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Mike Chitty

Helping realise development since 1986

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Inclusion

YOU are the problem we have been looking for…

Mike Chitty · February 9, 2020 · Leave a Comment

Mike Chitty Realise Development

This is the conclusion of many workshops, conferences and articles designed to help us to deepen our understanding, raise our awareness and develop more effective anti-racist practices.

The problem is what Professor Kehinde Andrews calls ‘The Psychosis of Whiteness‘. Whiteness as a historical process that perhaps can be unpicked, understood and transformed.

But Professor Andrews also says that ‘whiteness is not just for whites’.

It is not just about the skin tones of individuals, but about historical processes of othering, domination and exploitation which are still alive and well, perhaps in more covert and subtle ways that are no less powerful. The first recorded slaves were the Slavs.

The problem is perhaps the human tendency to dominate, exploit and dehumanise in search of safety, security and power. To secure power over. Domination and exploitation are not restricted to members of our own species. We will dominate and exploit anything if it meets our needs. Meetings, conferences, other species, ecosystems, planets, space… This tendency towards violence is in us. Part of our biology.

Part of our biology. Part of our evolutionary past. And our evolutionary future depends on us transcending it, quickly.

Recognising that domination and exploitation cannot be sustained. That our facility with violence has to be replaced with our facility to love, to care to nurture.

And this facility to love has to recognise the ripples, the tsunamis, from the past that still rage through our modern societies, organisations and our psyches, leading to exclusion and discrimination, allowing us to find ways to listen deeply and change how we behave. Change how we are. To be different. To learn how we develop power with and power to…create a better future.

And for me this is at the root of our work with the NHS Leadership Academy’s Reciprocal Mentoring for Inclusion Programme, where we bring together members of the ‘in power’ group, senior leaders, ‘bosses’ with a broad coalition of people ‘staff’ who feel less powerful, left behind, through race, gender, sexuality, age, disability or any other characteristic that to them feels relevant. Even the language of ‘bosses’ and ‘staff’ are deeply rooted in models of power, domination and exploitation.

Our starting point with Reciprocal Mentoring is not to induce the feeling that ‘You are the problem’. More that ‘We have a problem’ and the only way to explore it is to learn to talk together and change and to transcend the domination instinct. That by changing the way we relate to each other in the present, with a shared and growing awareness of history and human nature, we may be able to create a better, more loving and inclusive future that realises the ambition of the NHS Constitution that Everyone Counts.

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

Everyone counts…but some might count more than others?

Mike Chitty · February 1, 2020 · Leave a Comment

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
Mike Chitty Realise Development

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!

Mike Chitty

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