Category: NHS

Love Economics – Part 2

When the economic crash of 2008 happened and the banks needed bailing out, the City of Preston in Lancashire, refused to blame the poor or adopt an economics of austerity. Instead, they developed an alternative economy, which is being hailed globally as one of the most exciting possibilities for the future in terms of social justice, environmental sustainability and human flourishing. The ‘Preston Model’ has now been well publicised and is being considered by cities such as New York as a viable model for the future. It is based on a few key principles, one of which is ‘Anchor Institutions’ (which the health foundation have written about in some detail in terms of the role the NHS could play).

 

I could not recommend a better way to spend half an hour, if you want to be inspired and filled with hope about what is possible. I don’t think the Preston Model is perfect, nor would it claim to be, but it does begin to offer exciting options for a way ahead. Here is Cllr Matthew Brown, leader of the Council, talking about the key principles involved and how they are working in Preston. We were really happy to welcome Matthew to Morecambe Bay as we explore an economics that is fit for the future. Enjoy!

 

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Love Society – Part 3 – Hilary Cottam

We had the privilege of welcoming the ever wonderful Hilary Cottam to Morecambe Bay for our ‘Love Society’ event. If you have not read her book ‘Radical Help – How We Remake the Relationships Between us and Revolutionise the Welfare State’, then I would massively recommend that you do so. But as a little teaser, grab a cuppa, sit back, and enjoy this masterclass in the practicalities of how we build a loving society that works for us all. It is such common-sense but takes bravery and creative leadership to experiment in new ways.

 

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Wisdom From My Nanna

Last week, I was on the closing plenary panel at The Kings Fund, as we reflected on what we had learned together about ‘PopulationHealth’ across the UK. There were some really excellent contributions throughout the day.

 

Councillor Matthew Brown, leader of Preston City Council, talked powerfully about the new economic models they are using there and the incredible regeneration they are seeing. Councillor Becky Charlwood, spoke about the great work being done across the city of Leeds and how strong relationships enable them to flex around complex legislation. Mayor Andy Burnham spoke with humility and realism about the power of devolution and the challenges they face as a city in Manchester in giving kids a great start in life and ending homelessness. Liz Gaulton, Director of Public Health in Coventry, spoke about how the Marmot principles are radically shaping the future plans of the city in thinking about inequalities and how they face them together. Prof Kate Ardern, from Wigan, talked about how we need to change our relationship with power and work radically differently with our communities. Prof Dominic Harrison from Blackburn brought his wisdom on how we face up to multiple unhealthy risk factors. Perhaps the most important contributions from my perspective were from Carina Crawford-Khan, lead organiser of Citizens UK and Dr Charlotte Augst, CEO of National Voices who asked us to reflect on how “Powerlessness leads to ill health” – that’s a statement worthy of pause and much reflection. Power is the ability to act. Anger without power leads to rage. So, if we don’t radically change our relationship with power, we can never see true population health – rather we have disempowered people who feel angry and unable to be part of the change we need to see.

 

The reality is that all of the things we long to see in society will not happen unless we ourselves are willing to change. In all the uncertainties we face and admidst the brokenness of our political and economic models, how do we stand firm and find a new way through to a way of being together that is socially just for humanity and sustainable for the future? In reflecting on all of this in the final panel, I drew on the wisdom of my Nanna.

 

My Nanna, Joyce, who is 97 years old this year and who still wakes every morning to play Mozart and Chopin on her beloved piano, has always been one of the most important people in my life. In our family, we call her “Yoda”, because she is strong in the force and exceedingly wise! This 5ft tall lady, who taught me to bake, spent hours helping me with my music and can still whip my butt at scrabble and rummikub, is a truly remarkable woman.

 

When I was a boy, we used to talk to each other whilst making ginger biscuits. My Nanna is a deeply spiritual woman and she used to tell me about her favourite bible verses, one of which is from the book of the Prophet Micah, Chapter 6 and verse 8. That verse says – “God has shown you the best way to live – act justly, love mercy and walk humbly with your God”. I think those three statements hold profound and ancient wisdom that we need to draw on in the complexities of what we face together now. What does that actually mean for us in practice, as we try and transform culture, relationships and behaviours? I suppose I think it’s pretty simple.

 

Firstly, as leaders and as people who want to see change, we must act with justice. We must care deeply about issues of injustice in our society and be willing to challenge it whenever we see it. But we must not just care, we must act. We have to be willing to put justice into practice in what we build. We’re beginning to see this, and it’s exciting!

 

Secondly, we must love mercy. I think that means we have to love the principle of mercy and therefore we have to love people with mercy, or as I put it at The Kings Fund, with real kindness. I love what Prof Micheal West says, when he talks about looking at people with kind and fascinated eyes. We did a lot of thinking about the need for a different kind of power. I think we need to unashamedly talk much more about love and the transformative power it holds. MLK said that love on it’s own is anaemic – it certainly can be. Power alone is destructive. But power and love together is a force to be reckoned with! We need this kind of love in the power that we hold to keep mercy at the fore and kindness as our way of being.

 

Thirdly, we need to walk in humility WITH our communities. I replace the word God here, with communities, not because I don’t believe in God (I do), but then Nanna and I used to talk, she would tell me that walking humbly with God means walking humbly with other people – with your community. It is worked out in the practice of every day life and being willing to interact with and be changed by the person you most look down on or despise. Nanna isn’t a fan of people getting too big for their boots. She sticks her tongue out at arrogance and blows raspberries at pride. She’s not into titles or pretensions. As a true elder, she knows humility and walks in it. I have learned so much from her and it has shaped so much of who I am and how I choose to spend my time. We must learn to sit with, be with, learn with and create the future with our communities. We don’t have the right to dream up plans and do them to people. Together with, is the kind of humble, mercy-loving, justice-acting way that we so badly need. Without those under-girding, foundational truths, we will never see true population health. Our guiding principles and undergirding culture will shape what we become together.

 

In a time of so much uncertainty and complexity, we do well to stop and draw on the wisdom of the elders. And so I offer that of my lovely Nanna – in all you do, make sure you act with justice, love with kindness and walk in humility with your community. 

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Learning to Rest

At the end of last year, I very nearly burnt out. As a GP with a bunch of other responsibilities, I was finding it really hard to switch off and allowed my work to encroach on other parts of my life. I got really tired and felt stretched beyond my capacity. I knew this because my body told me so, but I was also becoming less caring, less compassionate, less patient and less focussed.

 

Then I read a couple of books about rest and I remembered some things I had forgotten. When I was a boy, I never worked on a Sunday. I’m the son of a preacher-man and we never worked on a Sunday. We would spend time with our community, eat lunch together, go for a walk, play some games, maybe catch a movie, but there was no work – none. Rest, it turns out, is not only vital for the human body, but it is seriously good for the soul. It is also the greatest piece of resistance against the ‘system’ and the ‘ego’ that I know of.

 

I have remembered to rest and put some things in place to help me do so, and I have honestly never felt so well. I actively look forward to stopping and out of this place of rest, I have found I can flow into the rest of my week with so much more kindness and grace, without feeling overwhelmed. It has given me a new perspective on the rest of life and enabled me to function without much stress or deal with stress more holistically.

 

On a Saturday evening (just because this is the time that works best for us as a family), we turn off all screens and all emails. We don’t do any work – no homework, no work, no nothing. We try and keep any household chores to an absolute minimum and take time to be. No shopping (because we resist the narrative that says we don’t have enough), nothing strenuous – just what makes our souls happy – not in a hedonistic way, but in a restorative way, so that we can live from a place of life-giving, others-empowering love the rest of the week. We have developed patterns that make sense of who we are – lazy breakfasts, time with community, gentle walks, good food, board games, time – wasting time – together.

 

I know it’s really counter-cultural these days – we wear busyness like a badge of honour. But busyness is isolating us, stressing us out and killing us. I once heard a preacher-man say that only the devil is always busy, but God knows how to rest. Rest takes humility. It means recognising that life goes on without me. But it also recognises that who I am and what I do is important and so I need to be replenished in order to be healthy and well. I can’t tell you how many people have told me how well I look!

 

So, if you’ve forgotten how to stop, reflect, connect and be renewed, then I offer this to you as a gift. Take a day off – I mean a real good rest, once a week – it’s harder than you think…..but there is little else I know of that will bring fresh hope and life to every part of you.

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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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The Morecambe Bay Approach to Population Health – The Double Pentagon

In this podcast (iTunes or Spotify), I give an overview, as Director of Population Health in Morecambe Bay, about the approach that we have developed as ‘Bay Health and Care Partners’ (BHCP) around population health. The double pentagon model draws on learning from across the UK and the world, leading think tanks, like the Kingsfund and local communities. The model has been developed with Dr Jane Mathieson – our wonderful Public Health Consultant, who retires this month, Prof David Walker – Medical Director at UHMB, Marie, Spencer, Jacqui Thompson, Hannah Maiden and Vicky Hepworth-Putt. BHCP is an Integrated Care Partnership which includes the GP Provider Alliance, The University Hospitals of Morecambe Bay Foundation Trust, Lancashire Care Foundation Trust, Morecambe Bay CCG, Cumbria County Council and Lancashire County Council and is committed to ‘better health, better care, delivered sustainably’.

 

So – if you’re interested in Population Health and/or you work as part of one of the organisations within BHCP, then listen in, enjoy and let’s continue this conversation.

 

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Poeting an Alternative Future

As part of the ‘love and kindness’ series on the Black Swan Podcast, I interviewed the brilliant  and award winning Spoken Word Poet, Matt Sowerby. Matt is 18 and lives in Morecambe Bay. I find his words to be beautiful, challenging and moving. Here are the links on iTunes and Spotify if you want to hear him perform and listen to us discussing a variety of things from education, to climate change strikes and politics. Hope you enjoy! You can also find his poem ‘breadlines’, which didn’t make it onto the podcast on YouTube with his other work.

 

 

 

 

 

 

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The Poverty Truth Commission – Podcast

One of the things I have most enjoyed and also felt privileged to be a part of over the last couple of year has been the ‘Poverty Truth Commission’. Here is a podcast I have done with some of the incredible community commissioners, here in Morecambe Bay about how a ‘together with’ approach to life makes a massive difference. It’s part of the series on how love and kindness are truly transformational. You can find out more about the Poverty Truth Commission through YouTube

 

Here are the links to the podcasts depending on your listening preferences!

 

iTunes

 

Spotify

 

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World Autism Awareness Day

Autism affects so many of our lives and families, and yet so many of us know very little about it, make unfair assumptions about people who live with it, or make crass jokes about people, using it as a derogatory term. In this episode of the Black Swan Podcast, I interview, the amazing Deborah Brownson, who recently won an MBE for her incredible work around autism. I am so glad that she is here in Morecambe Bay, though her work has a national and international reach – and rightly so!

 

World Autism Awareness Day is a good time to talk about Autism! The podcast is full of profound wisdom from a woman who has two sons with Autism and is working tirelessly to raise awareness, change perspectives and create practical resources and support networks to help people who live with Autism and the carers who support them. I hope you find it interesting, challenging, comforting and inspiring. Here are the links to the podcast, depending on your preferences!:

 

iTunes

 

Spotify

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The Rise of Antidepressants

The BBC ran a news piece today about the massive rise in use of antidepressants in England and Wales over the last 10 years. And depending on which study you believe between 1 in 11 and 1 in 6 people in England are now on an antidepressant (though we must remember, that antidepressants can be used for other conditions like pain management and irritable bowel syndrome – IBS). In the USA, antidepressants are now the second biggest group of prescribed drugs.

 

So, what should we conclude? Well, firstly, it is good news that it has become much more acceptable for people to talk about struggling with depression, anxiety and other mental health issues. It is good that people are going to see their GP when they feel depressed and anxious, rather than just trying to cope with it. So, we mustn’t now necessarily insinuate that the increase in prescriptions is a bad thing, because firstly, that can heap shame on those who are taking them, which is unhelpful at so many levels and also, we need to remember that there is actually a good evidence-base behind anti-depressant medication. They really do work – I’ve seen that again and again for my patients, who choose to go on them, and for sure, I would love to see more psychological therapies available on the NHS, as an alternative or as an adjunct to medication. Waiting lists are currently far too long for such therapeutic interventions and many people choose medication because they cannot afford to pay for therapy or indeed to wait several months for the help they need. We don’t report the use of antihypertensives to control blood pressure negatively and so we need to be careful about taking a dim view of medications which help improve mental health.

 

However, when so many in our society are struggling with anxiety and depression to this extent (and it’s really positive that we’re talking about it and that people are getting help), we need to ask ourselves some big questions about the root causes of this and what we can do as a nation to improve our mental health. One of all time favourite quotes is that of Archbishop Desmond Tutu, when he says:

 

“There comes a point, where we have to stop just pulling people out of the river. We need to go upstream and find out why they are falling in.”

 

So, in the rest of this blog, I’m going to explore some root causes, whilst recognising that for many people, endogenous depression (i.e. a neurochemical cause in the brain) IS the root cause, and therefore their depression may not have any other roots to it.  I’ve also done this vlog (which I did for mental health awareness week) about what depression is and some of the things that can help.

 

But in looking for root causes, let’s start at the beginning. I’ve written on this blog a number of times about the impact of Adverse Childhood Experiences and the impact of Trauma on our lives. So many of us live with unhealed pain, which over time eats away at us and makes it harder for us to remain mentally well. Many of us go through trauma and are able to survive it better than others, but that is because we’ve had other things in our lives at the time which have helped us navigate the storm. However, we need to recognise more the massive reality of trauma in our lives, so that we can face it, and find healing together. This is one of the reasons why I’ve co-written ‘The Little Book of ACEs’ with some friends and colleagues, here in Morecambe Bay. There is a free PDF version of it, if you click here. You may also find this inspiring talk by Jaz Ampur-Farr, herself a survivor of significant trauma, really helpful. Jaz is joining us in Morecambe Bay very soon, to explore some of these issues.

 

We must also be brave enough to recognise that we have a complex corporate history, which shapes our identity and we have a society, which is by no means equal or fair. Prof Bev Skeggs, and Prof Imogen Tyler, two of the foremost sociology professors in the UK/world right now, are writing so powerfully about this. It’s well worth digging into their work, and I am so excited that they are here at Lancaster University, in Morecambe Bay, and will be exploring some of these issues with us in more depth over the next few months. We cannot underestimate how injustice, poverty, and inequality impacts our mental health.

 

Stress has a hugely negative impact on our mental health. Our work patterns have become so manic and busy and our weekends often so full, that we have forgotten how to rest, how to stop, how to switch off and take notice of the beauty all around us – of the things which really matter. This takes a huge toll on us. The girl guides took part in a fascinating survey about what causes them stress and feeds mental health issues. The number one factor was the pressure they feel to do well at school. Our very systems and the treadmill of the exams are making our young people unwell. The idea of slowing down and learning to switch off from our ever faster, consumerist world, seems laughable to so many of us – and yet I would argue that this is one of the greatest causes of our ill-being. We have created an economy which treats people like fodder for the economic machine and is literally killing the planet around us – another underlying huge but often unrecognised cause of our stress. We must rebuild an economy based on wellbeing. It’s why I’m so excited that we’ll be welcoming Prof Katherine Trebeck to Morecambe Bay in the next few weeks.

 

Another causative factor of our growing mental illness in society, perhaps caused by all the busyness, is loneliness and isolation. Despite our many frantic activities, and social networking, 20% of the UK population say they feel lonely, but that jumps to between 50 and 75% of people over 75. We were made to be in relationship. When we are disconnected from community, we become sad and low. We need to remember how to love people, and also to be loved. Our disconnection is leading to increased separation, suspicion of others and a rise in racism and hatred. This is in no way good for our mental health. Valerie Kaur explores this so powerfully in her incredible TED talk on revolutionary love. We need to reimagine a society in which relationship is at the core of our being together. Hilary Cottam’s work is so vital in helping us recover this. Again, Hilary is coming to the Bay in the coming months to help us dig deeper as a community into these ideas.

 

I am so glad that we are talking about mental health so much more seriously. I am glad that people are able to take medication that can help them and that the stigma is being broken. I am hopeful though that we can recognise together just how broken our society is, and how our current political and economic systems (including our beloved health system) cannot fix this. Perhaps, in learning to be together in the dark, when we cannot see the light, wrestling with the complexity of our pain, healing our trauma and reimagining our future, we might find that our need for medication decreases.

 

 

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