- Every person has hopes, needs, cares, and fears.
- Other person’s hopes, needs, cares, and fears are less important than our own; we see others as objects rather than as people.
- To see a fellow person as an inferior object is to harbour a violent heart toward them.
- We communicate how we feel about others even when we try to hide it.
- When others detect violence in our hearts, they tend to become defensive and to see us as objects. Violence in one heart provokes violence in others.
- Most occasions of outward violence are manifestations of a prior, and often escalating, conflict between violent hearts; that provokes further violence.
- Any effort to reduce outward violence will succeed only to the extent that it addresses the core problem—the problem of violent hearts.
Three Dimensions of the Great Turning
Everyone counts…but some might count more than others?
We maximise our resources for the benefit of the whole community, and make sure nobody is excluded, discriminated against or left behind. We accept that some people need more help, that difficult decisions have to be taken – and that when we waste resources we waste opportunities for others.
NHS Constitution – Values
I think the NHS Constitution is a wonderful document. Beautifully written, it speaks powerfully to many of us about the NHS that we want to use and work in.
One of my frustrations in working with the NHS is the infrequency with which we consult the values explicitly to help us with decision making. The values are beautiful, but in my experience, appear to be used infrequently as a management and leadership tool.
There are 7 values in all and they set an incredibly high bar. Take this one – Everyone Counts. It is the value that to my mind speaks most explicitly about the NHS ambition with respect to diversity, inclusion and equality.
I think that, in practice, we often stop reading after the first clause. We maximise our resources for the benefit of the whole community. We do our best with limited resources to provide the greatest health gains for the greatest number of people that we can. We work on ‘population health’ But in practice this means that the second clause of the value often gets neglected – We… make sure nobody is excluded, discriminated against or left behind.
Because, in practice, in terms of health outcomes we have been ‘leaving behind’ the same groups for decades. Whether this is through processes of exclusion or discrimination, or just lack of clinical knowledge I am not certain. I suspect that many factors, mostly found in wider society, play a part.
But until our health and care strategies start with a real commitment to help those that have been systematically ‘left behind’ to catch up as quickly as possible we will have widening health inequalities.
So let us re-visit the third clause in the value We accept that some people need more help, that difficult decisions have to be taken. When we take these difficult decisions, what will benefit the ‘whole community’? A focus on creating as much health gain as we can, for as many as we can, for a fixed cost? Or spending our money in a way that helps those that have been historically and systematically left behind by the system to catch up? How do we find the balance?
Who are we choosing to ‘leave behind’?
This is becoming an increasingly pivotal question for me as I work in primary care networks, integrated care systems and NHS Trusts. And if you care about equality and inclusion then perhaps its need to be a question that you are prepared to ask too.
I am also increasingly striving to increase ‘community engagement‘ not through the usual processes of patient participation groups and so on but by going directly in to communities and engaging them in playful conversation, often with academics, clinicians, commissioners and managers so that their voices can be heard directly and relationships formed that will start to change the system.
I would love to hear what you do, in your practice that helps to raise awareness, interest and action in tackling health inequalities.
Please leave us a comment!
Achieving inclusion?
A very long time ago I learned, rightly or wrongly, that inclusion is not a destination but a quest. A search for a holy grail. A place where all voices are heard and share in power.
While the destination may never be reached the journey is essential.
This led me to a practice of enquiring “Whose voices are not being heard?” and “What would we need to do in order to hear them?”, “How do we invite them to join us?”, “How might we go and join with them?”
How do we go from “them and and us” to ‘we’?
So, for me inclusion became a very practical process of reaching out, and inviting in.
However, I began to realise that more important than inviting people to join my projects, perhaps I should show interest in theirs. I started to do work that allowed me to meet with groups that I hadn’t worked with before, especially in relation to homelessness, refugees and asylum seekers, black health and learning and physical disability organisations.
This certainly helped to broaden my understanding and led to me making a lot of mistakes and doing lots of learning. Making assumptions that proved to be wrong was my ‘go to’ error!
My most recent work has seen me holding a slightly different role, that feels more hopeful. On the reciprocal mentoring programme I am part of a team of facilitators who bring together large, diverse groups of people from within an organisation or a system and encourage them to have conversations rooted in their own experiences of diversity, inclusion, discrimination and power. We offer them support to stay with the difficult conversations. We use forum theatre to model effective conversations and videos and data to start to explore the nature of the challenges involved.
But mostly we work on a commitment to listen, and to let what participants hear change them, individually and collectively in pursuit of better futures. And having started with some of these conversations the intent is to support the reciprocal mentoring process over 12 -18 months so that these conversations become part of the changing organisational culture. We don’t work to achieve targets. We work to change the nature of the conversations and the relationships of the people involved in them. Connecting the system better to itself. Building trust and understanding, with a belief that, over time, a more inclusive and sensitive culture will emerge.
Inclusion comes when people who’ve been defined out of communities secure the power to re-define communities.
Cormac Russel
It feels like the next leg in the quest for the holy grail…
The Business of Human Endeavour
For a long time now I have had real concerns about the focus of policy makers, and the projects that they spawn, on ‘enterprise’ and ‘entrepreneurship’ as being too business oriented. It is as if the only fields of human endeavour that matter are commerce of some kind. Making money, contributing to GDP and economic growth.
For a long time now I have had real concerns about the focus of policy makers, and the projects that they spawn, on ‘enterprise’ and ‘entrepreneurship’ as being too business oriented. It is as if the only fields of human endeavour that matter are commerce of some kind. Making money, contributing to GDP and economic growth.
This is especially un-nerving when I see it played out in our primary schools as during Enterprise week, 6 year olds are encouraged to wear badges that proclaim them be a ‘Sales Director’, ‘Operations Manager’ or ‘Marketing Executive’.
The root of the word entrepreneur means ‘to undertake’, and it appears to also have some connections to the Sanskrit phrase ‘anthra prerna’ which means self-motivated. And my old boss and mentor, Ernesto Sirolli, claimed it was first used by an Italian General centuries back to mean ‘Act boldly’.
What about all of those other fields of human endeavour?
We need people with the qualities to undertaking things with self motivation and boldness in all aspects of our society, not just commerce; climbing mountains, creating art, having fun, playing sport, writing, cooking and so on.
What if we encouraged our 6 year olds to wear badges that proclaimed them to be ‘Footballer in Training’, ‘Ballet Dancer under Construction’ or ‘Surgeon to Be’?
Because what really matters is not exposing more people to the world of business and entrepreneurship.
It is teach them to imagine possible futures, and learning how best to navigate towards them. It is about developing people with a sense of agency and influence over their own futures. It is about building a generation with both power and compassion. And a generation who really understand how to use the tools of collaboration, association and cooperation to shape the future of our communities.
Enterprise, entrepreneurship rightly understood. And not just hijacked by the economists and business community.
Does it really only matter if their chosen endeavour contributes to GVA? Or is there more to our humanity that we need to recognise and encourage through both our policy and practice?
And this is not just an issue in schools. It runs through our communities from cradle to grave.
I think this is important because we lose so many people who might learn to become more entrepreneurial but are completely turned off by the thought of a world of commerce. Let’s face it we don’t all want to dive headlong into a world of Dragon’s Den and The Apprentice.
So what about if instead of focussing on enterprise and entrepreneurship we attempted to throw our net wider and to encourage and support people to build their power and compassion in whatever they choose to be their particular fields of human endeavour?
So, let’s be bold…
Hope and Social – All Our Dancing Days