Kia ora New Zealand

I first took notice of health and care services in New Zealand after reading a couple of Kings Fund publications on whole system redesign and accountable care.

As someone working in an organization that was delivering integrated health & social care, these publications gave me a lot to think about.

I’m eternally curious so went to a Kings Fund Integrated Care Summit. Commissioners & providers across public, private & third sector from around the UK plus international delegates discussed ways to meet the growing challenge of population health & wellbeing. The holy grail of effective & efficient person centred services. Whole system redesign. Some amazing projects were described but it was the stuff about housing & homelessness that still sticks in my mind.

At the time I wasn’t really paying much attention to the social determinants of health & wellbeing.

An organizational restructure later & I find myself responsible for care & support services in 3 extra care housing schemes. It’s all pretty straight forward. Won’t add much to the workload. Hmm…

It’s no cliffhanger that that wasn’t really the case. Don’t get me wrong we have a great team and great properties but it takes sustained effort to create and maintain a community. People with a level of need that meet the criteria for extra care living can easily shift from independence to dependence.

The question I couldn’t stop asking was but what gives their life meaning? This is not a care home. How do we help people connect or reconnect with their purpose?

Nearly 3 years later and we are very slowly nudging forward in supporting people differently on this bigger stuff.

My Fellowship has provided me with the opportunity to learn from others about their communities and identity, their traditions and rituals and how this impacts on how they deliver health and care services. It’s been a window into cultures I didn’t expect to look through.

Yesterday I shared my story of my experiences and learning so far with Te Puea Winiata and her team at Turuki HealthCare in Auckland. Te Puea and I met in Anchorage where she and some of her executive team and Board were also learning about the Nuka model created by SouthCentral Foundation.

Te Puea and her team are creating a relationship based care model that meets the specific needs of their people.

In my time with them it was clear that they have many of the fundamental elements already in place. They are standing in the gap for a community with complex health and social care needs. Their work around preventive health through the FitKids programme and support with housing shows a breadth of thinking and response that is truly integrated and person centred.

It was great to discuss my observations of how elements of the Nuka model could be adapted and adopted in other systems. We talked about the challenges of funding, how a whole system approach requires excellent data systems but that’s not very easy to achieve and how we need to pay attention to appreciating ourselves and each other.

We talked about the role of sharing story in relationship based care systems and how powerful it can be. I described a personal experience of sharing too deeply with people who were unprepared to appreciate my story. How that that made me feel and the potential impact on them. We need to tread carefully in developing these approaches in our own systems with the right support, training and assurances.

We had an interesting discussion on language and how we need to find ways to communicate with people that makes sense in our cultures but also explains the changing model and expectations on both sides. Not easy stuff.

Thank you Team Turuki for a thought provoking afternoon, your great hospitality and my lovely gift!

There is no size fits all but if we all connect and share our work we are stronger together.

Next week I will be in Hamilton with Pinnacle Health. It will be fascinating to see how their Health Care Home model works and what we can learn from that.

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A la perchoine 2

I wonder how many Fellowship blogs begin “I’m sitting in an airport…”

Well, I’m sitting in Guernsey airport trying not to get too nervous about the fact that there seems to be decreasing visibility airside. Fog – the blight on travel to & from our islands. As usual surrounded by people, I start to wonder why they are traveling.

Just bumped into one of my team waiting for a flight to the UK. Her relative is being medivaced for urgent specialist treatment in a tertiary care hospital tomorrow. Fog tonight has delayed the transfer. The medical flight can’t get in.

For islanders, travelling for medical treatment is part of the tapestry of island life. Or traveling to be with loved ones who are ill here or “off island”. We use these terms often, without thinking perhaps that this way of living is part of our cultural identity.

Me worried about flight connections pales into insignificance. If I need to change my plans it’s inconvenient and costly but it’s not life or death.

They are calling my flight. See you on the other side of the Channel.

Connecting or disconnecting?

Chelsea Flower Show 2018

Taking stock is something many of us do at the beginning of a new year. We make resolutions to do more of this and less of that. We promise ourselves we WILL learn to play the guitar, take up fly fishing or start writing that book. It’s not that simple of course. Motivation, competing priorities, money, time. Where we have capability and capacity we can make choices about changes in our lives. This year my resolutions are about self-care and finding joy in each day. A moment is all it takes sometimes. It could be as simple as watching the little robin that lives in the tree outside our building at work. The trick is being present and not walking with my phone open checking emails.

About 3 years ago I made a New Years resolution to reduce the amount of time I was on Facebook. I opened an account about 10 years ago. Wow! That’s scary! My daughter was 16 and in Scotland for a month studying dance. It was a really good way to keep in touch. There wasn’t that many people I knew who were using Facebook so it wasn’t the thief of time it became. Over the years, like millions of others, I connected with old friends and posted photos of holidays and my garden. It was great to share awareness of our Pink Ladies Breast Cancer Charity fundraiser, the Sunset Coastal Walk. But then it started to become a habit. Have dinner, check Facebook. And what? To see what people were having for dinner or where they were on holiday. The risk To wellbeing is the comparisons people make between their lives and others. The reality of anyone’s life rarely lives up to what they post online. There is evidence that while social media doesn’t intrinsically cause harm, if you are low in mood or have anxieties then using social media can amplify these feelings. I worry that as it has become easier to connect in the virtual world we are becoming increasingly disconnected and fractured in the real world. I get the benefits but I’m not sure we have evolved enough yet.

What worried me was that I began to know more about people’s lives than I needed to. I’m sure there is research that explains what it is about virtual communication that seems to mess with social norms. The societal boundaries we grow up learning relating to personal space seem to disappear and people share way more than I can handle. People I hardly knew became my ‘friend’ on a database. I couldn’t bear to watch another acrimonious break up being played out online. It will come as no surprise that I don’t watch TV soaps!

I decided I would take a break. It was surprisingly easy once I made the decision. Last year I actually closed down my account. It’s still there because Messenger is still useful for now.

I use Instagram now the way I used Facebook originally. My daughter and her girlfriend live in Vietnam and it’s great to see what they are up to and share in their life virtually but I don’t follow loads of people and I post rarely. I do use Twitter for work and find I have to give myself a talking to sometimes to use it sensibly. I am really good when I’m on holiday. In the same way I don’t check my work emails, I don’t look at Twitter.

A challenge has been posed this year to write more letters. Proper hand-written posted letters. It seems to me there is a quiet revolution about getting back some of the rituals we have lost with the march of technology. Vinyl record sales are on the rise with record stores opening up all over the place. Book sales too are on the increase as we fall back in love with the weight and smell of books. I am going back to the library now I can enjoy reading without feeling guilty because I should be studying. Libraries and record stores are full of people. We connect over shared interests and rituals that have been developed over many years. When I first moved to Guernsey, I wrote letters all the time, I loved finding unusual writing paper and having a great pen. Writing a letter to someone was like a gift. It requires intention and preparation. You need a pen and some paper for a start. You have to be present. The ritual of drawing the letter to a close and putting it in the envelope, searching for stamps, going to the post box and finally it was gone.

Then you had to wait! Can you imagine?! We are so used to instant responses we have lost the appreciation of delayed gratification. It’s like we are on call 24 hours a day, 7 days a week. Slowing down the pace of life allows us space to be more present.

I might put on some vinyl and write a letter.

John Cooper Clarke, Jersey 2012

Life is complicated

Port Soif, Guernsey 2018

Writer’s block. Yeah that’s a real thing. I get it and I got it.

2018 was an extraordinary year. Professionally some amazing achievements. Completed my Masters and an executive leadership programme. Awarded my Churchill Fellowship. Went to Alaska. Deeply profound experience. Learnt a lot about myself as well as how I can influence change in my community. Dealt with imposter syndrome, recognised the impact and importance of self-care and appreciation in myself and others.

Started some changes that will build and sustain our services with coaching, shadowing, in-service training for managers now in place. I’ve shared my experiences and learning with many different groups across our islands health care system and use what I’ve learned on my Fellowship so far every day.

So all good huh? Well professionally yes it has been a massive year. Personally life has been much more complicated with fractures in our family relationships.

Christmas is a big deal in our home, a time for families to be together. We have our family rituals and traditions created over time. This year was very different. My other half and I basically took a big deep breath In December and waited for it all to be over. We got the last Christmas tree at the garden centre on a rainy Saturday afternoon. It was 11 foot tall. After opening the car windows and me scrunched in the back seat, we got it home. Naturally it wouldn’t fit in the house and we couldn’t find the power saw. After taking 2 foot of the bottom and a foot of the top, we got it in the house. With the usual palaver of swearing and sweating we got it in the stand, watered and resting ready to decorate.

On the Sunday, left to my own devices I start to unpack all the boxes of festive frippery. So many boxes. Garlands for the stairs and the windows and the fireplace, lights and all the other bits and pieces collected over the years. With every box there is a new memory some that have to be packed back up because they are too painful. All was going according to plan until a I got to the last box. The Christmas tree decorations. 25 years of memories in one box. The ones chosen by the children on our annual trip to get the tree. The ones collected on family holidays. The ones I picked up on work trips or were given by people important to us. Each decoration holds a moment in time. My heart broke.

A box of memories

We got through Christmas and New Year thanks to the great people in our lives, our 3 crazy cockapoos and being able to see that we are fortunate. We have a home and jobs and most importantly a reason to carry on. Not everyone does. We lost a friend who committed suicide in 2018. To others his life looked wonderful. the reality is he had lived with severe depression for many years. People’s lives are complicated.

I haven’t had the energy to write. I haven’t had the headspace and I have felt that writers block. I have been thinking though. What gives me meaning & purpose in my life? It’s people I’ve connected with, the new people i have met along the way, the kindness of strangers. It’s having hope and being curious.

In care systems, our biggest and most important asset is our people. In SouthCentral Foundation in Alaska, I saw the importance of relationships and recognizing that we need to look after ourselves and the people we work with so that they keep hold of their purpose in work and have the care and compassion to give to others.

I’m writing now. I’m taking another deep breath but this time I’m ready to take on what 2019 has to offer. It will be complicated. Life is. Bring it on.

Anchored down in Anchorage

It’s been a month since I returned to Guernsey from Anchorage, Alaska. I travelled as a Churchill Fellow, spending time with the team at SouthCentral Foundation to learn about the Nuka System of Care.

Having met some of the team in London a few years ago, I wanted to understand what it was about this system that was producing such different results.

Nuka is an Alaska Native word used for strong, giant structures and living things. Southcentral Foundation’s Nuka System of Care is a name given to the whole health care system created, managed and owned by Alaska Native people to achieve physical, mental, emotional and spiritual wellness.

https://www.southcentralfoundation.com/nuka-system-of-care/nuka-system-of-care/

Nuka was developed in the late 1990s after legislation allowed Alaska Native people to take greater control over their health services, transforming the community’s role from ‘recipients of services’ to ‘owners’ of their health system, and giving them a role in designing and implementing services. Nuka is therefore built on partnership between Southcentral Foundation and the Alaska Native community, with the mission of ‘working together to achieve wellness through health and related services’.

https://www.kingsfund.org.uk/publications/population-health-systems/nuka-system-care-alaska

Thanks to achieving a Travelling Fellowship from the Winston Churchill Memorial Trust, I was able to set off for the United States in June this year.

The Fellowship Programme aims to improve people’s lives through connecting and learning globally. They also say “Fellows – this will change your life”. That’s a big statement.

Its taken me a few weeks to feel able to write this blog piece because I have been trying to make sense of how I feel about my time in Alaska. I can categorically say the personal impact of my time with SouthCentral Foundation has been profound.

I went to see whether it was a case of Emperors new clothes. Looks great on a website and at a conference but actually what happens on the ground? What does it feel like to be a customer-owner? Is there a sense of meaning and purpose in people’s lives?

This is a real organisation working through real challenges faced by everyone working in health care in the 21st century. They have the same issues as everyone else around managing resources, recruiting, performance management and meeting demand. The difference is they are completely transparent about what they are trying to achieve and how they are trying to achieve it.

You hear the term ‘agile’ in a business sense. My observation of Southcentral is that this is an agile organisation that has distilled complex theory and evidence to create a system that has a simple elegance.

Like the extraordinary landscape of glaciers and icebergs that they sit in, what you see on the surface has been honed over 30 years to create a constantly evolving model that responds to the environment it is functioning in.

I didn’t expect to spend time learning about myself, sharing story and making connections with people of such depth that took my breath away and brought me to tears on a number of occasions. And I’m not easily moved to tears. The Nuka model is relational. If we don’t understand ourselves how can we be present and honest in our connections with others? This stuff is so far removed from how we practice in a boundaried and restrictive way that it takes some getting used to.

More about that in the next piece – Swimming with the whales

I didn’t expect to learn and reflect on cultural identity and the impact that this has on health and well-being in communities. I knew that Southcentral provided services for native Alaskans. I have to be honest and say I never really thought about it. We heard in Core Concepts how people in these communities became disaffected with the impact on cultural identity through loss of land and language. Policy decisions meant that families were separated , children sent to boarding schools, elders banned from using traditional healing and prohibited from speaking their own languages, I began to understand.

Initially though I was thinking “this is really interesting but how is it relevant to my community? I just want to know about your model” Once I started to reflect at a deeper level, I realised that this was entirely relevant to my community, and any community which has suffered conflict or trauma. Which – lets be honest – could be any community.

Castle Cornet, Guernsey

There is particular relevance for the Channel Islands which I hadn’t really considered before. During World War II, the Channel Islands were occupied by German soldiers. During the war, families were separated with adults going to fight for their country, mainly men but some women, with the evacuation of most children to the UK but also Canada and through the incarceration of some people as prisoners of war by the occupying forces. If we think about the impact of occupation and the plight of refugees in the world today, we know and understand more that it’s likely that the impact of this trauma being observed in people today would have been present for our islanders during WWII. We understand the physical and emotional impact, we see it in the media and we expect these people will struggle with wellbeing.

I had never given this a moments thought. Yet here in the island there will be families still experiencing the after effects of WWII. This may relate to physical or emotional impact or separation of families. The intergenerational impact and legacy may have been thought about by others but certainly not me.

Traditional Guernsey singing

I thought a lot about the cultural identity of Guernsey while I was away and how that would have been influenced by the occupation in a similar way to what happened with indigenous people in the US, Australia and New Zealand. Families were separated, sons and daughters went off to fight and didn’t come home, children lost their ability to speak the local language, Guernesiais. I don’t know enough about this time or local culture to say any more here but I do want to understand our local heritage and culture better and see whether there is a connection with personal meaning & purpose that can help connect our community.

https://en.m.wikipedia.org/wiki/Guern%C3%A9siais

Part 1 of my travels has given me a lot to think about in relation to myself and my community on a much deeper level than I expected. I will be writing more about my personal journey as I start to understand it myself. I will also write more about my thoughts on how a better understanding of our cultural identity & heritage influences wellbeing from a population health perspective.

Yup’ik dancing

Part 2 of my travels will take me to New Zealand early in 2019. I have made some fantastic connections through the Nuka Conference which has widened my thinking about how I can develop my understanding about the importance of meaning and purpose in our lives to improve wellbeing in our communities.

Grateful thanks to the beautiful people of Alaska who opened their hearts and their lives to me so honestly that I truly feel like I have left a piece of myself anchored in Anchorage.

À la perchoine Guernsey

Day 1

Leaving Guernsey on a beautiful sunny afternoon makes me remember just how lucky I am to live here. We live a 5 minute drive from the most glorious beaches. The salty sea air feels like it cleans your mind & soul. We have so much going for us.

Saying goodbye to people (and dogs) we love is always hard but here’s where the World Wide Web comes into its own, making it so much easier to keep in touch.

I’m leaving work knowing I have a great team and fantastic colleagues who will keep doing the ordinary and extraordinary for people in the Bailiwick. Hopefully the email traffic will be light!My day started with a BBC Radio Guernsey interview with the JKT show. Jenny & Darren have been great supporters of my Fellowship experiences far. We are fortunate to have a BBC local radio station which works really hard to connect our community, reflect current issues but also remind us about our history and place in the world.

It was great to talk to Jenny about my hopes for my travels to Anchorage and how I will bring ideas back to improve our community. She was keen to know about the weather (pretty similar to here but variable) the food (Eskimo ice cream hmm not so sure but yay to smoked salmon) and the packing challenges!

So now I’m in Guernsey Airport Departures waiting for 1/6 flights of this adventure. The airport survey guy says it’s the first time he’s put Anchorage as a destination!

I’m super proud to be wearing my Churchill Fellow badge.

I also have my Queens Nurse badge with me which I will wear with pride too.

https://www.qni.org.uk/

What matters to me?

I will be in Anchorage, Alaska this time next week on the first leg of my Travel to Learn Churchill Fellowship.

This time last year I hadn’t even thought about applying for a Fellowship. So if you are reading this and have an idea that will help your community – what are you waiting for? Get your application in!

https://www.wcmt.org.uk/

The aim of my project is to learn what approaches other communities take around individual and population health and wellbeing.

I’m interested in how people are connected in meaningful ways. I want to find out about people’s ikigai – reason for being. I think I want to understand how we reconnect individually & collectively.

Two things I heard this week struck a chord with me around identity and personal meaning & purpose.

Clenton Farquharson MBE from Think Local Act Personal was one of the speakers at the Guernsey Academy. This initiative brings together people from public, private & third sector organizations to find new ways to think & work differently in Guernsey.

Clenton talked about his personal experience of the consequences of a traumatic event. He described his loss of identity and the frustration of being seen as something that needed fixed. Clenton was being seen in parts rather than as a whole because that’s how the system works. Fixing one thing as we know rarely works and can have unintended consequences.

What Clenton wanted was “an ordinary life”

It was when someone actually listened to what mattered to him and heard what would give his life meaning that he started to live what, in my view, is an extraordinary life.

Clenton’s challenge to us was around language and silo working. About seeing people as assets that add value rather than problems to be solved in isolation. From my research I know there are over 100 definitions of person-centred but getting it working in practice is tricky. System says no. I hope the Nuka System will show me how it’s shifted thinking through its coaching approach & multidimensional wellbeing.

Clenton and the team at TLAP are at the forefront of this shift in thinking in the UK.

Angela Catley from Community Catalysts talked about releasing the potential in communities. It was a fantastic session and really inspiring. She challenged us to think about our prejudices as the State, particularly in relation to risk. There are lots of opportunities if we work together and are creative & brave.

But the thing that struck a chord with me was a wee throw away remark she made during some group work. One of Angela’s pet hates is seeing the term “Service User” written in documents. “Like its a job title”

Wow.

Sometimes a mirror is held up which makes you see something for the first time with such clarity it stops you in your tracks.

I’m not a fan of the term service user. I’m a nurse but I’m not that fond of the term patient either. I prefer person or people because anything else masks the reality that we are people.

Both Angela & Clenton made me reflect on how systems reduce people. We do need systems but we turn people into units. It probably makes it easier for us to deal with because they are then things that we can fix or flow or whatever this weeks target is.

If we are going to get anywhere with a person-centered approach we need to start with people. Our uniqueness as individuals has to be the building blocks for happy & healthy communities that help people thrive and stay connected.

So I set off for Alaska on Friday. Part of these travel fellowships are about cultural exchange. I will look forward to sharing my experiences of participating in a gathering!

Oh and the photos are our wedding day 24 years and 1 day ago. And meet our dogs who love us unconditionally which is a lesson for us all.

https://www.thinklocalactpersonal.org.uk

https://www.communitycatalysts.co.uk/

http://www.alaskanative.net/

https://scfnuka.com/experiences/conference/

Connecting to learn how people thrive achieve meaning & purpose in integrated communities