Tag: uk

Learning to Celebrate Success

iu-2The NHS really is amazing. Today, I have been at the NHS confederation (confed2016), a conference which helps to set the pulse and rhythm of the health system over the following 12 months. I heard Dame Kelly Holmes speak movingly about her own experiences, help she received from across the NHS and how grateful she is to live in a country where there is such excellent healthcare available to everybody, no matter how rich or poor. As a double Olympic champion, she highly values her personal relationship with her GP, keeping care local and personal. She would not be where she is today had it not been for the superb care she was given when in the depths of depression only a year before she was able to achieve her dream. Had it not been for surgery, physiotherapy and nutritional expertise all from people working within this incredible system, she would never have accomplished what she has done in her career. And not only her, there was a moving tribute from her mother who has also had significant health problems over the last year.

 
In a time of austerity, although in the OECD countries, there have been 260,000 extra cases of missed cancer in the past year, not one of them has occurred in the UK!! The NHS is staffed by brilliant, caring, compassionate people, who are pursuing excellence in the care they provide. The NHS is able to provide some of the best health outcomes in the world and is still rated as the best health organisation in the world by the World Health Organisation, despite having one of the lowest government expenditures in the developed world.

 
We hear so much negativity in the press about failures, pressures, targets and financial strain that it is no wonder there is a low morale at times amongst the staff. But Kelly Holmes tells us that we must learn to celebrate our successes, because in our dark times (and there are many in the field of healthcare), it isiu-1 vital that we keep hope alive. There were many times, when the press was against her, out for a good story, many times when things did not go to plan, but the celebration of her successes along the way kept her hope alive. We are going to have days when we get it wrong. We are going to have increasingly more situations in which we feel squeezed, hard pressed and floundering, but there is so much we are doing every single day that literally transforms the lives of countless individuals. We look people in the eye and tell them our names, that we will be caring for them and that they matter to us. We compassionately communicate the best and worst of news. We use our skills to arrange appointments, clean, bathe, bandage, measure, test, diagnose, operate, teach, manage, cure, deliver new life, care for the dying and so much more. This is nothing short of amazing.

 

1973049_861ba277[1]I am so grateful for the teams I work with at Ash Trees Surgery in Carnforth, Lancashire North CCG and Better Care Together around Morecambe Bay. We are doing brilliant things together every day, as are countless teams across the UK. Part of the culture shift we need to see is for us to lift our heads, celebrate what is excellent and use it as fuel to propel us further forward into the love and good of the future. I thank God for the NHS, it is worth remembering what a treasure we hold in our hands and continue to be grateful for the privilege it is to serve people through it. If we don’t learn to celebrate our successes, we may not find the reslience we need for the path ahead. But with hearts full of gratitude and a sense of achievement, we can continue to go for gold.

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Reconnecting Clinicians to Healing

In the USA, doctors have the highest rate of suicide of any profession. In the UK, a similar picture unfolds. Why is it, that 69% of all physicians suffer with depression at least one time in their career? It could be because of the high workload, high stress, high demand, an increased sense of professional isolation coupled with a growing powerlessness to effect change to the systems that often work against the real healing of people.

 

I think all of those reasons are there for sure. But I also think that as doctors become increasing slaves of a system, they lose touch with themselves, the things that make them unique, and are expected instead to act like robots, or cogs in a machine that get people just well enough to return to work and be of benefit to the economy. We have managed to disconnect clinicians from their own sense of humanity. But the art of healing is so much more holistic and profound than the science of clinical medicine.

 

23ec23_61a12bbd059d4b3bbb53f656c3e7eaf7.jpg_srz_p_490_490_75_22_0.5_1.2_0_jpg_srzIf I were to design a health centre, it would not look like any of the places I work in. They are all far too clinical and are probably not very conducive to healing. For starters, there would be a whole lot more natural light, with beautiful artwork (I have some amazing pieces in my room now, by a brilliant local artist, Emma Hamilton) and sense of a continuum with the landscape. There would be places for people to talk with each other around tables where food and drink could be served, isolation broken and community restored. There would be places to encourage exercise or mindfulness through colouring. My room would have a piano in the corner and it would be filled with art, poems, quotes and there would be huge windows with magnificent views of the sea.

 

And my consultations (which could be conducted outside whenever possible!) would use not just my clinical knowledge, but would reflect more of iu-1who I am. Even now, I spend a lot of time laughing with my patients. Laughter is so good! It is healing in and of itself. There would be time for music. I would sing to my patients (they might well leave faster!)……Every doctor I know has talents, gifts, hobbies, and hidden depths that are rarely used when they encounter their patients. I wonder how much more effective we might be as healers, if we reconnected with the God-given sense of who we are and what makes our own hearts sing.

 

I love the story of the Obstetrician from Pittsburgh, who sings to every baby he delivers. What a beautiful thing. What might we all do more of as clinicians, if we thought of ourselves as healers? What spaces might we create? What might our consultations become? I wonder if we did this…..would we be less depressed and more happy in our work? And might we be more effective in gifting wellness to our communities?

 

 

 

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A Different Kind of Leadership for the NHS

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.

 

 

imagesAnd 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 odownloadf 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.

 

imagesThe 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 imagesand 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.

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UK, You’ve Had a Heart Attack – How Are You Now?

MIYou might want a cup of tea whilst you read this! I often see patients a week or two after they have been discharged from hospital with a Myocardial Infarction (what we often refer to as a heart attack). In this part of my home county, once someone is diagnosed with having a MI, they are admitted to Blackpool Victoria Hospital, where an amazing team of cardiologists literally save their life by putting stents into arteries in their heart that have become clogged up. It has been a phenomenal breakthrough in medical science in the last 15 years and has revolutionised how cardiology services are configured.

New medicines are prescribed to help keep the heart and kidneys healthy and patients are reviewed to see how they are getting on. What I always love in the initial consultation following a heart attack is how reflective a person becomes. Everything in their life gets assessed and reprioritised. Key questions are asked about how much stress they have been under, and why they were living at such a fast pace whilst forgetting about what is really important – living well, relationships, love, beauty, people and connecting with the story of who they feel they really want to be for the rest of their life. It is very rare to find a person who is desperate to get back to business as usual or someone who doesn’t ask some fundamental questions about what life is for. It is possible in some of these consultations to have some of the best coaching conversations a practitioner can ever hope to participate in. Asking some questions of the patient about what they are going to change and how they are going to do so.

And yet, in the UK (and indeed the west), we suffered a heart attack beyond all proportions with the economic crash of 2008. But we have not really reflected on the major warning sign that it was to us. We have a government and financial system intent on “getting us back on track” – and I wonder to what, exactly? It isn’t that the financial system alone, just happened to have an infarction. It’s like assuming that a heart attack happens simply because of a defect in the cardiac system itself – this simply isn’t true. The crash was only a sign of just how broken our entire body is and we would do well to reflect a great deal more about how we are living as a nation and whether it gives us any real sustainability for the future of the planet and the generations to come. Our current response is not only to “get back on track” with where we were, but  to “tighten our belts” (which means to cut benefits left right and centre without regard for the dehumanisation of people in the process). It’s like believing the correct response following an MI is to emaciate and punish yourself, without asking some fundamental questions about how healthy your whole life is.

So, what about about a national health check – let’s look at each system in turn and ask some questions – because the truth is, we haven’t faced the fact that we are in an age of transition in which answers are not obvious and we don’t have any experts who have been to the alternative future we long for. So, we have to learn together and ask open questions that provoke better conversations to help us.

Let’s start with Education. George Monbiot has written a stunning piece in the Guardian about the current health of the education system: http://www.theguardian.com/commentisfree/2015/jun/09/aspirational-parents-children-elite?CMP=share_btn_fb – well worth a read. Our education secretary, Nicky Morgan on the other hand isNicky Morgan intent on more testing of our children and has recently given a speech in which she claimed that arts and humanities subject choices close down a child’s career options and they will earn 10% more in their life if they do Maths at A level – whooppee do dah. For an alternative and altogether more inspiring approach, look to the lovely Ken Robinson:

Couldn’t education become about real learning in which our children feel inspired and find hope for the future?

Ecology – Oh dear – so far a string of broken promises on the environment from the western governments. It turns out that oil and industry is more important than the future of the planet. Is it? If not, what are we going to do?

Defence – undergirding our entire nation are three things: Money as debt (see finance), the state of the exception (see law and order) and military violence. The ultimate trust of our nation rests on nuclear warheads. How healthy is this? How much fear do we have to create as a narrative to believe this is actually a good thing? Do we want that to be the undergirding faith of our nation? And what about the change in rhetoric regarding soldiers who die in war. David Cameron recently referred to soil from the battle fields of WWI (which was brought to London) as ‘Holy Ground’ and he described those who died fighting for the ‘allied forces’ as ‘martyrs’. Is the nation state therefore the ‘saviour’? If it is, what on earth do we mean by this? If not, then is there other language we can find to use about the two world wars without creating a very dangerous worldview?

Housing – 69% of the land continues to be owned by 0.6% of the population and there is a real lack of social housing available in deprived areas. This is causing significant problems for those already under huge financial strain, given the effects of austerity measures. Who does the land belong to and why?

Justice – How many of the perpetrators of crime are victims of a system that left them with little or no other choice but to commit crime? How restorative is our justice process?

Law and Order – our prisons are full to breaking, our police force is being cut and replaced with private security firms. How effective is our law and order system? And what undergirds it? Georgio Agamben cuts through to the heart of the issue in his exquisite book ‘State of Exception’. Underneath the whole of western ‘democracy’ lies the right for the government to suspend the rule of law i.e. invoke Marshall law if deemed necessary. I look at the people movements emerging across Europe right now and wonder how far we are from the ‘state of exception’ being invoked. All it will prove, as we already know, is that democracy is a vain imagination. What is it that undoes ‘the powers’? Could a movement for positive peace, founded on love offer any realistic alternative? If so, what?

Immigration – apparently the answer to our problems is to become more fearful of the ‘other’, create a politics of fear and blame immigrants for our financial problems. We are barricading our doors Syrian Refugeesand building up our walls to ‘protect our way of life’. And while there are currently 4 million homeless Syrian refugees, the UK has welcomed 147 of them in total. Did you know that the entire world population could fit into Texas? Our concerns about lack of space and lack of jobs is really unfounded and we seem willing to ‘love our neighbours’ with great initiatives like comic relief and generous charitable giving, just as long as it doesn’t actually have to affect us and our way of life…..how loving is that? How healthy is love that does not truly cost us and change us?

Health – this whole blog is about it, but 1 in every 5 pounds spent in the NHS is due to poor lifestyle choices we are making. We can’t live imgresexactly how we want if we hope to continue with a health service that is free for everybody. How will we change the culture? Can we find innovative ways of working collaboratively within the system that breaks down the silos in order to work more effectively for the good of our national health? Is privatisation the answer? If not, what are we willing to change/protest about to keep it public?

Government – a majority with 36.4% of the vote? Deeply wrong. There continues to be profound disengagement with the system and a deep cynicism that the current style of government can bring any real lasting change. We need a new politics – what might that be like? Where are the leaders who will choose to facilitate instead of dominate?

imgresEconomy – ah yes, that old chestnut. Do we want an economy in which the gap between rich and poor continues to widen? Do we want a system in which the poor are punished whilst the rich are exonerated for their greedy crimes? The entire western economy is based on a system of debt that requires us to continually grow and expand our borders so that the debt can be serviced. We have become slaves to the economic beast. Where are the alternative experiments emerging? What can we learn from them? Are we brave enough to try something new? I have posted this before, on my other blog – www.reimaginingthefuture.org  but Charles Eisenstein is so worth watching:

The human heart provides us with a great metaphor. The health of our nation(s) is not good. We’ve had the wake up call, and if we’re not careful (this is a warning from a doctor, so take heed), the next heart attack will be even more catastrophic. We have to reflect on where we are and ask ourselves where our current trajectory will lead us. I don’t want to get back on track if it leads us to more depression, destruction and decay. I want to find the road less traveled by – the one that leads to life, hope, love, regeneration, recreation and a beautiful future for our children. So many questions. So much to learn.

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