Come to the edge


“You have 3 choices in life: give up, give in or give it all you’ve got” Kim Garst

As I watched the sun drop down in the sky and cast a golden glow over the naked trees and the frosty grass, I took the opportunity of a rare, quiet moment to reflect on the past year. It’s been a year in which life, in the words of Forrest Gump, truly has been like a box of chocolates. I love this analogy, not just because I love chocolate, but because they are most often an unexpected gift; they’re something to personally savour but also joyous to share and, if you’re anything like me and lose the little flavour guide, there is an element of risk and surprise when you bite into them.

In 2014 I’ve made much more of an effort to embrace and make the most of life. Supporting the establishment of a brand new school (which opened in September) and learning to be school governor has been and continues to be hugely rewarding. I feel so much fitter now I’ve lost 2 stone and I’m really enjoying being part of a running group. Spending more time with friends and family, despite more travelling and time away from home, has been just wonderful. I’ve also joined the NHS “Future Focused Finance” (FFF) national work-stream for “Great Place to Work”, to connect with and support NHS finance colleagues around the country.

I have high hopes for 2015, as I’m very much looking forward to building on the successes of 2014 and continuing to share with blog readers what I observe and learn along the way.

“Sometimes the most ordinary things could be made extraordinary, simply by doing them with the right people” Elizabeth Green

 Many readers will know that I’ve worked in the NHS for a long time – over 20 years. If I had a sum up what it’s like (for me) in one sentence, I’d say “incredibly challenging, but hugely rewarding”. It’s worth taking a few moments to understand why it is so incredibly challenging. At a recent conference, Heather Rabbatts (lawyer, business woman and ex-CEO of London Borough of Lambeth) captured it beautifully: there is constant change, constant scrutiny and the responsibility for managing public (health) risk.

During the 18months I’ve been writing my blog it has become increasingly clear to me just how interlinked my work (NHS) and personal worlds are. For this blog posting I’ve therefore decide to tie my two worlds together.

As members of the NHS workforce, we’re committed to “high quality care for all, now and for future generations” (NHS England Mission), where “everyone has greater control of their health and wellbeing, supported to live longer, healthier lives, by high quality health and care services that are compassionate, inclusive and constantly improve” (NHS England Vision), valuing:

  • Respect & dignity

  • Commitment to quality of care

  • Compassion

  • Improving lives

  • Working together for patients

  • Everyone counts

These values are my values. They’re why I get out of bed in the morning and why I have loved and continue to love working for the NHS. As Mahatma Ghandi said: “Happiness is when what you think, what you say and what you do are in harmony”

On the 23rd October’14 the NHS Five Year Forward View was published by Simon Stevens, NHS England Chief Executive Officer. The key points are:

  • Getting serious about prevention; radical upgrade in prevention and public health – hard hitting on obesity, smoking, alcohol and other major health risks

  • Empowering patients; patients’ control of their care will increase

  • New care models; barriers between organisations in relation to care provision will be removed

  • Local co-design and implementation; there will be a small set of national organisational models and local community will implement the most suitable one

The first two bullets of the Five Year Forward View, which is only 41 pages and a must-read for all NHS colleagues, herald an era where everyone has to take more responsibility for their health and wellbeing. Via the national media, most of you will already have seen NHS chiefs and ministers preparing the ground and the start of the Public Health England campaigns around smoking and obesity. Without change, the increasing demand for NHS services will significantly outstrip resources. It is estimated that if nothing is done the NHS will have an annual funding gap of £30bn by 2020/21.

There are lots of theories about why NHS demand has increased, but here are my personal thoughts. With today’s medical advances people now survive, with significant interventions and aftercare, events such as strokes, heart attacks and cancers. Often, people survive these events on multiple occasions. Health issues are now picked up earlier and treatments provided to avoid events or to prolong lives. At a recent conference, Dr Sanjay Agrawal (Consultant in Respiratory and Intensive Care Medicine, University of Leicester) described Victim of Modern Imaging Technology (VOMIT) syndrome, where patients’ scans pick up possible secondary medical issue , leading to a series of follow up investigations, where (thankfully) nothing of concern is usually found. In a nutshell, people are living longer but need significant public resources to do so.

As a nation we have also seen significant change in relation to family units and how members are able to support one another. In days gone by families would generally have lived closer together and provided support during periods of emotional, social and physical need. Today, there is much more reliance on the State.

Unless we are prepared for endless, unaffordable tax rises, to take out health insurance or to “pay as we go” for services when required, as a society and as individuals we have to start taking responsibility for our own health and wellbeing.

 “Make the time to fly every day or there will come a time when you completely forget that you have wings” Katrina Mayer

The need to take responsibility for our health and wellbeing is more than just a financial imperative – it is fundamental to our happiness.

Those who have read my previous blog posts will know how passionately I believe that we are all masters of our own destiny and therefore our own happiness, health and wellbeing.

At a recent conference, Paul Hannam, a psychology academic, author and director of iPerfom presented research which shows the determinants of happiness (and therefore wellbeing) as:

  • 50% genetic

  • 40% intentional activities

  • 10% circumstances

So, on average, 40% of our happiness is based on what we choose to do. Paul explained, using research by Carol Dweck, that having a growth mindset, rather than a fixed one is key to achieving it. A growth mindset is one where we believe that we can learn, develop and grow, rather than believe we’re born the way we are and we can’t change.

During his conference session Paul also made a powerful observation, which I feel that it is important to share. He said that “In the NHS we focus on patient wellbeing, but not on that of employees – it needs to be holistic; we need to look after ourselves.” The Five Year Forward View recognises that workplace health and wellbeing is central to the NHS strategy. In Chapter 2 there is a section on workplace health, with NHS staff becoming “health ambassadors” in their local communities. The expectation is that NHS staff lead by example.

 “You cannot go through a single day without having an impact on the world around you. What you do makes a difference and you have to decide what kind of a difference you want to make” Jane Goodall

 In practical terms, what can we all do to take charge of and improve our wellbeing ? In October 2008 the New Economics Foundation, based on comprehensive research, published five ways to wellbeing, with wellbeing defined as having two elements; feeling good and functioning well: These activities create a wonderfully simple, understandable framework around which to build a full and contented life and have been adopted and are promoted by many organisations already, including MIND:

  • Connect: with people around you, with family, friends, colleagues and neighbours. Building these connections will support and enrich you every day

  • Be active: Go for a walk, run or bike ride. Step outside. Exercising makes you feel good. Discover something active you enjoy

  • Take notice: Be curious. Catch sight of the beautiful. Remark on the unusual. Savour the moment. Be aware of the world around you and what you are feeling. Reflecting on experiences will help you appreciate what matters to you

  • Keep learning: Try something new. Rediscover an old interest. Set a challenge that you will enjoy achieving. Learning new things will make you confident, as well as being fun.

  • Give: Do something nice for a friend, or stranger. Thanks someone. Smile. Volunteer. Join a community group. Look out, as well as in. Seeing yourself and your happiness linked to the wider community can be incredibly rewarding and creates connection with people around you.

 “Come to the edge” life said

They said “we are afraid”

Come to the edge” life said

They came

It pushed them

And they flew

Author unknown

 Change is scary; courage is required. No-one can underestimate how much of a challenge it is going to be for the NHS to implement the necessary practical and cultural changes to support the shift from citizens’ reliance on the NHS to empowerment and self-reliance, or the challenges every one of us as citizens will face to accept and make the necessary personal changes. As a mother, I see parallels with parenting; we support our children to grow wings so that they can one day fly. Of course, we’re always here to support when wings are damaged and flying conditions become difficult; to offer tough love as and when required, to keep our fledglings on the right flight path.

For the reasons I hope I have explained above, it is in our best interest, as individuals, NHS staff and members of society, to allow life to push us off the edge, spread our wings and take responsibility for our own health and wellbeing. It will certainly be at the top of my New Year’s Resolution list for 2015. Will it be on yours ?


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