It’s time to do the impossible. It’s time to turn the tide.
In my last blog, I talked about the exponential potential of what could be possible if clinicians worked together in a more collaborative way. However, far more can be achieved if we work together in and with our communities to create a social movement together around being more healthy and well. I’ve talked previously about the “battle royale” that occurred between Béchamp and Pasteur over whether we should promote health or fight disease. The answer is, of course, that we need to do both, but the clinical community is not equipped with the resource or power to do it alone.
What we cannot accept, though, is our current apathy or malaise that some of the health 
crises we now face are too much for us to do anything about. We are in the midst of a battle, which we are currently losing and it is time to gird our loins for a turning of the tide. Here in Morecambe Bay, we have started a conversation, not just among the Clinical Community but with the wider population about how we might become the healthiest place in the UK. Yes, we mean this in a very holistic way, but there are also some specific foci we have so we can together reverse some of the appalling health statistics we are facing.
For too long, we have simply laid down and allowed exercise to be taken out of schools, whilst our kids consume a bath full of sugar every year. All the time our own work and eating habits have become significantly unhealthy. We have relied on expensive drugs to fix our problems, rather than tackling the root causes of our excesses. It has lead to 1 in every 5 pounds in the NHS being spent as a direct result of our lifestyles and 1 in 11 pounds being spent on diabetes. We say we value the NHS above anything else as a nation (maybe an issue in it’s own right…..) but we do not behave in ways that show this value to be true. We have not been brave enough to challenge the status quo and together make a wholesale change both about how we promote health and look to aggressively reverse it when things begin to go wrong.
I suggest that within a generation, if we wanted to, we could render Type 2 Diabetes a rare diagnosis. We can do this through encouraging far more healthy lifestyles in our children and young people now, like running a mile a day and learning to eat food that doesn’t actually harm them! I believe we could significantly reduce the need for so many people to be taking medication for hypertension and diabetes now, prevent many strokes and heart attacks, by being violent towards these conditions with major changes in lifestyle, though diet and exercise, rather than the prescription of drugs, using coaching, peer support and local champions to give psychological motivation and encouragement. We are beginning to have some excellent discussions and develop some exciting plans around this.
Our NHS health checks should serve as a major motivational opportunity for someone to
pull themselves back from the brink of a lifetime of medication and we should use all medication reviews as a chance to help people adopt lifestyles that might reverse the need for such drugs. In the process, we would also significantly reverse our number of cancer diagnoses – many of which are linked to our lifestyle choices. We simply can’t afford for our current and failing approach to continue. We need to be braver together! And this means the NHS must be willing to partner in new ways, not only with local people, but also with businesses like the major supermarkets to help reverse our current direction towards the abyss, in which there is no longer a healthcare system that serves the needs of everyone, no matter where they come from or how much they do or don’t earn.
Don’t get me wrong! We should absolutely use medication to its fullest use for those who are at risk and have not responded to major lifestyle changes. For example, we can wage war on Atrial Fibrillation, ensuring far more appropriate use of anticoagulation, in the most cost effective and safest way, therefore preventing many life-changing strokes in the mean time. And for those who, despite lifestyle measures, still have a high blood pressure or continue with diabetes, we should not withhold medication that would prevent major issues later on. It’s just at the moment, we’re reaching for the prescription pad too readily and not looking to reverse conditions completely before they set in. We need more education out there around the early signs of cancer, so we can hit it early and reverse it’s effects when we have a better chance. Respiratory disease is another area where we could seriously make a change. We need to think of ourselves as one big respiratory team, tackling smoking, housing damp and carpeting, whilst ensuring every person has an understanding of their condition, how to use their medication effectively and what to do when things flare up. A cohesive clinical community really could deliver something special in each of these disease areas.
We could also be a great deal more effective in how we care for the frail elderly. We don’t need anywhere near as many hospital beds. We can provide care in residential and nursing homes, avoiding double payment for beds, by shifting resource out of our acute hospitals and into the community. We need to have a far more grown up conversation about why we admit people to hospital when there is very little proven benefit of doing so.
Taking a strategic shift towards a social movement for health, significant lifestyle changes and treatment only after these things have been given serious attention, but unapologetically so once they have, we can turn back this battle at the gates and change the health of this nation for generations to come. We can undo the unaffordable situation we find ourselves in and discover together a much more healthy future.
We can absolutely do this!! It’s going to take some serious resolve and we’re going to have to withstand the fear and pressure of some pretty powerful lobbies, like the sugar, alcohol, tobacco and pharmaceutical giants, and perhaps even the government itself, but it is time for us to do the impossible. With love, hope and faith, we can do this! Yes we need to focus on schools and work places. Yes, we need to partner with organisations we’ve never worked with before. Yes, we need a far more effective media strategy and yes, we need to allow clinicians to work very differently. But we cannot do nothing. So let’s try something a whole lot more radical. That’s what we’re going for in Morecambe Bay – not just better care together, but better health together – you can watch and wait, and see if we sink or swim, or you can join us!
There are many times when people come to see me, as a GP, and I cannot find a physical cause for their pain. There are various other conditions when people have what we call “medically unexplained symptoms”. For others, they can get stuck in a rut with their mental health and feel unable to get out of it. In the west, we are not as comfortable as we might be in dealing with the concept of spiritual health. Our spirit, the true essence of who we are, can also suffer damage and ill health, which in turn can lead to physical and psychological manifestations of that same pain. One of the things I have seen time and again as one contributing factor is when someone is finding it difficult to forgive a past hurt. In this vlog I talk about the great power of forgiveness in helping us to be more well. In the one after this, I will talk about how we can actually go about forgiving someone who has hurt us.
So, focusing in on the UK (maybe some thoughts on the lovely USA another time), if we are to shift the political discourse towards something more healthy for the future, we need to learn to listen to the part of us that feels the need to be safe. We need to understand the ‘shadow’ part of our corporate personality that is anxious and fearful, admitting to ourselves what drives our thoughts and actions. When a Type 6 personality is not in a healthy place, they will begin to regress into a Type 3 pattern of thinking. So, the underlying drive to be safe becomes the need to get noticed and be special. So, post-brexit, some of which was about the need to be safe, we find our politicans trying to re-assert our Soverignty and our ‘Greatness’. Only a couple of weeks ago, Boris Johnson, the Foreign Secretary, was declaring on the radio that we don’t realise quite how the rest of the world sees us. Apparently, they admire us and think we need to continue showing great leadership in the world. We continue to believe this about ourselves, that we are very special and have a vital role which the rest of the world needs us to play. I wonder if we actually asked the rest of the world whether or not this is true, they might laugh in our face, pat us on the head and gently remind us that the world has moved on, but maybe we have not.
feeling low/down/hopeless/sad/apathetic/bored/exhausted, I might invite you to imagine what life might be like if you weren’t feeling that way. You might tell me that you’d feel happy and then I would ask you to tell me what ‘happiness’ might be like for you. I’d ask you to describe in as much detail as possible how you would know that you were happy – what would be different? I’d get you to put as much colour on that as possible. And once I understood how you would know you were happy, I would ask how others around you would know – what your partner/children/friends/pets would notice about you…….suddenly your mind is alive with an alternative reality to where you are currently and although things won’t be suddenly better, your mind has been awakened to another way of being! And that brings a beautiful thing – it brings possible solutions to the problem.
There is no doubting that the problems in the NHS are vast. One of the things I have found is that if you try and enable someone to think about the solutions without allowing them to tel you what the problems are, you won’t get very far. A certain amount of catharsis and expression of the issues is important. So here goes: here is a picture of the problems the NHS faces (and these have already been stated many times over, but let’s just be clear):
The NHS is under-funded. Cuts to other services, like social care have also had a massive impact on the NHS as a system being able to work and targets are being missed as a result. People are living longer and this means more complex health problems and a rise in dementia. There is more obesity and diabetes and this has a huge impact in the cost of healthcare. The way the NHS is funded is ludicrous and puts parts of the system that should be working collaboratively in direct competition with each other. Teams across the NHS are clumsy and clunky with little ability to work smartly due to constraints of historic ways things were set up. Demand and expectation are extremely high and yet there are multiple missed appointments. And I could go on!
eat moany pie together and complain about the issues. Throwing mud and finger pointing, blaming everybody else but ourselves will solve nothing. The awful tribalism and over politicization of the NHS is preventing us from finding a way forward. What might health and social care in this country be like if open our mind to new possibilities? What if we stopped focusing on all the problems and dreamed of how things might be in 5, 10, 50, 100 years time? We’ve been doing this in Morecambe Bay and we’re moving from not only dreaming but to doing something different!
We’re working with our communities to help us all live more healthy lives, thinking about health as a social movement. 97% of all health monies are spent once people are ill. We’re taking prevention seriously! We are breaking down walls between our organisations and sharing our budgets. We’re building relationships between clinicians and managers across many diving lines. We’re collaborating to share our resources and using our budgets in a way that makes sense for our communities. We’re unashamedly talking a new language of love, building trust and establishing infrastructures of positive peace. We’ve worked out where we are being inefficient and sharing our conundrums with our communities (we do actually have to be responsible about what we spend – the NHS is not carte blanche). We’re working out how to work differently and more smartly. We’re sorting out our IT. We’re redesigning care so it makes more sense for our patients. We’re working on our consultation and communication skills. We’re being more proactive in getting positive messages out there. We’re building for the next 100+ years not just the next political cycle. This is better care together!
have huge health inequalities. There are major issues with housing, economic policies that are not working for huge swathes of our population, with more people having to use food banks, struggling with fuel poverty, living in damp houses and unable to make ends meet. Yes, our kids are spending more time on screens and less time in activity. Yes, the sugar lobby, alcohol lobby and advertising giants have far too much power. Supermarkets are designed deliberately so that we buy things that are bad for us. And sometimes, we just make poor choices (if you can call them choices, which for some people, they aren’t always) – we do not all live as healthily as we could – we eat the wrong stuff, work highly stressful jobs, and exercise less than we are recommended to. Mental health issues are on the rise, especially for teenagers, due to crazy targets and league tables, with all the pressures they face. We are less happy and more separated than we ever used to be, despite the rise in social media…..(or maybe because of it……)…..Man, I can paint a negative picture – it’s like storm clouds and darkness everywhere……..
But what if it wasn’t that way? What if we got a bit angry about it, but instead of finding someone to blame and pointing the finger; instead of getting all tribal and throwing stones at others, we chose to use our energies creatively to find solutions, to work together and make positive changes?! Let’s put away our pointing fingers and our ranting tongues and let’s work together for a better future for everyone! Doesn’t that sound good?! It’s what we’re trying here in Morecambe Bay, and I’m hoping it spreads like wild fire so that we can become a place where health abounds and beauty surrounds (that’s the motto of this place!). That doesn’t mean we stop speaking truth to power, but we also let our actions (and maybe our votes) speak louder than ever before.
We’re talking together, taking time to dream about what it would be like if we were the healthiest area in the UK. We’re training up many people to host conversations, so that we break down walls and learn to collaborate for the sake of everyone. We’re not just dreaming about physical health, but mental, social and systemic health as well. We’re encouraging those who want to rise up and take some leadership, to be pioneers in the stuff they are passionate about. Even in my little town, we now have a mental health cafe that is literally saving people’s lives, because a lady called Jane wanted to make a difference. We have a cafe for all the people who have circulation problems because one of our nurses wanted to break people’s isolation and improve their healing rates at the same time. 
We’ve got a carers cafe, a dementia cafe and will soon have a breathing cafe for those who have severe COPD, sharing ideas and diminishing anxiety. We’ve got exercise classes to help with pain, a community choir, dog poo wardens to help us take more pride when we walk down the street and food banks to help those who can no longer afford to eat.![image[1]](http://reimagininghealth.com/wp-content/uploads/2016/03/image1.jpg)
We have 2000 kids aged 4-11 running a mile a day at school with staggering results for our children here in terms of physical, mental and educational health. We’re hoping over time, this becomes the Morecambe Bay Mile, part of a cultural shift towards being more active. We are working with local chefs and supermarkets to enable people with pre-diabetes or weight struggles to eat more healthily. We’re choosing to lead by example in the NHS to work well and flourish in our work places. We’ve made a commitment to see the 5 ways to wellbeing in every NHS organisation and we’re hoping many other systems and businesses will follow us in this. We’re finding radical ways to help people who are struggling with alcohol and drug addiction, get free and stay free with amazing results. We’re helping people live well with and beyond cancer.
We’re changing the way consultations happen in the NHS to enable people to make more informed and better choices about their own health and conditions, so they feel empowered to make changes that work for them rather than beaten up when they go for an appointment! We’re launching the Morecambe Bay Poverty Truth challenge, learning from those who are lived 
experts in poverty to help us work together and care better for those most struggling in our society. We’re having difficult conversations about death to help people be prepared for every eventuality.
will be awakened? What other partnerships, collaborations and relationships might be formed? Being all tribal and accusatory of others saps our energy and stops us being creative. Mud slinging and blame will achieve little. We have to work from where we are. We have to build bridges and work together. We have to build a future of positive peace and that means binary thinking is over! The future doesn’t have to be full of doom and gloom. It is alive with hope! What resources might we find? What talents might we discover? What might we see develop over the next 12 months/years/decades as we look for solutions together for a better future for everybody? Don’t you feel just a little bit excited?
Last weekend, I spent the weekend with my wife and a bunch of close friends, immersing ourselves in the enneagram. It’s something I’ve done a bit of before and highly recommend it! The enneagram is an ancient way of understanding the human personality, our instincts, gifts, struggles and strengths. There are several different perspectives on it. There are similarities between the enneagram and various other approaches to understanding ourselves and each other better, like the Myers-Briggs, Strengths Finder etc, all of which I have found really helpful. On Myers-Briggs, I’m an ENFP. My core strengths are ‘believer’, ‘activator’, ‘communicator’, ‘achiever’ and ‘woo’ (the ability to win others over). I love knowing this stuff, especially in team dynamics because it allows each person to play to their strengths and to some extent, cover each others weaknesses.
What I love about the enneagram is that it helps me, more than anything else I know, to face up to my struggles, my shadow, my ego and my unhealthy behaviour patterns without leaving me feeling ashamed or condemned. It helps me get to grips with my blind spots when it comes to my raw instincts and enables me to draw on others for support and help in making healthy changes. For those of you, who have never read anything about it, there are basically 9 personality types, each with 3 basic instinct types attached to them. Understanding your type and your instinct (especially your blind spot) can really help you on a journey towards freedom, wholeness and peace. It made me reflect so much on how I practice as a doctor and how often I might actually try and medicate someone or ‘therapy’ them, to try and soothe their pain when they might just be at a monumentally important moment of transition, discovery or realisation.
actually my blind spot – I’m just not that great at being disciplined in taking care of my basic needs e.g. diet and exercise, or my motivation for doing these things is not self-care!), social adaptation or sexual attraction (that’s my prime driver – rather unfortunately termed, as it doesn’t mean I’m some kind of sex fiend!). Being a type 7 is actually awesome (of course). It means being an optimist, an activator, an enthusiast, a visionary and an adventurer. I see potential in people and possibilities and carry a strong belief that things can and will change for good. For me, life is fun and full of joy and I love to assimilate loads of interesting knowledge, being a generalist (suiting my work as a GP, rather than a specialist)……What’s not to love, right?! But here’s the thing…..
conversations with people, as I hate causing pain in others. I love to find the next new thing, but this means I get easily distracted, my head is full of new ideas and lots of wonderful imaginings so I find it hard to focus, to stay in the present moment and be at peace. My visionary side can easily lead to idealism and when things don’t turn out the way I had imagined, I can verge towards anger or resentment. Even though I know this about myself, when I am not doing so well, when I am not as healthy as I could be, I see these patterns emerging. And my root struggle (and this is entirely true!) is gluttony! When life is painful, instead of embracing the pain, exploring it and confronting it, I take comfort in eating – (type 7’s often have yo-yo-ing weight or other addictions). I’m on a quest to lose a stone at the moment, but because self-preservation is my blind spot, this isn’t as straightforward as it sounds!
most important person in my life, deliberately fools me into suppressing the vulnerable or shadow part of me, which if I embrace, can actually allow me to become a great deal more healed. If I can face up to the little person inside me, that I hide away and try to squash, who feels worried at times that I don’t have enough and that I’m feeling a bit overwhelmed by the build of issues on the inside of me; if I can recognise when I have entered the realm of fake joy and anticipatory energy and instead of veering towards trying to control everything and make everything feel happy but rather admit where I’m really at…..then and only then can I find a place of true contentment, where simplicity is restored, where I can focus, be present and know things are ‘perfect just as they are’…..then I can let go of idealism and enter the realm of sober joy, where truth resonates with hope and allows me to be the very best version of me.
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