Healthcare leaders returning health to its rightful home

My first blog of 2016 has to start with this great recent article by the former NHS man and independent Peer Lord Nigel Crisp. Published in the December edition of the British Medical Journal (which also contains a recipe for baking a ‘brain cake’), Nigel lays out his vision for ‘Building a health creating society, with all sectors working towards a healthy and resilient population’.

The article is a passionate cry for a major re-focus on prevention. It also reflects a growing recognition by the current NHS leadership and others of the tremendous positive value that can be created when we recognise everyone has a role in creating healthy humans and communities, from housing associations to our next door neighbours.

To make his point Nigel quotes the inspiring African expression which pretty much sums up my overall philosophy on health care.

“Home is for health, hospitals are for repairs”

Over the past two years my own organisation has established numerous health and wellbeing tests and pilots (yes more pilots), and in the process has partnered with many acute hospitals, hospices, countless doctors, nurses and many many patients.

Our work has provided us with invaluable insight into how the health care system operates, strengthening our ability to support people to live comfortably and securely in their own homes. It has also revealed to us the tragic results when our various public services fail to connect (or to deliver) and how just disconnected some people are from the non-professional community that exists outside their homes.

Our partnerships have also revealed some incredible people working beneath the radar in Healthcare, people who are attempting to achieve the vision that Nigel and others are calling for. You suspect that without them the vision is simply not achievable. They are often quiet and unassuming, rarely using the ‘innovation’ lexicon of policy movers and shakers but are making a significant difference from the ward upwards.

For me they all share 3 common characteristics; 1) they always, almost religiously, put people (patients) first  2) They believe that illness should not mask the gifts, skills and knowledge that all patients have 3) and they all understand that there is a rich world that exists outside the healthcare system that they need, must, find ways to connect with.

Here is a just a small list of some of those unsung heroes that I have encountered in my travels over the past 18 months. I guarantee they will all humbly reject my adoration, but nonetheless I will ruthlessly celebrate them and their work.

I have to start with…

  • Emma Hodges (CEO of St Giles Hospice). It was almost three years ago when we first teamed up with this passionate and innovative Hospice leader to help her to bring care out of the Hospice and into people’s homes. The result was a new partnership ‘My Home Support’ that has won acclaim throughout the international and national palliative care community. It’s also allowed us to support Bromford customers in ways were never thought were imaginable.
  • Tony Bullock (Public Health Commissioner- Staffordshire County Council). Knowing how humble Tony is he will hate me mentioning his efforts, but he has been a great local ally in helping us to support customers who are battling addiction. He is also a huge advocate of Asset Based Community Development and strength based approaches to tackling drugs and addiction, recognising the important role that communities play in the road to recovery.
  • Lizzy Rankin (Rheumatology Consultant- University Hospital Birmingham UHB). Again a quietly unassuming clinician with a fierce intellect and a passion for the health of young people. From a coffee in their canteen in 2013 we devised a plan to bring housing expertise into a busy A & E department. The impactful findings, which revealed large levels of self-harm related admissions, will be presented at a national conference next year.
  • Antony Cobley (Equality and Diversity Lead UHB)- Again of UHB, no honours list would be complete without the thoughtful, funny (understatement) and engaging Anthony Cobley. Having had the pleasure of working with him for a short stint in 2014, he continues to drive forward his plans for making wellbeing a central focus of one of the busiest Acute Trusts in the land.  He’s also helping to establish an orchard for patients around the Queen Elizabeth Hospital site. I recommend a visit.
  • Paul Dodd (Respiratory lead for the West Midlands Respiratory Network) I didn’t get to work with Paul so much last year but he did update me recently on the brilliant work he has been doing with partners in embedding the principles of ABCD into how Hospitals address the socially isolating condition of COPD. The Ripple Project which he has been developing with Coventry & Warwickshire Foundation Trust has recently been funded by the Health Foundation, you can find information about it here.

They are all, in small and big ways, making the NHS a much better place to receive care in, bringing it out of our hospitals and into our homes and communities.

Heaven knows where we would be without these unassuming radicals.

Have a great 2016 everyone

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When the lights go out in your street who will you turn to for help?

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If all of the lights go out in your neighborhood who do you turn to for help?

This is not a question that I ponder every day but two weeks ago after putting my two daughters to bed our home lost all power. Our family were left without any electricity and I had to furiously riffle through every draw for candles and torches to discover to my horror that we were not prepared for such events.

My first thought was… we need to urgently buy them (after scolding myself for not having them easily available). My Second thought was I need to buy them from our local corner shop. Leaving the house I discovered a street blanketed in darkness with every house alarm in two blocks screaming aloud. Walking to my nearest shop I was greeted with the shop assistant trapped inside with his electric doors firmly closed. He seemed as amused as me about our predicament.

After I found another shop via my car I returned home with candles, torches and provisions to see my neighbor in her dressing gown leaving another neighbors home. She had just helped a 94 year old neighbour who in the pitch blackness of her home had fallen over, laying face down crying out for help. Her panic alarm, predictably of no use.

It was a sobering experience to discover that such a vulnerable person was living on our street and uplifting to know that my nearest neighbour was their to assist her. Sobering still to know that without her our frailer neighbour may have not been so lucky. Our community was hit by an energy black out that affected over two thousand nearby homes. We were not alone, we were united by our collective lack of power.

The situation has taught me a number of things. To share my number and contact details with my neighbours to stay connected when such events happen again, particularly in support of our 94 year old neighbour. Some thing I have failed to do since moving into the area earlier this year.

Secondly having explored the importance of community connectedness for the best part of five years I clearly don’t practice it nearly  enough in my own life.  As I’ve written previously here, I personally owe so much to the kindness of strangers.

Our frailer neighbour is proud to live independently and doesn’t want to be hidden away in a care home surrounded by what she describes as other ‘older people’. She wants and has a right to live in her own home for as long as she can. However without a community that cares (twinned with funded social care services) which share her aspirations this just isn’t possible.

It also raised the real spectre that over the next decade we will no doubt be hit by such catastrophes (from climate change to terrorism), far more extreme than the one I faced. These events will no doubt test the spirit and resolve of even our most connected communities.

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From Groundwork South Community Prepared project

I was recently alerted to a fascinating new project in Devon run by the national UK charity Ground Work which is hoping to build the capacity of local communities to withstand catastrophes when they strike, particularly of the environmental kind such as floods.

My fear is that without such endeavors (way before events occur) we may find that we experience my own sense of powerlessness on a massive and rather more terrifying scale.

According to a recent European Poll the UK was the second least neighborly country in Europe. Interestingly we ranked among the highest for having a positive home life. Clearly community does not feature at the top of our list of essentials to achieving wellbeing.

In the end does the success of social enterprises like my own rest on how strong and connected our communities are in the face of whatever the future may bring? If so is it time to prepare our communities to have every success of coping when such events strike?

Worth also noting today’s excellent new report from Joseph Rowntree on a personal account of how one neighbour can make a difference in their community…

We must build and let homes that strengthen communities not weaken them

Across the UK and beyond is an exciting momentum building that is fundamentally challenging the traditional methods that underpin so many of our public services and our wider economy.

A wave of recent pilots and studies have sprung up throughout the land which are attempting to shift power away from institutions and into the hands of local people and communities.

Some say this is a cynical Big Society 2.0 attempt at masquerading and devolving cuts, whilst others point to decades of practice that is finally becoming more visible. Either way there is definitely something in the water that is being drunk by many commissioners, services and communities that I regularly meet.

Earlier in the year I worked closely with the amazing Patrick Murray of the National Housing Federation in creating a resource for housing associations that showcased how this momentum is building across health, social care and supported housing.

Phrases such as ‘Strengths’ or ‘Asset Based Approaches’ have been circulating for years but are now popping up with increasing regularity in health and social care, becoming a central part of the new Care Act . The recent Five Year Forward NHS strategy also demonstrates just how mainstream this thinking is becoming.

Personally I think more work could be done to radically shake up my own sector, Social Housing, a business model that is totally dependent on the Needs of individuals and their communities. ‘Needs’ as my boss John Wade has so eloquently described in his blog is what our sector thrives on.

Lack of housing supply and other factors have led to the rationalisation of our social housing stock towards the most ‘at need’, leading to the design of housing allocation practices which force people into perverse demonstrations of how needy they are.

For some this has led to communities becoming concentrated with the poorest and most vulnerable in society, exasperating local economies and locking people into a cycle of poverty. Need is real, but when it becomes a central part of a mechanised system it can create Frankenstein services that robs humanity of its colour.

This is a complex narrative with many factors at play, not least a chronic under supply of housing. However a need based system in a world where resources are at a premium is surely ripe for a long overdue dose of disruption?

Our Innovation Lab has taken the challenge of testing whether or not assessing strengths of communities and individuals alongside their needs could become an integral part of how and where we allocate future homes.

This builds on our place based endeavours in Staffordshire with Nurture Development which is encouraging us to pay far greater attention to the micro details of our communities where we build and manage our homes.

Taking into account the strengths of people alongside their needs may also enable a truly personalised approach that can both transform personal circumstances and the communities where individuals live.

As an organisation we are committed to supporting the most vulnerable in society, ensuring everyone has a chance to reach their potential. However fulfilling this objective by purely focusing on the needs and deficits of individuals and communities will only exasperate the situation not strengthen it.

Is it time we made ‘strengths’ an essential part of #ukhousing?

 

Former #ukhousing NED made special advisor to Number 10

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As I’m speaking at the NHF’s conference this week on all things health and housing, I was hoping to upload my musings on the subject this morning. However after last week’s reported rumours of  the ‘re-nationalisation’ or ‘reclassification’ of the sector it’s been difficult to focus on anything else.

Having recently written my last blog on the highly influential think tank, Centre for Social Justice, which has achieved many policy breakthroughs of late, I couldn’t help but notice a new Government appointment this month. CSJ’s now former director Christian Guy has been appointed by #Number10 as a special advisor on welfare and poverty. Yet another political breakthrough by the think tank.

Unsurprisingly the appointment has received few comments in our sector more concerned with whats emanating from the Treasury, but this is a huge coup for fledgling housing associations. Christian was a NED at the HA Yarlington Group and was only recently promoting the sector’s contribution “Housing is our bedrock so One Nation Conservatives should tackle this crisis head on” and  “Housing Associations transform thousands of lives, but we have an image problem.”

The latter quote is from a recent constructive critique of our sector’s ongoing image problem and indicates that we may have a very useful ‘critical friend’ in number 10. Considering Christian’s public views on our sector, I think this shows that there are those in Government that do recognise the value that our sector can create for society and communities. But as Christian has also written, unless we can radically change our image problem across the political divide it may be a value we struggle to create over the coming years.

How can Housing Associations make their own political Break Through?

After a long Blog sabbatical I’m finally back… so here goes

I recently decided to steal a precious moment whilst at home to empty the ‘off limits’ work cabinet. I discovered, as expected, loads of academic waffle I never found the ‘precious moments’ to read.

Right at the bottom of it, beneath various think tank pieces, housing association brochures and many forgotten NHF reports and policy documents, was Ian Duncan Smith. Well not literally Ian, but the report ‘Housing Poverty’ for the 2007-8 series of Break through Britain by his Think Tank the Centre for Social Justice.

I sat down and morbidly flicked through its pages.

The Break through Britain series and the IDS endorsed Think Tank has greatly influenced the way this Government has governed.

The Housing Poverty text was either deplored or ignored at the time in my own sector, but much of its policy ideas have come to fruition. Like it or not Break through Britain has ‘Broken Through’. Here is an extract that sticks out…

“Social housing should continue to be used to meet a great range of needs. However, the period in which a tenant finds themselves in social housing must be used to build aspiration, not stifle it. This can mean that, wherever appropriate, social housing is a step on the property ladder used for shorter periods of time to help people in a crisis or to overcome homelessness. It should be a dynamic resource, playing a part in helping people to get back on their feet either by working their way from social tenancy to private tenancy, then to shared equity and finally outright ownership; or through altering the tenants’ relationship with the state so that they become, not a tenant, but a part owner.”

I think some may have read this and said “well we will weather this waffle for five years and then get Labour back in”. My views were mixed, but the document’s essence I didn’t disagree with.

Over the past few months, depending on your political persuasion, you may have been bathing or basking or perhaps drowning in the aftermath of the election of a Conservative government minus the Libs.

If you work for a housing association you may feel like a rabbit in the head lights right now, bemoaning the recent Channel Four coverage, 1 % decrease in rent, wondering which direction to run in. Some are running south fleeing social housing all together. I sense some deep fault lines emerging in our sector and I suspect my blog may make some explode.

In times like these I find myself switching to reflection mode. It probably seems mad and time wasteful. But we as a sector need to stand still for a moment, understand why we exist and begin to prepare for the reality that may well be working and living under a Con Government for the next 10 years. Our next move counts.

I’ve been wondering if as a sector we’ve played it the right way over the past five years. Clearly our political messaging didn’t get through. More Homes for Britain was a slick campaign, and unarguably did more to raise housing up the political priority ladder. But in its simplicity of arguing for just, well more homes, did it loose the nuances of the debate?

That we need homes is without doubt. But we (social enterprises) want more homes delivered and managed by us social enterprises, that can help people get on in life and reach their true potential. Yes people need a roof, but we believe people need so much more to move on in achieving these aspirations.

Sadly it’s a nuanced debate that probably doesn’t grab the headlines. But debates are not won through a single slick campaign, they are battles of ideas over a sustained period of time.

Whether or not you agree with the Housing Poverty sentiment, its people like the Centre for Social Justice that have successfully influenced how this Government thinks and leads. Its people like Steve Hilton (where George Osbourne recently attended his book launch for More Human) and former policy advisors Phillip Blonde and Danny Kruger that represent the part of the machinery that are open to our thinking and what our sector has to offer.

Danny Kruger in particular has written a thoughtful analysis which few of us in our sector would disagree with. I particularly like his support of an Asset Based Philosophy, an idea that has taken hold in my own organisation and that of many HA’s across the UK, including our partners in adult social care and health.

We have a long road ahead of us, one that could be cut short if we decide to batten down the hatches and refuse to engage Government. Or worse, if we drop our social mission altogether.

Like many in our sector are now saying, we need to break out of our comfort zone and engage a public realm that quite frankly, have no idea what we do or why we do it. We need to think ‘how they think’, however uncomfortable it may make us feel. Ignoring social policy debates, as some are suggesting, will only cause us more harm.

Is it time to rethink how we can ‘Break Through’ into Government and public consciousness, dust ourselves down, and find the friends and allies across the divide that can help us build a case for why we should exist in delivering a better society.

Leading by Stepping back

(Article first featured on the National Housing Federation blog 2015)

Over the past two years I have had the privilege of being a Clore Social Fellow sponsored by the National Housing Federation. The Clore Social Fellowship is a national leadership programme aimed at supporting emerging social sector leaders who are seeking to make long lasting change in their communities. As part of the fellowship you have to undertake a 2-3 month secondment, attend various training opportunities, residencies and conduct a piece of individual research.

It’s been an exciting adventure and one I must thank the Federation, the Clore Fellowship as well as my employer Bromford for enabling me to undertake over the past two years. The area that I decided to research was the emergence of ‘assets’ or ‘strengths’ based working across adult social care, housing and health. It’s a theory and body of work whose time I believe has surely come.

For many in housing, the word ‘assets’ has a completely different meaning altogether. I should know as I used to sit right next to the ‘asset’ management team, and their role was not to unleash people’s potential. Their role was to manage and maintain the ‘asset’s in our housing portfolio, to joe public this means their homes.

Assets and strengths in my paper, are terms that are being used with increasing regularity by many across the respective divides of adult social care and health. An ‘Asset’ through this lens means the gifts and resources that exist in the neighbourhoods that we serve. Assets range from the personal gifts and skills of individuals to local community groups and social enterprises.

With the significantly reduced Supporting People grant, the appearance of the new Care Act, and the rising plight of loneliness in our communities, many local authorities, providers and communities are looking towards the adoption of ‘asset’ or ‘strength based’ approaches that turn the current ‘deficit’ or ‘needs’ based public service culture upside down.

It is a distinct move away from a deficit model where commissioners identify problems and we as providers go about solving them, approaches such as Asset Based Community Development seek to empower local communities to take a greater role in improving and shaping their own communities.

Organisations such as the Foyer Foundation are leading the charge in young people services, challenging the orthodox view of seeing young people in foyers as ‘disadvantaged’, and instead promoting an ‘advantaged view’ where we recognise that young people are full of skills and gift, with our role to help them realise their potential. Bromford, my own organisation, has transformed how it delivers housing and support services by building our services around what communities and individuals inspire to do, as opposed to what we believe they need.

With my own modest paper, I investigate asset based thinking and its application across health, adult social care and housing settings, to understand the different drivers and motivations behind it. But the thinking could transverse the realms of care and support, and could help to influence how we build our homes and regenerate our communities.

My challenge to housing associations, and particularly those that support vulnerable people, is your glass half full or half empty? Do you see your communities and service users as passive recipients of your services for life? Or do you see them as active creators of meaning, both in their own lives and but also in their communities?

This paper will hopefully be of use to housing associations beginning to walk away from the traditional deficit model and to those actively exploring asset based approaches for the first time.

Mrs Moseley and how I discovered the Art of Connecting

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“There is no such thing as strangers, just friends you’ve not met yet!”

To this day I can still remember our neighbour, Mrs Moseley and her ‘lottery tins’ of assorted biscuits. Would she select a lovely, fresh from its packet, custard cream, or would it be ‘the one’? The biscuit time forgot.

Mrs Moseley lived beneath us in a block of flats, opposite Stowe Pool in Lichfield, the year was 1995. Living alone in her exquisitely adorned flat, she would always be scheming with my dad, chatting away, and sailing off to meet friends in the nearby cafes. At ninety she was turbo charged and set out to enjoy every moment life could spare her. As a 11 year old desperate to run around outside in the sunshine, sitting in her living room being fed biscuits was not at the top of my to do list. But it was a duty my dad made clear we would undertake, regardless of my fear of stale biscuits.

She was our neighbour, and I would soon discover, our saviour too.

Later that year, I watched my father from my bedroom window, he was hunched over sitting on a heap of magazines. With his back to me he was carefully stripping each one from their plastic sleeves and dumping them into a skip. Occasionally he would flick through their pages, reminiscing on how he helped to make and produce each one of them, the photos of friends and family who posed for them, the recipes and budget tips he penned himself with our help. My dad was preparing to take thousands of magazines to a nearby recycling centre. The magazine was called Singled Out, the first and I believe last social enterprise magazine specifically designed for and made by single parents.

Founded by my Dad that same year, the Magazine rose to an impressive monthly readership of over 20,000 copies, uniting single parents across the country to challenge the stereotypes of the day and build a community they could be proud of and seek support from.

I couldn’t remember any tears from my dad that day, although he was quiet and thoughtful, he just got on with it. Having published six editions of the magazine over a dizzying and exciting eight months of production, taking his family across the UK and television in the process (in one month we were on the Big Breakfast, Richard and Judy and even Kilroy- good grief), the business began to falter. Having taken the magazine to its limit my dad needed capital to grow it further, and being pre-internet at the time, it depended on expensively communicating via television and radio. Something he just couldn’t afford to do.

So the debts started to accumulate and before long people started to turn up at our door demanding repayments. It was only much later when the words came into fashion, that I realised my Dad was a social entrepreneur and Singled Out was indeed a social enterprise. The repercussions of my Dad’s business dream collapsing, were monumental on the life of him, my sister, my brother and me. He ran the business from our home in Lichfield, in an amazingly spacious three bedroom flat. With little money to pay the rent and huge debts we needed to escape, and fast.

Zig_and_Zag_with_US_flag_on_Tubridy_Tonight,_2008

Looking back it was a surreal time to be growing up. A few months before we were Family of the Week on Big Breakfast, one minute sharing gags with the puppeteers of Zig & Zag (pictured above) and the next minute we were being harassed by debt collectors whilst on the set of the programme. I remember there being an angry red faced man remonstrating with my father and him being pulled away by the ex-Neighbours star Mark Little. Weird times.

Back in Lichfield, beneath our flat, Mrs Moseley was no doubt staring out of her window at my dad too. Mrs Moseley was an elite connector. She knew all and sundry, everyone and their fathers’. Our fall from grace was pretty public to our neighbours, and no doubt Mrs Moseley would have cottoned on to our situation. On hearing the news from my dad after inviting him in for tea, Mrs Moseley did what was instinctual; she phoned a friend she knew in a village just outside Lichfield. An old vicarage with two bedrooms was vacant and needed someone to take care of the church and its grounds.

As soon as the call ended, the plan was actioned, we were to move immediately to the cottage and start our life afresh, somewhere new, somewhere curtesy of Mrs Moseley and her endless web of connections. Of course as an eleven year old I was oblivious to this act of kindness. Mrs Moseley was a 90 year old lonely woman that I associated with stale biscuits and moments away from the sun. This was an act I would only learn about in later life, but Mrs Moseley was the chance bridge that helped my dad and us through a troubled and perilous time. She was not passive, vulnerable and isolated. . She was fiery, kind and connected…

My Dad and Mrs Moseley were natural connectors, and made a bond that would prove critical in our times of difficulty. Someone would argue that people like my dad or Mrs Moseley were blessed with the social skills and connections of a more affluent society. I’ve never believed this. The best connectors I know have the fewest material resources to connect with. They connect to survive, and find whatever resource to do so. That’s what my dad did. Mrs Moseley lived in a posh flat, but she honed her connecting skills during a time of war and poverty, when connecting was her only survival skill.

Having joined Bromford 18 months ago I was rekindled with the City of Lichfield and these memories. I hadn’t returned for almost ten years, shunning it for the furthest points in the map I could find. But indeed I returned and on doing so I’ve been able to contribute something back to the City I grew up in.

With the help of a few connections and friends that I have made since joining Bromford plus the support of the Clore Social Fellowship, I have helped to kick start a number of initiatives that hope to mobilise the natural connections that exist in every community, finding the numerous hidden Mrs Moseleys.

In partnership with a host of local organisations, we will be seeking to work with local ‘community connectors’ to grow hospitable and welcoming communities in Lichfield. We will be learning from the likes of the excellent community builders Nurture Development, playing close attention to the pioneering work of the Asset Based Community Development Institute in America, three decades of community building from around the world.

As I have discovered in my own life, everyone has a story to tell, everyone has strengths beneath the conceptions that you have of them. But if you’re curious enough, you may just find that the answers you’ve always been looking for are there, often right beside you.