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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
Diversity, Inclusion and Power – some personal reflections on why it matters to me.
This reflection has been prompted by my experience working with the amazing Charmaine Kwame from the NHS Leadership Academy on Reciprocal Mentoring Programmes. I get to work with some amazing people, both ‘faculty’ and participants, on these programmes and the work feels like some of the most important work that I do. It connects with me on a very personal level. And it forces me to reflect. To think and to listen. I am not an expert in this field. I am the student. And I think that approaching the work with a ‘beginner’s mind’ might just be helpful.
I have been in the education, training and development profession now for almost 40 years. During my teacher training in the mid-80s tackling discrimination and inequality in the classroom and the education system were a major priority. Reading lists on race, class, gender and to a lesser extent disability were mandatory and I just ‘connected’ with the importance of this work. I still do. I am just not sure why. It is a gut feeling I have, an intuition that it is important.
Almost 40 years after I first engaged with the academic literature on diversity, inclusion and power we seem to have made little progress. So perhaps some reflection and a change of tactics might be called for…
On the way back from a Reciprocal Mentoring event in Birmingham Charmaine, Tina Deen and myself were talking about working in Arabic cultures and I was asked how I reflected it in my work in Oman and Qatar. I mentioned how I use Rumi and especially his poem about two kinds of intelligence. He talks of the first kind of intelligence being to do with learning and books. It is hard to maintain and quickly ages. It is seated in the brain and is the kind of intelligence that brings material power and gains. The other kind of intelligence is the intelligence of the heart or the soul. The intelligence that is like a babbling spring of fresh, clear water that just pours out of you – once you have found it and released it. It needs no maintenance. It just is. The intelligence of intuition and gut feeling. The intelligence of love.
I talked about how so much of what we do in the world of leadership and organisational development is about the first type of learning, the book knowledge, and not enough is about finding and expressing the babbling stream that springs from the soul. The authentic self I suppose. We have allowed our heads to overwhelm our hearts and souls. Our intelligence to overwhelm our intuition. And I think the recognition and inclusion of ALL of the babbling streams is at the heart of our work on inclusion.
On the journey home I started to reflect on why I found the Reciprocal Mentoring work to be so demanding, risky and crucial. It feels like a part of my babbling spring. It feels intuitively right for me to be doing it.
But, why?
I was born in 1962 in one of the most privileged villages, in one of the most privileged counties in one of the most privileged countries in the world. Virginia Water in Surrey, England.
The place is famous for being on the edge of Windsor Great Park, having a couple of world class golf courses, and the Holloway Sanatorium. The Wentworth Estate was the home of choice for stockbrokers and bankers from the city, celebrities (Bryan Forbes, Nanette Newman, Bruce Forsyth, Elton John and 5-star were all residents, alongside General Pinochet for a while when he was on house arrest). Average house prices in Virginia Water? £5m
This is where I was born and bought up for the first 18 years of my life. But these were not my people.
Because I was born in Trumps Green, Virginia Water. The estate at the bottom of the hill, built with a view to housing ‘the servants’. The people who would maintain the golf courses and gardens, clean the houses, chauffeur the cars. My Dad built lorries and my mum typed up hand written manuscripts for a couple of local authors and doubled up as a school dinner lady. Later on she became Headteacher in the same school in an amazing story of ‘social mobility’. From dinner lady to Head. My first jobs were working on the ‘big gardens’ and servicing the ‘Colonels’ Mercedes Benz’.
So from a very early age I lived in a divided community. Those that lived on the private estates, with ponies and summers in Tuscany and those of us that lived in Trumps Green whose parents rented the milkman’s caravan in Selsey Bill every Summer for a week. We didn’t get to mix with the Wentworth Estate people very much. They had their own private schools and their own private estate. Their kids went to drama and ballet school while we played football in the park. Yes, jumpers for goalposts. There was us and them. And we were overwhelmingly white British.
When the two tribes did come together it would usually be at the ‘top shops’, he parade of shops closest to the Private Estate, where Bryan Forbes owned the bookshop and the Genzianis’ ran an Italian restaurant.. Occasionally we would need something that we couldn’t get in the ‘bottom shops’ and I would walk the short distance up the hill. Often there would be a moment of excitement as a Rolls Royce, Jaguar, Aston Martin or Mercedes Benz pulled into a parking bay and the door would open and out would step ‘one of them’. Usually a faceless banker, but occasionally someone you recognised ‘off the telly’. I still visit Virginia Water often as mum still lives in the house I was born in. I still get this weird feeling, 50 years on when a Range Rover, usually with blacked out windows, pulls up at the top shops and out steps one of ‘them’. Now much more likely to a Russian oligarch but still we get the occasional celeb.
As a kid growing up I would imagine the privilege that folk enjoyed behind their private signs and their security fences, with their villas ‘on the continent’, their polo matches, swimming pools and tennis courts. I used to hang out at the top shops hoping to meet them. To join them. To be like them. Because as a kid I thought they were better. And I was envious. It took me a good while to grow out of it…perhaps, I never fully did.
The only other place where our paths cross were at Wentworth Golf club, where there were a number of opportunities to make a few bob. Firstly you could hang arond at the caddies shed, and hope that one of them would pay you to carry their clubs around and advise them on the course. As the sone of lorry builder and dinner lady whose only knowledge of the game was from watching it on the telly and who had never held a club, I was seldom chosen. More reliable income for me was from collecting ‘lost’ golf balls and selling then back to the players as they went to their car on the way home. I would spend hours scouring the ‘long rough’ in search of these white spherical cash cows. I can’t remember what we used to get for them, but a new ball, with no splits and the right brand name was a precious find.
We also knew several places on the golf course where the players would take a driver from the tee and their balls would roll out of sight over the brow of a hill. We would hide in the bushes at the side of the fairway, waiting for thwack of the drivers. We would watch the balls come to rest and then grab them before running back into the bushes. We would then wait for the players to come over the brow of the hill, suppressing our giggles as they searched for the balls. After a few minutes of cursing their luck they would drop new balls and go about their game. This wasn’t stealing. It was wealth re-distribution.
Our other money maker was to wade into the water hazards, usually at night, feeling for golf balls in the silt. Water damaged balls were less valuable than pristine ones, but if you got the timing right you could come away with dozens of them.
I think these early experiences of class, wealth and difference and what I learned from them really gave me a sense of injustice, of us and them, of othering. It was a dynamic that I had experienced for myself for the best part of 20 years and it is dynamic that is still easily triggered in me. I am not equating it with other forms of injustice and oppression, and I am not saying that I am not privileged, because I am. I am just reflecting on why THIS work feels so important, so personal and so challenging.
At the root of much of our work in leadership and organisational development are the psycho-dynamics of othering. For me this means using differences, almost any differences as a reason to see people as different and then to use this difference as a way of blaming and rejecting. Instead of seeing our common humanity we see often superficial differences and use that as a mechanism for distancing ourselves, defining ourselves. I realise now that I had become an expert in this by the time I was 5. I was sensitised to class based differences and had become an expert. A large part of my journey into the world of inclusion must be to recognise and come to terms with my own social conditioning.
Othering is such a powerful psychological force. A means for the ego to defend itself and to justify itself. A way of defining and claiming its existence. And a way of building some connections while sabotaging others. A fundamental denial of the wholeness, the oneness of all living creatures.
This takes us into the realms of the spiritual and the existential. Back to the babbling stream of the soul. And leadership and organisational development territory where apparently ‘there be dragons’.