A Difficult Conversation About COVID-19 – Care Planning

For those of us more at risk from Corona Virus, over the next few days and weeks, your GP will be in touch to have a difficult conversation with you about care planning. That means a conversation about what your wishes would be, if you become very unwell from COVID-19. We find ourselves in unchartered waters and unprecedented times. Conversations about what might happen if we become seriously unwell, or have to face death are never easy, but they are really important. Here, I invite us to start having those conversations and to think about what really matters to us.

 

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A Message to Our NHS & Public Sector Staff & Community Volunteers

This is my message to NHS & Public Sector staff, and all our community volunteers, during this Corona Virus Pandemic – so grateful for all you are doing. Let’s look after each other.

 

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4 Things to Do If You Are ‘Isolated’ at Home Because of Corona Virus

I’ve been thinking about how people can best use their time, if they are stuck at home during this Corona Virus, Covid-19 Pandemic. Some people will be asked to ‘self-isolate’, along with their household for 14 days because they have symptoms of a high temperature and/or a persistent and troubling cough. Others will be asked to do the same for 12 weeks if they are pregnant, over 70, or usually receive a flu-jab on the NHS (due to having an underlying health condition or on medication that suppresses their immune system). The reason for all of this is to try and suppress the spread of this virus, and maintain health in the wider community until we are sure we have better treatments and a vaccine that we can use across the population. Obviously, if you’re unwell, the first priority is to give your body time to recuperate by taking plenty of fluids (2-3 litres of water per day), eating well, sleeping and letting your immune system do it’s job, whilst you take paracetamol (at the recommended dose) to control your temperature and levels of pain. For many people, however, this time may feel frustrating, because symptoms will be mild or absent and some will be wondering what to do with the time they have been ‘gifted’.

 

There are 4 things, which I believe we can all do during this time, if we find ourselves in the situation of being in isolation, but not actually feeling too unwell.

 

  1. REST
  2. REFLECT
  3. RE-IMAGINE
  4. RESET

 

REST

This is something which we tend to not be very good at. However, we have been given the opportunity to step back from the fast-paced, consumerist-approach that we have adopted in society and take some time to just BE. Learning to accept that we are where we are and deliberately slowing down will enable us to find new strength and reconnect with that which is most important. Deliberately slowing down our breathing, our pace of walking and learning to calm our racing thoughts allows us to enter into a different mindset. Choosing to turn off our screens and disconnect from social media for good portions of the day allows us to create space in our heads and our hearts for another way of being. I know that social media can be a really important and safe space for many people to continue to connect and feel part of community, breaking down a sense of isolation and loneliness, but if we’re on there all the time, it can really fill our heads with unhelpful traffic and noise, which stops us being able to enter rest. As we rest, we are invited to spend our time differently – to do things that are good for the soul. You could take time to create, write, read, sing, dance, pray, go for a gentle walk, cook, sit round a table and build Lego or do jigsaws with others or on your own. There is no need to accumulate new things, what can you make do with or mend? What old or new hobbies might you rediscover or pick up? How about deliberately choosing not to get a thousand and one jobs done around the house or not rushing into a new decorating project. Just stop for a while, slow-down and rest.

 

REFLECT

When we consider the far reaching potential effects of a global pandemic, like the one we find ourselves in, it causes us to pause, notice more the interconnectedness of human life across the world and the utter fragility of our systems. It should cause us to notice more deeply the injustices upon which we build our society, the insecurity of work and the implications of global capitalism on the poorest in our communities and indeed our environment. During this time, we do well to reflect on what we are learning together. Birds are heard singing for the first time in years in Wuhan – a city usually thick with smog. Destructive air pollution has reduced by over 25% in China and Italy. The canals are cleaner than ever in Venice and global air travel has decreased significantly. Of course, we notice some of the worst bits of our humanity – driven by fear – and some selfishness. But we also see the indomitable human spirit at work – huge acts of love, courage, kindness and generosity. There are amazing offers to help and support with home schooling and teachers are going above and beyond their usual brilliance, thinking creatively about how best to enable their students to thrive. Healthcare workers continue to put themselves at risk and pour themselves into the work of healing. Voluntary food clubs to feed the hungry, delivery services for shopping and medication, community support schemes and the ongoing service of the most vulnerable in our society – it’s amazing. This ability to re-organise ourselves, to connect together differently, to make wider political and economic decisions and find a way to be that feels more wholesome should give us plenty not only to be grateful for but to reflect on about why we put so much energy into maintaining the usual status quo. What good things are we noticing and learning?

 

RE-IMAGINE

What might be possible together? Can we imagine a world with less commutes and more digital connection? Doesn’t it seem more possible to cut global emissions a great deal more quickly, when we’re forced to focus our attention? Could we work and earn differently and be more generous with wages and leave, so that we don’t see so many people left in such a vulnerable state. If we can find the ability to be so kind to each other at such a time as this – why not more so all the time? As we’ve recognised the fragility of our lives and existence, are the grudges we hold worthwhile? Are we able to forgive and reconnect? Might we adopt a way of life that is more about sharing and regenerating than grabbing all we can? Isn’t community one of the most delicious and richest of experiences? How can we build more of it? Can you sniff an economics that is more about wellbeing than profit and a politics that is more about connection and participation in our life together than centralised sovereignty? How about an education system that doesn’t treat our children like fodder for the machine, but invests in their ability to build a beautiful future. Have you seen how relationship really could be the foundation of our public services? So how might we think differently about our governance structures and the way we organise ourselves – think ‘Radical Help’ (Hilary Cottam), ‘Doughnut Economics’ (Kate Raworth) and ‘All Our Welfare’ (Peter Beresford) – plus many more. Can you imagine a society in which we really put the wellbeing of all people and the planet at the heart of what we do? If so….why would we continue with a way of being together which is so detrimental to both?

 

RESET

Our invitation, therefore, is to reset. This invitation comes from the earth itself, from our deepest longings, and from the source of all love and life itself. We don’t have to continue living in the story of selfishness and scarcity. We have shown ourselves that there is a more ancient and wonderful story of connectedness, restoration and hope, to which we all belong. We don’t have to go back to how it has been. Step by step, we can use this ‘kairos’ moment to walk into a new future together. A future in which we heal our divides and regenerate our planet, forgive our deep, historical wrongdoings, rebuild our ruins and restore our relationships; do away with injustice and create reconciliation. It’s time to reset. Are you ready to press the button?

 

Here is a beautiful poem, by Kitty O’Meara, to help us rest, reflect, re-imagine and rest.

 

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Facing Death

My friend, Lucy Watts, is dying. She knows that her beautiful life will be cut short by the condition which she lives with. Death is something we often find hard to talk about, but it is one thing we can be certain of. How do you feel about death? What are your hopes and fears? Have you thought about what would happen to those around you if you died quite suddenly and unexpectedly? Or if you are facing death yourself, in a very real way, have you thought about your wishes, in terms of care, where you might like to die, and what would be important to you about your funeral? Have you instructed a Power of Attorney? Do they know what you would and wouldn’t want? These are certainly not easy conversations to have, but I am so grateful to Lucy for telling her story and how it has given her the determination to really live:

 

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Creating a Culture of Joy – some practical ideas!

I am hugely passionate about how we create great cultures in which to live and work. One particular thing I love is building a culture of joy! My friends Rachel Pilling and Dan Wadsworth have come up with a super easy way in which to practically build joy in work, through this simple but excellent idea of 15-30. This is the magic that happens when clinicians and managers work together. Watch it, if you work in the NHS then sign up and get involved and if you work outside the NHS – the idea is entirely replicable in any other part of life. By you going the extra mile now, you could save your friend a marathon….Building joy in work is, according to the IHI, the most important foundation on which to build a safe, sustainable and excellent health and care system. With staff morale as low as it is, let’s do what we can to promote joy in the daily grind. Here are Dan and Rachel explaining more in their excellent TEDxNHS talk – well worth your time!:

 

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How Does Change Happen? Part 2

This question has become extremely important to me, in my work around how we tackle health inequalities and social injustice. It’s all too easy to take sides, point fingers and play the blame game. But if our political system teachers us anything, it is that this kind of didactic, oppositional approach to life, brings about little change, if any.

 

Over the last few years in Morecambe Bay, we’ve been exploring the power of Social Movements and how we can best work with our communities to effect real and lasting change. As, I said in part one of this series, we’ve been very affected by the need for personal change and the need for deep listening. Change begins with us and this requires genuine humility and deep listening, putting ourselves into uncomfortable situations and surroundings. How can we possibly make decisions for communities with whom we have never spent any time? It’s important that we do our own work and reflect on what we hear and be willing to change our way of working as a result. Series 3 of The Crown, highlights this beautifully with the inauguration of Prince Charles as The Prince of Wales. His relationship with his Welsh tutor utterly transforms the way he sees the plight of the welsh people and indeed his understanding of power, but it only comes from being immersed in Wales and having some significant challenge brought to his world-view.

 

Personal change does not just happen through encounters. The encounter with ‘the other’ invites us into a deeper journey of change. It’s why I have personally also found The Enneagram to be such a helpful tool when it comes to dealing with my own internal issues and mechanisms. For me, as a type 7, it has helped me to understand why I run away from pain and needlessly distract myself from the present in search for ever more stimulation. I have had to face this head on, in order to learn to become more fully human and the best gift I can be (nowhere near there yet!)….

 

I believe we will not see societal change if we are not, ourselves, willing to be changed. Personal transformation, however, is not enough, vital though it is. In thinking about wider social change, I have been really influenced by the philosopher, Valerie Fournier. She talks about three key components which are necessary to drive change within communities. Firstly, she says we must cultivate anger. Initially this seems like quite a strong statement, but what she is referring to is the need to stir a corporate sense of passion around injustice. I have certainly found this to be an important aspect of enabling change in our communities. If we’re not careful, we can spend much of our waking life asleep. If we are to be truly woke to the issues we’re facing across our communities then we must create a space in which people can become stirred to care enough about the reality of the status quo. We have found that people across Morecambe Bay really care about the fact that people living only a few miles apart can have a 15 year difference in life expectancy and an even bigger gap when it comes to years lived in good health. Our experience is that if we give no voice to the discontent within the communities, especially for those at the receiving end of systemic injustice, then we can end up going round in circles, unable to move forward. We definitely don’t want to remain in the place of anger, but it can be harnessed as an incredible energy for good. 

 

The expression of anger is an important part of The Poverty Truth Commission process. Those who are subject to poverty and at the receiving end of the coldness of ‘the system’ need to be given voice to express what that means for them and how it impacts their sense of wellbeing. I think in Britain, we’re not particularly good at ‘anger’. It’s uncomfortable for us. It doesn’t feel polite. We would much rather keep things under wraps and hide away that which makes us feel ashamed. However, when we choose to be present enough to suspend what we think we know about poverty and the experience of it, and really listen to the harrowing reality of it, in another human being and then go on to build relationship and even friendship with that person….then we too are invited into that same anger, not to rage against the machine, but to use the power of our ‘fileo’ (friendship) love to become an agent of radical change. 

 

Anger harnessed in this way leads to Fournier’s second step in social change: ‘Challenge inevitability’ – challenge the inevitability that things must always be this way. When we think about issues like poverty, health inequality, social injustice, adverse childhood experiences – things which feel ‘too hard to change’, it’s easy to resign ourselves to the notion that things will always be this way – therefore we should just ‘keep calm and carry on’, and just do what we can to ‘help those less fortunate than ourselves’….but all this does is reinforce the same old story. Social change requires that we challenge the inevitability of the status quo and that means challenging the world views we hold and the stories we tell ourselves. It doesn’t mean that we must therefore create a greater division between rich and poor or make enemies of ‘the elite’. It’s about taking ideologies that we hold to be ‘true’ and asking probing questions of them. In fact, it’s about giving them a really good shake and uprooting those that are deeply damaging and throwing them on the fire. There are great examples of this kind of work in economics – Kate Raworth in her book ‘Doughnut Economics’, or Katherine Trebeck in her book ‘The Economics of Arrival’ – both challenging economic theory built on GDP and obsessed with growth. We see it in Hilary Cottam’s tour de force ‘Radical Help’ in her challenge to the transactional basis of the welfare state. Bev Skeggs and Imogen Tyler, sociologists both challenging the way society is set up. Rob Barratt, challenging the way we think about education. 

 

At the same time as challenging inevitability we just also incept our thinking with possibility of an alternative future, asking ourselves some powerful ‘what if?’ questions. I wonder what an economy might be like if it held wellbeing of people and the planet as it’s core principles? – a question they are asking in Scotland, New Zealand and Iceland. What if we had a society in which women (change women for any other subjugated group) were treated as true equals? I wonder what education might be like if it were truly future orientated and took climate change seriously? If we challenge what is, it allows us to reimagine what might be.

 

New ideas though, are not enough. The undermining of our current realities opens up the possibility for Fournier’s third aspect of social change, which is to ‘Create moral alternative economies’. We must move from anger and challenge, into experiment. Appreciative Enquiry is a great approach to help us move into this space. It allows communities to focus on what is strong, rather than what is wrong. If we’re going to experiment with new ways of building society, politics, economics etc, we need to so on strong foundations. Once we have cleared the ground in our minds of what has been stopping us find kinder ways forward, we can then focus in on – ok – so what is good?

 

As a result of this approach in the Poverty Truth Commission, for example, we’ve been able to work together on designing the kind of job roles that would really help someone navigate the complexities of the health, social care and welfare system, when they are on the ropes. We heard the anger about where it isn’t working, challenged our own thinking that we can’t really change things and have begun to experiment with the ideas put forward by people on the receiving end of unkind and punitive processes. We’re creating a moral alternative economy. When our city council in Lancaster, recently voted to protect the rights of gypsy-travellers by buying their land and promising to ensure it is fit to live on – they also responded to the anger of deep injustice at what was being proposed (the selling of their land), challenged the inevitability that they had no choice in solving the matter and instead intervened with a moral alternative economy, that protected the ‘poor’ and actually worked for the benefit of everyone. Or, we could take an example from education: When a teacher refuses to tow the line to isolate a student and have them face a wall all day and instead finds a more creative way to understand their student’s anger, challenging the inevitability of school exclusion (and all that will lead onto) and finds an alternative way to help them process their trauma and make the system work for them, rather than the other way round – that teacher is creating a moral alternative economy. You see? We can begin to do it everywhere! And when we begin to experiment with new ways of being together in communities, we begin to tell each other a new and altogether more loving story than the one we’re currently living in. The more we experiment and either fail or succeed, the more we discover how to build a society that works for the wellbeing/peace of everyone and the planet. 

 

So, where do you need to listen more deeply, to allow yourself to be made uncomfortable by the palpable anger that is underneath the surface, or sometimes erupting onto our streets? Why is the anger there? What does it tap into? Where is it coming from? Who is it aimed at? Is that anger able to be channelled in a way that can leverage an altogether more loving and kind society? What inevitability in your personal or our corporate thinking needs to be challenged as a result? What ‘truths’ need to be questioned? What space might that clear for new experiments to emerge? What if those experiments began to interconnect and learn from each other, sharing resources and encouragement along the way? What might then become possible? What if we actually took a breath and decided to genuinely think and work in this way? Can you see the change ahead?! Go ahead and start creating it!

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Living with Trauma – The Realities of PTSD

I’ve written a number of times on this blog about the impact of Adverse Childhood Experiences. However, trauma can happen to us at any stage of our lives and its impact can be absolutely terrifying and profound. Here, my friend Charlie Webster (who some of you will recognise from various sports commentary with the BBC) tells her story to shed light on the realities of PTSD and what can help. I’m grateful for her bravery:

 

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How Does Change Happen?

How does change happen? This has become an incredibly important question to me over the last few years, and I am still on a big learning journey in discovering some answers. There is so much that needs to change – so much that is currently going on in our communities that simply doesn’t work for people. So I keep asking – how does change happen?

 

I recently read a book called ‘The Moral Imagination’ by the great peace-builder and activist, John Paul Lederach. In it, he talks about the concept of ‘critical yeast’. Yeast is itself changed in a new environment (surrounded by flour) and then begins to bring about phenomenal change around it. You don’t continue to see the yeast, but you surely get to see it’s effect!

 

For me, change begins with listening, and by that I mean deep, generative listening to those who we could think of as ‘critical yeast’. The kind of listening in which you can no longer continue to see things the way you did previously. As you listen in this way and find your self changed, you can longer continue with things as they are – you realise that things around you need to change also.

 

It’s one of the reasons why I am absolutely committed to putting myself into uncomfortable surroundings or situations which challenge my neatly held world views and beliefs. I try and make sure I take the lanyard off my neck, step out of the clinical settings I know and the board rooms I sit in and spend time in and with the communities we serve. I really believe it is vital for all leaders, especially those in senior positions to regularly take time away from the boardroom and really sit with the communities they are paid to serve. If you don’t have your finger on the pulse of the pain people are experiencing, then it’s all too easy to make decisions on behalf of them which utterly lack compassion or kindness.

 

So, together with my good friend, Yak Patel, who is the CEO of the Lancaster CVFS (Community Voluntary Faith Sector) and a man of real humility who holds our communities in his heart, we went to be with some people doing amazing things across our district. Yak is great at holding me to account and ensuring that I put my money where my mouth is!

 

We started on The Ridge, the largest council estate in Lancaster. There we spent time with Lisa, who we know through ‘the art of connecting communities’. She runs the community centre, and we wanted to listen to the experiences of people living on The Ridge and understand some of what they are facing. Simple things, like a cut on their bus service (as timetables massively favour the University) is leaving people isolated and cut-off, especially elderly citizens at weekends.

 

I asked Lisa what she thought about the growing rhetoric that the problems communities like ‘The Ridge’ are facing are not to do with ‘resources’ – she rolled her eyes and retorted – “easy for people to say that, but over the summer, I couldn’t pay myself a salary for 2 months, so that I could ensure that the youth provision needed through the holidays could actually run – the funding for those kind of activities has been cut so much, it’s a joke….” Lisa, like so many other big-hearted and socially-conscious community workers, had to work 80-90 hours a week, holding down a second job, simply to be able to pay her own bills – similar to what happened at Christmas, when she worked long hours to make sure that 75 children on the estate actually had something to eat and a present to open on Christmas Day. People of good heart are feeling overwhelmed, unsupported and burnt out. I asked Lisa what she would love to happen – she wants to bring the community together, to talk about what’s strong, not what’s wrong, ask the community what it is they actually want and need, rather than assuming the providers of public services somehow magically know (!) and focus on what The Ridge could become – for the community, by the community.

 

On The Marsh, we met Debz. Debz also came to ‘the art of connecting communities’ last year. You might describe Debz as a ‘salt of the earth’ person. Down to earth, she has seen it all. I asked her what the biggest problem is for her community…..”drugs…..the place is overrun with drugs – and people are on the ropes”. The food club was happening, thanks to fareshare, when we arrived (although huge trays of strawberries were already completely mouldy)….and there were queues down the street….she shared with us some of the complexities involved for young people and the situations they find themselves in – multi-generational trauma….but what she struggles with most is that those who are supposed to care, don’t seem to want to understand. She told us of difficult encounters with the local GPs, the local hospital, social services (one family had had over 24 social workers – what’s the point in that, she asks?), police, schools and city council….although she has noticed some attitudes begin to change (perhaps because of the poverty truth commission).

 

She feels that people on ‘The Marsh’ are judged, looked down on and it’s reputation is very hard to break. But she also knows that people who live there want things to change and they want to be part of the change. That can be really tough, with the threat of violence and the very real involvement of gangs from Liverpool and Manchester, bringing intimidation. “Why would people not do drugs and get involved in selling them? It pays better than any work available”, she shrugs.  She believes the community can find some more hopeful dreams and she talks about the difference a new church in the community centre are making (a conglomeration of a few different congregations working together)….She wants to bring the community together to talk about what they want to see change, but especially how they can be part of that change….however, she doesn’t think it can happen through some kind of new found motivation alone – it’s going to take real investment. She tells me that if we want to stop seeing men dying in their 20s, from drugs, violence and suicide – we need to think altogether differently about how we work together with communities. Yak nods in agreement – he used to have Debz’s job, before he became CEO of the CVS. He tells me how many funerals of young men he has been to from this community. I feel deeply sad.

 

Then we’re on to Poulton (which has the worst health outcomes in North Lancashire), to meet our friend Joanne, who runs Home Start for Lancaster and Morecambe. What an amazing lady! And such a great charity! We sit with Joanne and one of her trustees, Sheila (who used to work in children’s services at Lancashire County Council, before she saw the decimation of her team and the unacceptable levels of stress she and her team were having to work under, which she deemed to be totally unsafe). The work they are doing for young families is extraordinary. Most of their referrals come from Health Visitors, but they are now full, and simply can’t take any more referrals unless more volunteers arrive. What I love about Joanne and her team is the collaborative-coaching approach they take. As they have worked alongside families, and discovered what they want and need, they have seen co-produced groups around issues like Domestic Violence and Autism support. What Joanne is most proud of is that they have created a culture in which you can walk into a room and no one knows who is a ‘client’, who is a volunteer and who is a member of staff – brilliant! “A community of mutuality” – she beams! Humility is the order of the day and it leads to real relationships that bring real change. As services have been cut and fragmented, increasing pressure has fallen onto the charity sector to hold things together – but resources have not followed. Despite great connections across the sector, the pressures are mounting, the cracks are showing and the risks are increasing.

 

I have no idea how much money Lisa, Debz and Joanne must be saving the public services every year, in terms of health and social care….but I do believe we could be making some far better and wiser investments with the ‘public purse’. We should be putting a whole lot more faith in community centres and workers, like them. If we do so, we will find it much easier to tackle deep-seated health and social ineqaulities right in the heart of our communities, taking an asset-based approach, being brave enough to redesign around relationships rather than transactions (as my good friend Hilary Cottam says in Radical Help) and find that communities really do want to be a part of transforming their own futures. Just like in Wigan, there needs to be a New Deal between communities and the public services to ensure that there is mutual vision and accountability for the resources that are available. What are we brave enough to stop doing, so that we can learn to do what is altogether better? Are we able to change? Not if we remain in our silos and ivory towers and continue to tell ourselves the same old stories. But might we dare to step outside the fortresses of what we know and learn to deeply listen? If we can do so, we cannot help but be changed….and as we begin to change….well…..then change begins to happen!

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Do We Believe in Rehabilitation?

The NHS spends a huge amount of money every year, along with local government to help people who have struggled in addiction to find rehabilitation and recovery. Much of it is ineffective (but that is a conversation for another time). However, what’s worse is that once people do recover, and find a new life, we don’t actually let them make a clean start – here my friend, Kate Morrissey bravely tells her story:

 

 

 

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The Resilience Myth

My friend, Dr Sammy Batt-Rawden knows only too well the dangers of just keeping her chin up and carrying on. In this beautiful, but heart-wrenching TEDx talk, she tells her story.

 

Staff in the NHS (and indeed all our public services) are working against a tide of a huge rise in public demand, funding constraints and dangerously low staffing levels for what is required. The old edict to ‘keep calm and carry on’ simply misses the point. There isn’t a culture of shirking responsibility in the NHS. People are going way above and beyond every day, and it is taking it’s very real toll. Yes, we need to increasingly develop cultures of joy and kindness in how we work, but there must be determined change by leaders in the Government to ensure that the buck is not passed when it comes to who is responsible for ensuring the wellbeing of our clinical teams across the UK. Teams are already doing much to take care of each other and themselves, and yet staff surveys across the UK show that absenteeism is increasing, along with burnout and morale continues to decline. Do the maths!

 

Listen to Sammy’s story and let’s change the tone of the conversation so that we can work on practical solutions together. Those solutions will include everyone. Part of the solution lies with learning to work radically differently with our communities. Some of it lies within our choices of how we use the health service. There is of course work to do in how we care for people who work across the NHS and set good working patterns. But there is still much work to be done by those in power to think more carefully about where and how budgets are spent. The new spending plan for the NHS pays very little attention to safe staffing levels or staff development – it needs much more care and attention.

 

I’m so grateful to Sammy for changing the nature of this increasingly important conversation:

 

 

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