for a very long time, the facades which are held up to pretend that everything is ok, are well and truly down. Here in front of our naked eyes, we see the stark reality of the way things truly are.

 

Consider the following:

The rate of climate change is accelerating with devastating consequences.

There are now 89.1million people being displaced globally, including 27.1million refugees. All the while, we draw up the bridge and threaten those who flee their war-ridden nations with deportation to places where we will not have to see them.

Global financial uncertainty, with market volatility, rising inflation rates and stalling economic growth is leading to rising poverty. The gap is widening between the richest and poorest, globally, nationally and regionally. The cost of simply living is becoming unaffordable.

Huge food insecurity is driving millions of people globally into poverty, with staggering problems around hunger, rising starvation, famine and drought.

Over a million species are at risk of extinction, with terrible consequences to our loss of biodiversity.

The toxicity of nationalism and sovereignty is laid bare through senseless war and the breaking of unions.

And governments, banks and global financial institutions look to placate and reassure the markets with the same old answers to the same old questions as if they will lead to radically different answers.

 

Our world is sick. Our society is sick. The storms are raging. And millions upon millions of people are crammed into the valley of decision.

 

How do we heal? How do we respond in the face of such devastation, brutality and madness? There is no other way, but that of faith, hope and love.

 

Faith, stares fully into the outrageous abyss of what the apocalypse reveals and refuses to accept that it will always be this way. Faith knows the markets and its associated economic theories do not hold the answers. Rather, it enables us to challenge the inevitability of the status quo and see that the world can and must be made new. Faith trusts that God is with us in the midst of the multiple crises and is bending the arc of history towards goodness, despite what the evidence may tell us. Faith knows that simple small acts of radical kindness, when multiplied a billion times around the globe, can bring about life-giving change.

 

Hope helps us find a way together, even though it feels like we are too late or too far down the road to recover. Hope is not some kind of wishful thinking. It is, rather, as Rebecca Solnit reminds us, an axe we break down doors with, in an emergency. It is true that hope which is continually deferred makes our hearts sick. But hope that is coming is a tree of life and we must eat its fruit and allow it to infuse every cell in our beings. Now is not the time to lose hope.

 

Love, as bell hooks tells us is a verb! It is gutsy, determined and action orientated. Love refuses to stigmatise. Love dares to cross the dividing lines. Love welcomes the stranger and embraces the needy. Love is humble enough to change. Love embraces the ‘enemy’ and lays itself down for the ‘other’. Love always trusts, always hopes and always perseveres. In the midst of the storm, only when we lock eyes with Love can we find the creative force needed to overcome the odds and build health and wellbeing in our communities and our ecology. Love never fails.

 

Whatever else we do, we must not turn our eyes away in this apocalyptic moment. Let the full pain and horror of this moment fully reveal the monstrous truth of the staggering injustice we have built through abusive power. Then let us turn our faces into the winds of change and set our sights on the future which is coming towards us. Let us throw off everything which hinders us and let us walk together into the way of peace.

 

 

 

 

 

 

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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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