Transition Network Annual Conference

I'm at the annual transition movement (UK) conference this weekend at Hope University, Liverpool. I'm going to try to keep a blog over the weekend - see my first blog:

Friday afternoon - Transition northwest meet-up

I arrived in the rain at Hope University for the northwest meet-up.  A bit late, everyone’s in a circle introducing themselves (approx 25 people). Michelle, the only person who would volunteer to organise such an event(!) suggested we have a few small group discussions (world cafe style). We started off talking about what was going well in our different groups. Lots of inspiring stories, including Lancaster who are setting up a community interest company to manage finance and employment, and Bolton who have just had a meeting, co-organised with the local college where 22 local organisations joined in. They made cards with words such as energy, food... and asked each group to take cards which were appropriate to their activities – then used these as conversation starters in small groups – a great way of engaging diverse groups and starting conversations. Another great example from Bolton was a kitchen in a high street shop. They had received lottery funding, and were located between veg shops – it regularly attracts a multi-cultural group – Somali, w. Indian, Pakistani.

We then moved into new groups to meet new people and discussed problems/challenges and other issues. Some groups had experienced difficulty communication with councils – eg one of us felt that their council were coming to realise that some of their economic plans aren’t going to work out. The economy isn’t going to recover the way it was. Also councillors had strong business interests; prioritising roads, supermarkets, football...

Other groups had positive reports about the council. Lancaster has several Green Party councillors and these are supportive of transition projects. At my local Transition Village Eastham and Bromborough two of our local councillors are regular attenders at meetings. Talking about meetings – this was another problem. Too many people are put off at the prospect of 2hr meetings, particularly when you consider the ratio of meeting time to activity ‘doing things’ time (sometimes more than 1:1).  It was suggested that activities could include talk, for example at a community orchard, talking could be done whilst working on the trees.

I was asking others how to really get our community projects out into ‘community’. We have received funding for a small healthy food growing project (from council and housing association). So we’re keen on getting going and getting people involved – and due to the funding we need to get this done and evaluated! This need to get things done and have visible outcomes came up a few times too. Several people suggested that slow and gradual was better than fast and burning-out. That maybe if nothing seems to be happening, it may still be smouldering under the surface. However this doesn’t usually fit with funding routes... but maybe we should also be challenging the status quo of funding structures...?

Final discussions were about links with other groups – virtual networks or real networks... There was no consensus on twitter, facebook, ning or googlegroups, so we ended up with the usual email list on a piece of paper... Although we did all say we’d try to get onto the northwesttransition.ning.com site.

We all agreed that we would like to continue the conversations, with future visits to exciting projects, and networks. We’d like to continue discussions around advice and guidance, and highlight stuff that’s working. There was a concern about burn-out and advice to be confident about asking for help.

Thanks to Michelle for organising and Dinah for tea and coffee, then we quickly dispersed to go and register for the conference!

Working together for a stronger NHS

Modernisation of Health and Care (Dept of Health). This is not consultation part 2 - the reorganisation has already started with redundancies ('frontline' as well as 'managers') and 'clustering' of PCT's. This is PR, but merely for the record, a few things from the flash new 'leaflet':
'No change is not an option' (not because the country is in debt, but because of pensioners etc). Why did Cameron say no more top-down reorganisations then - what's changed?

I haven't read the whole thing, but I've searched for a few keywords, which I think are important qualities of a health service. I haven't managed to find the following words: quality, sustainable, waiting, accountable, value, reliable, resilient, transparency, equality (or inequality).
I did manage to find: personal (as in budgets, not care), morale (bureaucracy bad for..., not reorganisation bad for...)

Equality, Health and Climate Change.

Great interview with Naomi Klein by Rob Hopkins at her recent visit to Transition Town Totnes.

Talking about several of the issues discussed at a recent Crisis Network conference on violence and climate change. Within our discussion group I asked whether it was useful to link all these ‘social objectives’ like equality, justice, and health to climate change. Is this strategy ‘greater than the sum of the parts’ or bring each down to the ‘lowest common denominator’ i.e. if our critics find a angle to argue against for the climate change debate, does that bring the social justice down as well? Will the critics presume that we are using climate change for our left-wing causes, thus providing another reason for them to be distracted from the issue?

"Maybe it did work, but like I said, the whole discourse on the right is about how climate change is a socialist plot to bring in world government and redistribution of wealth!  That’s the discussion that’s going on.  We’re not in any way responding to it and laying out a world view and saying, “yeah, we do believe in internationalism and here’s why.  We do believe in redistribution of wealth and here’s why we do think it will benefit your community and the vast majority of people on this planet and here’s why we don’t have to be afraid of it.”  Naomi Klein by Rob Hopkins

I guess I'm trying to look at this from a local perspective. If these arguments can work globally why can't they work nationally or locally? This is my argument for linking health inequality with climate change in Liverpool and Wirral. We have great social inequalities just within Merseyside. So we need to lay out a new world view - one that is Equal, Green and Well (Sarah Dewar, 2020 Decade of Health and Wellbeing). Can this start from communities fighting to maintain services and infrastructure and work upwards (as opposed to waiting indefinitely for that trickle to come down?) Completely different to Totnes but with a similar history of radicalism (see City of Radicals, hosted by Liverpool City Council in a completely ironic way...), could Liverpool be the place to develop this new world vision? As the annual Transition Network conference is heading this way in summer (8-11 July)- it could just happen!

Prof. John Ashton and Maggi Morris:‘The future of Public Health in England’

My notes from a recent Duncan Society event ‘The future of Public Health in England’

Professor John Ashton, Director of Public Health and County Medical Officer – Cumbria and Chair of United Kingdom Public Health Association (UKPHA)

Maggi Morris, Director of Public Health at NHS Central Lancashire

Venue: Quaker (Friends) Meeting House, Liverpool

(NB these are my notes, not a complete transcript and should not be used for navigational purposes)

Neil’s summary: The main message was that we're going back to a similar arrangement to the past. But with modifications which may yet prove successful. Although big society is nothing new, Maggi suggested that this could encourage development of asset based community development (Chicago-style). John was enthusiastic about Health and Wellbeing boards harking back to Chadwicks original idea, which never got off the ground.

I thought an interesting point that John made was that this may be successful even if not all GPs want to be leaders and budget-holders etc. All it needs is a minority of keen and 'progressive' GPs to take on that role and this peer-leadership structure may be respected by the majority of GPs. i.e. it may be a more effective way of engaging GP's than the PCT arrangement (On the other hand they may turn into way-overpaid managers!) Maggi suggested this may be a way of encouraging GPs to focus more on prevention - and highlighted Sokrates course at LJMU that she developed with Mary Lyons - where they were able to support GP's to do PH training with locum provision to give them enough time to do some service reorganisation towards PH.

My interpretation is that spirit of all this is:

let's make the best of a bad job and

with a little luck we may be able to get some extra gains out of this.

JA

Bit of organisational history:

In 60’s and 70’s: 5000-6000 people under medical director in council

                This generated silos as people wanted their own space

then same people moved to PCT

Important to include all social and health practitioners within PH

even RSPCA officer can have PH role – also important for health and social

Inbalance in remuneration: Newlands (engineer), £800, Duncan (medical officer) £300, Fresh (nuisances) £150pa

Sanitation – separating human / animal waste from drinking water and food

                founding (and organising) principle in development of PH

                maybe this needs to change now

What good things could come out of restructure:

John thought that Health Action Zones might be start of board of health.

Chadwick started this, but only lasted a few yrs

                Could board of health and wellbeing be what we’ve been aspiring to?

Link between poverty and illhealth – almost a litany – rehearsed almost without meaning

lifecycle approach is good

                can’t get rid of poverty, but can minimise impact of poverty

Bismark – took action to increase equality – started welfare benefits

John’s previous TV documentary in Weller St in Dingle, for healthy cities - interview with Kitty – her idea of health‘a nice house, some food for the kids and a bit of money in my pocket’.

Lack of ‘ownership’ of programmes  –

 noticed refurbishment of social housing every few years as tenants didn’t feel commitment to neighbourhood

Reframe the 5 giants

                marmot’s 6

problem is high level of abstraction – but the mood music is welcome

minimum wage moved on to liveable wage

John (UKPHA) calls for fundamental change to energy fee structures to tackle fuel poverty

                standard charge – everyone pays

                first 1000 most expensive

                so poor pay more, relatively

                many excess winter death due to keeping one room warm downstairs

                need to change to progressive charges

                also added benefit of sustainability

Ownership and locus of control – paternalism no longer fit for purpose

                need to engage with this discussion – big society etc

Whether a slimmer public sector rolling back the state Tea party style

                or transforming to an enabling, supporting, active citizenship,

NHS started as tripartite system, hospitals community and local govnmt

                future:  GP/hospitals (some PH), PHE – programmes, dPH wellbeing agenda (local govnt)

                i.e. PHE sitting between GP and local government

dPH and wellbeing board may have to take a semaphore stance –

pulled in two directions – one arm up - accountable to minister, one arm sideways – accountable to local government.

local board of H&W – representation of GPs

                local authority sponsors

postmodern formula, fragmenting and trying to bring together again.

                interdepartmental parliamentary committee at top – but how effective can this be?

Maggi Morris

Civic society inversely proportional to inequality

immunisation discussion – responsibility and control will be within health and wellbeing board

COPC – community orientated primary care – comprehensive engagement

                GPs resistant to this idea at the mo. due to case load and business model

Sokrates programme (LJMU) started to get GPs onto the programme with locum cover, to enable them to reorganise their services to improve prevention

Smokefree Liverpool, Manchester and other boroughs bottom-up approach – experts came in when necessary

Q&A

NC – Maggi made an interesting point about immunisation decisions being made locally? I’ve done a bit of an analysis of the PH white paper and for every statement about localisation there is another statement on centralisation. The policy states it’s aim is localisation but do you think this is likely to happen?

JA – similar to comments on dPH being pulled in two directions – there are conflicts

                described arrangement as in three columns and two (or three) rows

columns (accountability from minister): Public Health England, Health and Wellbeing Boards, and GP consortia

rows cross-cutting work locally – mainly through H&W board, cross-cutting in government, will there be some regional working as well (not called regional though!)

Question  – return of old system?

JA - likely to see return of regional hospital board – health commissioning board – subnational or supralocal

JA - GPs become deskilled in cities – because they can just send them up the road to the consultant       no change since Acheson

                partly what Darzi reportt about

Question – at a mental health meeting there were concerns for champions for community engagement

                4 GP seriously interested in mental health – only one of which attended meeting

                patchy interest of GPs?

JA – JSNA will have to be delivered by consortia – held to account by H&W board

White paper: ‘GP consortia and LA equal and explicit obligation to prepare JSNA through H&W board’

at the moment the biggest variation in service is in general practice

                but these changes may be transformed if GPs take leadership from their peers who are keen to develop leadership

                needs can’t be met in ‘hospital style’ approach which we have at the moment

 need radically different – primary care approach

MM – Asset Based community Development (ABCD) – in US,  

often in impoverished neighbourhoods

                idea of developing resilience

Marmot – and white paper – communities that lack aspiration are hit hardest

                and lower life expectancy etc

JA – economic decline of West relatively – rebalancing of global power

                even more important that social institutions are strong

                insist on value for money from public service

MM - Margaret Mead – “history is not a pendulum – it’s a helix”

MM – should publish GP wages and all add-ons

A couple of interesting references:
Local Government Association 'The Health of the Public'
King's Fund, Chris Ham's blog 'Ten Questions to ask about the Health and Social Care Bill'