Having recently returned home to England from a nine-year stint across the pond, I've spent the last few months reading articles, asking questions and drawing diagrams. Earnestly I've been trying, and more often failing, to get my head round the various NHS organisations and how their remits intertwine and overlap as they desperately strive to work together to provide and improve health and care across England.
My first observation is that it's complicated, so complicated in fact that at times I've found myself scratching my head and repeatedly muttering to myself one of President Trump's most astute and truest statements, 'Who knew healthcare could be so complicated?'
Most of us would agree that we are facing a period of great economic and political uncertainty – and at a time when the NHS is under increasing demand and pressure.
We have to work in radically different ways to meet the challenges facing the health service - as the NHS Five Year Forward View and the Next Steps on the NHS Five Year Forward View made clear - and a key part of this is breaking down organisational barriers and joining up our efforts in a multi-agency health and care economy.
Networks and their leaders are a critical vehicle for achieving the changes that are needed across health and care – they sit at the heart of great leadership and large scale change. Networks have the potential to revolutionise the way care is delivered.
There are lots of different styles of clinical leadership, for example transactional, transformational or situational. There are also lots of roles undertaken by clinical leaders, such as medical director, chief clinical information officer or chief nurse at a clinical commissioning group. Sustainability and transformation plans are gaining pace, talk of accountable care systems is rising from murmurings in policy circles to organisations outside of those circles and clinical commissioning groups are merging. These are all signs that 'places' are getting bigger but also that the definition of where 'places' are is becoming more fluid and therefore less predictable.
The joy I had in my work in the 1980s caused me to create Buurtzorg in 2007. We now employ 14,000 people in Holland, and are expanding across the world – including in the UK. The government came to play an important part in our growth in Holland, but not by accident.
In the 1980s, I was a nurse, it was my vocation, but it was also very creative and exciting. Every morning you didn't know what you could expect from the day, and every weekend we’d sit down and discuss the difficult things, learn from each other, and find solutions for the problems we met in our daily work.
Kaleidoscope has just reached its second birthday. Throw confetti, chow down on some cake or create a cotton masterpiece – any and all forms of celebration welcome.
Now that we’re the wise old age of two, we’ve started to ask ourselves the serious questions. Can we still call ourselves a start-up? When do we become just an ‘up’? As a former (or possibly still present) start-up, have we really drunk enough hipster coffee or tried our hardest to work a man bun?
Are you the same person at work as you are at home? Some? A bit perhaps? This might matter to you immensely, or not at all, but almost all of us would see there being some difference between how we think personally and professionally.
Sometimes this is helpful (not everyone needs to know about your Panini sticker fascination), but sometimes it’s not. The annual NHS Providers conference is an extravaganza of the complexity of healthcare policy. Critiques of control totals, tinkerings with tariffs, and processes to produce plans abound. This is peak-profession conversation (I don’t know how your household runs, but it probably doesn’t have much room for marginal rate emergency rules).
The world is increasingly dichotomous, issues and solutions are presented and processed as either black or white. The divide between competing ideologies is widening and the grey area is shrinking as people cling firmly to the right or left.
However, dissemination of research is universally promoted, clung to and agreed upon as vital to policy, practice and all users of research. We also seem to agree unanimously that bridging this gap between health research producers and users is hard. We agree on the importance of producers and users uniting in this endeavor and that cross-disciplinary discussion catalyses unification, but the struggle of actually doing this is real and felt equally by all sides. Why can’t we overcome this impasse?
What if we’ve been going about it all wrong all along?
Language is a crucial marker of tribal identity. Both ethnic and professional tribes use language to recognise members of their own tribe and to exclude members of other tribes. Two ethnically related tribes may be distinguished by their use of different languages, but in other cases the linguistic differences may be subtle.
Small but significant linguistic markers of identity are known as shibboleths, after the Old Testament story in which the pronunciation of this word was used to identify members of an 'out-group.'
Where two tribes share a genuinely common language, tribal politics may encourage the creation of artificial shibboleths. Serbs and Croatians share what used to be a common language, but Serbs chose to write it using the Cyrillic (Russian) alphabet while Croatians adopted the Latin script. Over time, small differences in usage have evolved.
Someone somewhere once said you can't teach an old dog new tricks. But who said anything about new tricks?
I recently had the immense pleasure of visiting my family in Australia. I'll admit, it's a familiar route for me, but this time was different; I was on a mission. I had arranged that while I was in Melbourne I would film my Grandpa for a TEDxNHS talk. He is quite something. Old Jewish Grandparents are supposed to bore their friends kvelling over their average to over-achieving grandchildren but the tables have most definitely turned in this case.