An Open Letter to NHS Staff – This ‘crisis’ is not your fault – you’re doing a great job!

If you work in the NHS, in any capacity, this letter is for you, no matter what your role.

 

Dear NHS Staff Member,

 

I write this to you as a GP, who cares for many people who work in the NHS and sees the huge stress many of us feel under. I write it as a ‘system leader’ in my role as Director of Population Health and as someone who has been a patient myself, twice in the last 12 months.

 

We are constantly told that the NHS is in crisis (I’ve even written blogs about it myself!), that we’re not meeting targets, that we’re getting things wrong, that we’re struggling to cope under the strain of demand but not being efficient enough and it can feel like what we’re doing isn’t up to the mark. With all the other current surrounding narratives we live with (like Brexit and Climate Change), things can so easily feel overwhelming.

 

So, I just wanted to write and tell you that the NHS is not in a crisis. We’re just underfunded and understaffed and we’re doing the best we can in those circumstances. Demand is growing year on year and we’re dealing with real complexity. We’ve been under the biggest and longest squeeze on our finances in NHS history, for the last 9 years, and the 3.4% uplift we’ve been promised, although welcome, is not enough to keep us running as we are and do the transformational work required of us. We don’t have enough people to deliver the work we’re being asked to do and so it’s no surprise that morale is low and burn-out levels are high. None of that is your fault. You are doing an amazing job. Every day, you turn up to work, in the context of everything else you have going on in your life and you are helping to deliver a truly world-class health service. Good job!

 

Amidst all the rhetoric you hear, the targets you feel under pressure to meet, the constant flow of people through the doors, the blame and complain (and sometimes bullying) culture that can grind you down, the traumas that you deal with every day, the pain that you help people process, the love and compassion that your pour out, the siloes and frustrations with the clumsiness of the system at times and the long hours – of which you work above and beyond most of the time…..know that you are more than your job and you are valuable just for who you are.

 

So, in all the busyness, remember to listen to and look after your own needs and those of your team around you. You can only do what you can do, and you’re doing a great job. Think about Maslow’s hierarchy of needs and how much you are attending to those things.

 

Physiological Needs – are you listening to your body? Are you getting time to have a drink, eat well, stretch, sleep and get to the toilet ok?

Safety – Are you feeling safe in your work? Do you feel protected? Are you worrying all the time about making mistakes? Do you feel it’s ok to make a mistake and be able to talk about it and learn from it, without fearing some awful consequences?

Love and Belonging – Do you feel like you are an important member of your team – that you matter, that you belong, that people around you care about you? Maybe in the humdrum and mayhem of everyday, we forget to tell each other.

Esteem – How is your self-esteem? Do you feel confident in who you are? Are you treated with respect and kindness and treating others with the same – no matter who they may be?

Cognition – Are you in a place where you can think clearly, make rational choices and in an environment which values learning and development?

Aesthetic Needs – Are you taking time to admire the beauty around you and enjoy life? Without this, it’s really hard to keep motivation alive, especially when things are tough and work feels really pressured. Taking time for this changes your perspective on everything else. How is your perspective? Is it in or out of kilter?

Self-Actualisation – Are you able to be spontaneous, making wise and creative, moral choices, problem solving without prejudice whilst accepting the facts in front of you?

Transcendence – This is the place we are aiming for as human beings – that ability to move out of our ego and into the place of gift from which we can love the ‘other’ and even our ‘enemy’ with the kind of transformative substance that changes the world.

 

The truth is, you can’t get to this place of self-actualisation and transcendence if the other areas aren’t looked after – so what needs attention? What are you noticing that needs taking care of? Don’t worry about all the pressures from on high – it’s all part of a system of biopower that needs to measure things to keep control. You – yes you, are valuable and important and the contribution you are making every day is phenomenal. You will certainly make some mistakes. It’s likely that you’ll feel overwhelmed at times, so listen to what your body, mind and heart needs and give yourself some space to attend to those things. Your own health and wellbeing really matters. So if you need help – and most of us do at different times, then please talk about it and give it some focus. We need to take care of each other – it’s ok not to be ok. Only when we create supportive environments for each other can we bring our ‘A game’ and keep providing the phenomenal care, innovation and transformation that we do every day.

 

Thank you a million times for everything you are doing, despite the struggles and pressure. Together, we need to create a culture of joy and kindness. That is partly the responsibility of leaders, but its incumbent on all of us, to treat ourselves and those around us with gentleness and respect. Go ahead and keep doing the great work you are doing every day – you really are a wonder!

 

Love and gratefulness

 

Andy

 

 

 

 

 

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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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