This blog is the 2nd of two linked blogs and was written on 2 July 2017
In the 18 days that have passed since the awful disaster of Grenfell Tower we have learned that the type of cladding used to refurbish the block was to blame – that and a faulty fridge on the 2nd floor. We now know that the Public Inquiry will be focused on the technical aspects; how the fire started, how and why it spread so quickly and what internal precautions were in place for alerting residents. And the incompetence of the local leaders (and national policy-makers) whose watch this happened on is revealing itself daily.
No wonder people are angry.
What the authorities are failing to grasp is that Grenfell was the result of a monumental failure in listening and responding. The residents of Grenfell Tower knew there were issues with fire safety and raised them repeatedly … but they weren’t listened to. Not only was nothing done about the fire issues they knew about but decisions were also made to make their homes even less safe by fitting less expensive and flammable cladding. This ignore-ance (as opposed to ignorance) had led, over time, to a culture of indifference and contempt for people and their wellbeing and the consequences are continuing after the event, with very painful consequences. This is what people are angry about.
The real cause of Grenfell is a culture among those in positions of power, of ‘not listening’ which led to a lack of understanding and a lack of trust. This is a common problem – more common in places or professions where the differential in status between those who do and don’t hold the power are stark.
If there is just one thing that the NHS must learn from Grenfell, it is how to listen and respond, not just to the main arguments but to the nuances of what people are saying. The health sector badly needs a revolution in listening not just to prevent a large-scale incident but to improve people’s lives and health on a daily basis. Here’s what needs to happen now.
First, we need to acknowledge that indifference to the realities of people’s lives and not addressing the root causes of their health issues or distress is harmful to them. The NHS’s indifference comes from it’s almost total focus on fixing the illness, rather than on addressing root causes. An extreme but not uncommon example is discharging a rough sleeper back onto the street following treatment, rather than collaborating with housing services to provide accommodation with support.
Second, NHS frontline staff must be trained in how to hold a different sort of conversation with people. Genuine listening is critical because it enables trust to be built and that leads to a greater understanding both about the underlying problems and of what potential solutions.
Third, we need to work directly with people and their networks and communities to find different types of solutions – because given the right conditions people are infinitely resourceful and can solve many issues themselves and they can tell service providers precisely what they need to enable them to do that.
And finally by changing our systems so that NHS staff can act to meet their requests in an equally nuanced way. This is the most difficult bit, because it requires systems to be flexible and this doesn’t fit comfortably with a rigid guidance-led approach to service delivery. But it’s also the thing that makes health creation possible!
Merron Simpson is Chief Executive of Health Creation Alliance and its National Executive Lead on Housing.
communities
Let's make community pharmacy a hub for healthy communities!
This blog by Mark Robinson discusses why pharmacy is at the heart of healthy living in communities – and explains how pharmacists can play a wider role in supporting the objectives of the new Health Creation Manifesto
The NHS Alliance has consistently said that community pharmacy is an under-utilised asset within the NHS family. They are the front line professional clinical retail element of healthcare – and the focus of self-care for the population – representing ‘health on the high street’ and within our communities.
Our view has been that the health and care system has needed to better recognise the vital part that the nation’s community pharmacists play in improving the care of patients and in helping people to stay healthy and we have argued strongly for a greater role for pharmacy within primary care.
Our advocacy for the value of community pharmacy – and it’s importance as a hub for healthy communities – is now further amplified in our “A Health Creation Manifesto” – launched in May 2017. This groundbreaking and visionary manifesto sets out 10 high impact recommendations to create a wellness-based health system, aimed at tackling the root causes of ill health and the continuing problem and social injustice of health inequalities. Health creation is an evidence-based approach that is about putting people in control of their own lives and we have developed a deep experience of actually making it work.
The essence of this health creation approach is based on ‘3 Cs’:
- control over the circumstances of our own lives
- contact with other people that is meaningful and constructive
- confidence to see ourselves as an asset
We have to create the conditions for people to increase their confidence, to connect with others and their families, to give them hope and empower them. We have to help to put them in control of their well-being. We have to do things that will help them feel well. And crucially, we have to show them that they can do it themselves and they don’t need the constant attention of their doctor. People don’t need a pill for wellness!
This is where the community pharmacy sector is a crucial and dynamic resource for supporting health creation and wellness, because community pharmacies are not just accessible geographically, they are also accessible psychologically. People aren’t intimidated going into a pharmacy and talking to a pharmacist – and that, in part, is because their local pharmacy’s focus is also on health and wellbeing, rather than solely on sickness. What’s more, the staff in a pharmacy are invariably drawn from the local community and therefore they often know many people within the neighbourhood. That sense of familiarity actually gives a real and tangible sense of confidence and trust to the local people coming into their local pharmacy.
The Health Creation Alliance would now like to see a natural evolution from healthy living pharmacies to health creating pharmacies, and for community pharmacists to welcome and embrace the opportunity to provide their local communities with advice and support on health creation, health creating services and initiatives to encourage a sense of physical, emotional and mental wellbeing.
Health Creation Alliance has seen many excellent examples of innovative community pharmacy involvement in health creation around the country. One such example, cited in our Manifesto, involved community action in reducing GP appointments. Community groups and residents in Eccles learned about the Minor Ailments Scheme and were encouraged to tell other residents to visit the local pharmacy before the GP. Children, parents and clinicians co-wrote a story that was read out at the local school – teaching children to steer family members to the pharmacy.
The scheme had support from seven local general practices. In six months, pharmacy consultations rose from around 250 a month to more than 350. There were also signs that fewer parents went to the GP for minor ailments, with a sharp decline in surgeries prescribing paediatric paracetamol and ibuprofen.
Health Creation Alliance contend that only by forming strong relationships and listening to communities can we address the ’causes of the causes’ of ill-health and for community-led solutions to be found. So let us maximise the skills and expertise that community pharmacists bring to health creation – and make our local pharmacies a vibrant and proactive hub for health creating local communities!
Mark Robinson is a pharmacist with extensive experience within the NHS – and is the Health Creation Alliance National Executive Lead on Pharmacy.
We need a revolution in listening and responding
This blog is the 1st of two linked blogs and was written on 17 June, 3 days after the Grenfell Tower fire
The people of Grenfell Tower died because the people in power didn’t listen to them and didn’t care about them.
This is the conclusion I am coming to as I listen to the reporting on the tragedy. There are some people who will try to tell you that the fault is ‘tower blocks’ and we simply shouldn’t be building them or human error installing the external cladding. And it’s true that the tightening grip of austerity over the last 9 years has driven cost-cutting to dangerous levels. But it’s becoming patently obvious to most of us that decisions were taken at various times by several people operating at different levels of government that compromised safety, and that the concerns of the people who were most affected by those decisions fell on deaf ears. By far the biggest problem that this awful disaster has exposed is a shocking disregard for people who are not in positions of authority.
As someone who is closely connected to the housing world, I know that the repercussions of Grenfell will be far-reaching. In addition to the Public Inquiry into the incident itself, this will trigger reviews of building regulations and fire safety at the very least and will reach into reviews in procurement practice, regeneration, governance and beyond. It will make housing departments and associations revisit their evacuation procedures, tenancy sign-up procedures and property management plans to explore whether they should decommission more high-rise blocks. And hopefully it will lead to a resurgence of genuine ‘tenant scrutiny’ by which tenants get to scrutinise and have a say in their landlords’ plans.
But if the influence of this disaster is limited to the housing sector, we will be doing the victims of the Grenfell Tower tragedy a gross injustice.
At the heart of this is a deep problem that is endemic to many professions, including the health service. Grenfell was no accident; this is what happens when we stop listening to each other. The health service has had its own share of large-scale disasters (think Mid-Staffs) and every day, many small personal tragedies happen because we don’t listen and because even when we do, the systems don’t respond: the person with mental health problems who needs help to make amends with one or more members of their estranged family; the community that knows why the children growing up in their neighbourhood have poor health prospects and, moreover, want to do something about it; the patient who wants to die at home, but who is caught up in protracted hospital discharge procedures. The system is so often incapable of offering people what they really need and want.
‘Listening and responding’ is one of 5 features of health creating practices that Health Creation Alliance has identified in its Manifesto for Health Creation as enabling people to become and to stay well. Listening is not a soft, fluffy skill that those lower down the health hierarchy can do while those higher up get on with the serious business of planning ‘systems of service delivery’. Listening and responding – yes, both are required – is the most powerful thing a health professional and the system can do. It is what makes the right things happen.
We need a ‘revolution in listening’ across our public sector including our health service. And this means making our systems flexible so we can respond. Because people know what’s wrong and they often know how to put it right. All professionals need to do is to find out what people need in order to be safe and well, and then give them that.
Merron Simpson is Chief Executive of Health Creation Alliance and its National Executive Lead on Housing.
@merronsimpson
A tale of two conferences
‘We need to develop and disseminate an entirely new paradigm and practice of collaboration that supersedes the traditional silos that have divided governments, philanthropies and private enterprises for decades and replace it with networks of partnerships working together to create a globally prosperous society.’ – Simon Manwaring
‘“Somewhere, something incredible is waiting to be known.”― Carl Sagan
I recently attended two events. They were very different – made up of people who probably never meet. Yet there was a song to be heard through both. They both made me think and gave me hope. They reminded me of the words of the famed cosmologist Carl Sagan. Sagan wrote of how the nitrogen in our DNA, the calcium in our teeth, the iron in our blood, the carbon in our apple pies were made in the interiors of collapsing stars. We are, he said, made of starstuff. Further he said ‘ “We are star stuff which has taken its destiny into its own hands.’ These conferences were made of the same stuff and it really was starstuff – starstuff making its destiny.
The first was at the Forest of Arden in Birmingham. It was organised by Lankelly Chase. Lankelly Chase is a progressive organisation that seeks to ‘to bring about lasting change in the lives of people currently most disadvantaged in our society.’ Lankelly Chase seeks a change that is ‘systemic, structural and cultural’. It funds many projects across the country. These include new projects such as Agenda working with women suffering violence to well established services like BARCA ( working with drug and alcohol issues, youth work and community development ). Lankelly have a Promoting Change Network that brings together those who use services, commissioners and service providers to interact and learn together. This was a PCN event. My good friends Leeds GATE were present. Leeds GATE work tirelessly to improve the quality of Gypsy and Traveller people. Their work is to ensure the voices of Gypsy and Traveller people are heard. They had very kindly asked for me to be able to attend.
There were about 140 of us meeting for two days. I was deeply impressed by the spirit and common vision. I could see how the people there – from GPs to people using services – were working to create new possibilities and models. These themes were written into fabric and heart of the discussions and group work. I was especially enthused that we started with the big picture – how we create a society which works for us all. I came away happy and thinking. I had promised the Lankelly leadership that I would write a blog about my experiences. As I travelled home my heart was full but I wasn’t sure what my mind would write.
The next day I travelled to Manchester to speak at the NHS Alliance Practice Nursing event. The NHS Alliance is a grass roots movement working to create best primary care. Its rallying call is ‘connecting, integrating, innovating‘. The Manchester event was the work of two amazing nurses Louise Brady and Heather Henry. It was a meeting of patients, nurses, doctors and health staff. The event was to celebrate the great work practice nurses do in our cities and across our country. The event was marked by a spirit of kindness, humour and connection. I was one of several speakers. When my time came I spoke. Afterwards I returned to my place. I then realised that what I had said was what I had seen in Birmingham and was now seeing in Manchester. My words were a reflection of what two movements for change were doing, seeing and seeking.
What I said in that speech was three things –
- That we can make a difference. I told a story from 20 years ago of working alongside a Third Sector service with a service user. The amazing recovery journey of that person and what we did as services – the NHS and Third Sector together – showed me the great gifts and potential people have. It also taught me together we can make a difference. From that time I have tried to create connecting open door services. Moving from silos to symbiosis. Twenty years on I am still singing this song.
- Disrupt the Narrative. The second part was that we have a duty to disrupt a common narrative that says we can’t change anything and that we cannot make a difference – that things are bad and that’s it. Not only do we have the duty but what I saw in Birmingham and Manchester is evidence that a new script is being written. A script about co-creation and co-learning. Forming alliances and care for and with communities.
- Celebrating the good. The NHS was formed 67 years ago and at the time people opposed it. They said it couldn’t work. They said it was impossible. Well sometimes when we believe the impossible we can do the incredible and that’s what the NHS – despite everything – does in so many places. And not just the NHS but other statutory services, the third sector and faith communities as well as so many inspiring individuals. We need to hear and share the good and build the better. We need to forge these living alliances with carers, families, communities and all sectors working from street to strategy level.
These three elements for me sum up the message and magic of both events. We live in challenging times. Like the start of Dickens ‘ A Tale of two Cities’ it is the best and worst of times. It carries awful challenges and changes. It also hold real possibilities of creating new ways of doing health and care. I do not believe we should see life or history – and that’s where we operate – as a static block. It is rather a dialectical dynamic process which we can affect. We can’t always stop the bad but we can seek to structure the good in the midst of it. It is a truly shocking thing that people do not have food in our country. It is also a sign of hope and kindness that the food movement has spread across our country with a message that we will support those suffering with food poverty. We will not stand aside but work to help.
These two events show the a manifesto of working to build new ways to work together. They incorporate the vital need to focus on moving from silos, embracing the other, listening to the experience of those who use, commission and provide services, to focus on what is best in and for people and communities and to let this flow on deep heart values. In the events I saw a glimpse of what the future can be and should be. Bucknminster Fuller the wise American architect philosopher once said that we don’t change old systems. Rather we create new models that make the old systems obsolete. The good news is that these new models are appearing. I believe I saw them on those days in Birmingham and Manchester as dynamic and caring people and services met to work out the way forward. I don’t know how but I am committed to seeking ways to bring these streams together more and more. In that encounter will be new energy, ideas and life. In dark times our role is not to curse the darkness but to light up the landscape. Let’s do that.
John Walsh. Practice Manager. York Street Health Practice