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SoWhoCaresAnyWay E17 Start with what's strong, not wrong · SoWhoCaresAnyway

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Hello and welcome to So Who Cares Anyway, the podcast that shares learning, innovation and ideas from the world of health and social care and beyond.
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My name is Ruth Germain and I'm inviting you to join me each week with my inspirational guests to hear about who cares.
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What they do, their passions, their knowledge and ideas, and importantly, the difference they are making to improve the health and wellbeing of people in our communities.
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I consider each of my guests to be incredible individuals working with people in new ways or with key messages to share.
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People from healthcare, social care, the voluntary sector, community groups, and more.
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To join me each week to find out, so who cares.
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Anyway, to find out more about me, who I am and what I do, please head over to my website, www.reflectiveruthconsultancy.com,
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where you can also catch up with previous episodes and read my blogs.
Hello and welcome to this next episode of So Who Cares.
Anyway, today I am delighted to be joined by Cormack Russell.
I first saw Mack's posts on LinkedIn when I started to link in with Adam, lent around the Do with Movement, and was really interested in hearing what I.
Cormack was writing about the asset-based community development work that he's doing with the European directive of asset-based community development.
I think I've said that right, Cormack.
So I'm gonna pass over to you to perhaps introduce yourself a little bit more and hopefully a little bit better than I have just done.
And then we are going to talk about that a bit further.
That's great, Ruth.
Thank you for that introduction.
So.
It's great to be with you and I love what you do.
It's really important work, so thank you for firstly having me on and the opportunity to have a fireside chat together.
You're welcome.
I think in plain speak, what I do, get rid of all the jargon for a second because acid-based community development is really just jargon for starting with what's strong and local in people's lives.
And one of the challenges a lot of the time is that we often think about health as though it were just healthcare and health is so much broader than healthcare.
So I'm coming.
My own view on things is that I'm coming to genuinely believe that you can't be healthy and experience wellbeing outside the context of the community, however defined.
I know there's lots.
And lots of definitions.
And one of the challenges is so much of modern life is about consumerism and products and professionalism.
And so to end up with is a story and the stories that my health is in the hospital and in the hands of a doctor or a clinician.
And I think the difficulty with that is as well, it's partly true, maybe 15% true.
It's not the whole truth.
And so I think what we end up with is really burning out actually a lot of healers and practitioners and people who are dedicated to healthcare provision and also in a way blocking from view what I think people would've known quite clearly in the past.
That my connections, the strength of my community, the strength of my local economy.
The quality of my environment.
These are all really important markers and factors in, uh, being well, having a good life.
There's lots of different ways of describing this.
So my work is very much in that space.
How do I support not just communities, so local places and community, people who care effectively, but also professionals and institutions.
So I work with a lot of around the world hospitals and.
The local governments and central governments in different countries trying to figure out how do we get a better alignment between our institutions and communities.
Just one final thing on this.
It's really striking me that at the very moment that generally speaking, the level of trust in our institutions is at an all time low.
Yeah.
Particularly post.
Right.
And yet our expectations and demands on institutions are at an all time high.
And clearly that's a, an alignment issue that the relationship between community and institutions needs to be better.
And my work is to get alongside those conversations and help with that alignment problem.
So already you've got me absolutely fascinated, and I've been, as you know, I've been reading your book, rekindling Democracy, but actually what it's talking about is a lot of what you've spoken about here, and you've talked about some of the work that you are doing.
One of the things that you talked about before, you've mentioned how you work with hospitals, but also community and government.
So you seem to work at a number of levels, and I'm just wondering.
Um, if you perhaps might describe some of that work, but also I suppose what I would really be interested in is how did you get into this line of work? So what drove you here in the first place? So perhaps that's my first question.
What drove you to this type of work and working? The really early motivation to do something useful with my time and my life and growing up in rural Ireland, I think community was a big part of just natural life.
And so when I first.
Started professionally working.
I started working with, this was back in the nineties with the Irish Health Board at that time, as it's now known as the Health Service executive, HSE in Ireland.
And I was working very much at the interface between.
Historically, what would've been the shutting down of a lot of institutions that were run by religious orders.
And in many respects, these were institutions that were now aware, really are a stain on the Irish psyche In terms of the harm, yeah.
That was being, uh, in these places.
So the state was coming to a reckoning in a sense that we needed to move into another model of.
Community care, if you like.
And so very early on that was something I was interested in, but something I also realized that while we were removing children from very, very problematic and quite dangerous situations where their welfare was completely compromised, I.
Into what we were calling community care.
So they were moved into local neighborhoods in effect.
So instead of this very classic kind of big weeping gray building where 80 to a hundred to sometimes more children were put, we were really trying to do the work of giving children a normal experience, but it was still a residential.
Context.
So while we would rent homes in neighborhoods, try to keep siblings together and so on and so forth, it still really struck me that what we could never do was build a relationship between the actual community there and the kids.
We, it's not that we couldn't do it, but we weren't set up to do it.
So a lot of how we were approaching things was very siloed.
So many of our team were social workers or had clinical backgrounds, but they had no community development experience.
So while we had rented or bought premises houses, in effect, in neighborhoods, we had done none of the building work, the trust building work in the neighborhoods to actually make it possible for connection.
And that really, really struck home.
So very, very early on, I thought, boy, we're missing a trick here.
Uh, this seems so important.
We've taken these kids out of their family context, out of their community context.
We've got to do more to build the bridges with family, with kin, and with community.
So that really became a very strong passion for me, and I realized we needed better ways of thinking about this.
So I was very fortunate to have the space to actually go and look at different, uh, approaches.
And one of the places I went to was Chicago and I met up with somebody who eventually became a friend over the last 30 years, and he just died at the age of 92 last November.
John McKnight, professor John McKnight is his name and what I saw.
In his work was somebody who was actually doing the community building that we weren't.
He was building the bridges between family, between communities, and between folks that were really, really struggling in all kinds of different ways and very tricky circumstances.
So I thought, well, this is what I want to do.
This is the way I want to work.
And so I left the port on good terms, but it just, I recognized that wasn't something that was going to allow me just learn how to do this work well, and I did that in 1995.
I.
And I set up nurture development as a social enterprise, which still continues now in 1996.
And really the adventure has just been unfolding ever since, in the sense that as I learned the craft and really started getting clarity around how to do it well.
Uh, and then eventually becoming a trainer and whatever.
Um, my work is now getting alongside people who back in the nineties were like me, because I often look back and think what would have been helpful or useful to somebody like me is that writing a letter to your younger self kind of thing and having a wayfinder, having somebody.
Who has walked the path a little bit ahead and is willing to sh not just share insights, but actually also listen and unpack the dilemmas.
So we've been very, very fortunate to do that across 38 countries now.
But it started from very modest.
Um.
Humble impulses really, and curiosity.
And I've just been following my nose ever since.
Yeah.
And you say humble and impulses, but that curiosity, it came from a fact of a certain passion that drive to make a difference, seeing this isn't working and um, yeah, I started nursing in.
85, so quite some time ago.
But I was aware quite early on that actually some of the things I wasn't doing.
I can remember having a conversation with my grandmother saying some of the things I'm doing.
I know that they're not gonna quite make a difference when people go home 'cause it was very much hospital care there, but I didn't quite know what to do about it.
But somehow you, then you moved yourself to that space to start to make a difference.
So.
Yeah, I admire that, that you've done that.
So I wonder if maybe for people listening it might be useful and for myself included, to have a picture of perhaps something that you do or that you've done a particular piece of work that will really illustrate to us what.
Asset-based community development is about why it matters and then give that bigger impact as well.
What's maybe helpful then, as I share some examples, is some of how you see your community playing out is very, very local.
It's where you live, it's close to your own doorstep, which is of course hugely important 'cause that's where you really feel things.
As you said, Ruth, it's about passion and some of the work.
Is not so easy to see.
So a lot of citizens might not necessarily notice the impact of the work because it's more within the system and it's about trying to help people in hospitals or local governments think of it differently.
So a good example of the two, right? The micro, very local and the macro, which is more institutional, strategic stuff.
Would be leads.
So LEED city council back, I think around about 2013, really started talking about adult social care in a much more community centered way, and a less kind of institutionally focused way.
So what they wanted to really do is to say like, okay, it's important to work with individuals and support them, but it's also important that those individuals.
Have strong communities around them, experience, belonging, and also can add value to those communities.
So how do you do that? So in leads, and I can't claim anything, all I'm really doing is just being a sounding board.
So I'm not an important part of this.
So this isn't about my work, it's about their work really.
Okay.
But what I would say is that their work was very much about, first of all, reimagining.
Reimagining what they understood public service to be, whether it's social care.
And interestingly in Leeds, they, they were able to get outta the silo of social care and they talk about health and social care, which is very sensible, I think, because the two are so connected.
So when they were thinking about, look, how can we be useful to older people, and especially older people who are lonely? A lot of what they came to was, well, a lot of people experience loneliness and aging somewhere if they're not in a, a residential context, they're living somewhere.
And so they, today, for example, this is many years on now, but they have community builders in neighborhoods and the job of the community builder is to help that neighborhood to connect again, to make sure that people who are at the edge.
Of that neighborhood are able to contribute.
And it's not that we're saying, well, we're going to find lonely people and do something to them and for them in a kind of a rescue sort of way.
But it's much more about empathy than sympathy.
It's about saying actually a lot of people who are isolated in our neighborhood have a lot to offer and we need to figure out how we can support those gifts.
To be contributed.
So an example of this would be in one neighborhood.
A gentleman by the name of Robin had become very isolated and lonely.
Uh, his wife had died a little while previous to, at the start of the story as I'm telling it.
So he was quite depressed.
He was grieving and had become quite socially isolated.
Interestingly, he used to be somebody who was very, very active, very engaged.
He previously worked for.
Local government.
He was actually working in the parks department of LEED city council.
But anyway, for various reasons, as can often happen, can happen to any of us.
Really.
He became isolated and one of the things he was doing was he was going to a luncheon club to get food because he wasn't cooking in the house anymore.
And one of the people that was working there had been trained in asset-based community development, which as I said earlier, is, well, maybe let me tell you the story and I think it will explain itself.
Okay.
One of the things that you're trained in A, B, C, D is to ask different questions.
So what this community builder was noticing, it was nearly all of the professionals were focused on Robin's needs and deficits.
His sadness, his social isolation, and so they had lots of categories.
He's lonely, he's depressed, he needs counseling, he needs bereavement, therapy, whatever it might be.
I.
And that's all true.
Of course, I'm not minimizing that.
But the value add that the community builder brought was, she started asking the question you asked me earlier, Ruth, which is, what are your passions? What passion drove you here? Or what were some of your passions in the past? And through that process, Robin shared that he was passionate about carving, walking, so whittling, essentially carving fallen branches.
Sticks, et cetera.
And so that began a little bit of an adventure where ultimately the community builder supports.
She doesn't anymore, but she supported Robin to become a leader of a group that he runs himself.
People of all age groups who share a passion.
Around Whitting.
So the car could be carving walking sticks for people locally.
They could be doing something else.
It doesn't really matter, but it's a group of people with a shared passion.
So it's not a group of labeled people.
This isn't the convening of a group of lonely people that we feel sorry for.
This is a group of local people that are deeply gifted, share a passion, and are actually doing and making things.
That they can then share with their community.
Now, I think the great value in that story is that it's a story about taking somebody who could have been defined as a problem to be fixed in an institution, and ensuring that they're defined as a gifted person actively.
Alive, even contributing and interacting in their own community.
So that's happening in 17 neighborhoods in Leeds at the moment and at the macro level, I think also what we're seeing is just a lot of great public servants thinking differently about helping.
I.
Thinking differently about how they can help.
So really asking community first questions.
Is there a community solution to this problem before we start institutionalizing somebody or before we start moving into a clinical intervention, might there be a non-medical way of supporting this person? Of course, if they need medical intervention.
They should get that.
That's not the point being made here.
It's not a binary argument.
It's a both end argument.
Can we make sure that as well as people getting the services that they require, that they can also have that associational life? I worked with somebody once who very wisely said that people die twice first socially and then clinically.
Wow.
And so we do more with the social 'cause I think we're quite good with the clinical.
Yes, and I think that's a fascinating story, just turning that around.
Completely.
I done my nurse training in the days where people were sent to an institution and I was one of the last people to do part of my nurse training in that mental health institution.
And people were sent in and I can remember thinking, gosh, why are they here? Because they need to be with their family.
They need to be with their friends and people they care for.
But absolutely what you were talking about earlier is those institutions, and I'm going back a bit in your conversations, were closed down.
Because we all said we shouldn't have these big mental health institutions and write the show.
So, but those people were then putting into communities where they weren't actually accepted and there wasn't that link for those people.
But what you're talking about here is just looking at a person and going up to them and saying, well, what are you passionate about? What, what is it that drives you or motivates you in in your life? And maybe that's not happening now.
And how can I.
How can we support you to do that? So, and there's a massive thing that's come from that because the knock on effect of that question isn't just that one person, but in actual fact, he's then developed a group that it may be having knock on effect so much wider.
Yeah, completely.
And when you look at health from a strength-based perspective, what's strong not wrong? Say here is somebody who has lots to contribute.
So you're not having to send him off to get him training or to get him volunteering.
He's naturally doing this, but he's disconnected.
So he has a gift to give, but he has no way of getting that gift received.
I.
And so the value, the healing, I don't even know how to find language that convey this because it's so powerful when you see it happen.
But the transformative nature of somebody who doesn't have a valued social role in a neighborhood regaining a valued social role is incredibly important to their mental health and their physical health.
And it can create all kinds of outcomes that we simply cannot provide.
Through classic service provision or intervention or even prevention.
It's really interesting.
I mean, an awful lot of how we talk about prevention today is about preventing illness or preventing falls.
All very, very important, but it's still in the sickness paradigm.
I.
We're preventing sickness, that's fine.
But what are we trying to create? So that this question of we're trying to create joy, we're trying to create freedom, we're trying to create liberty, dignity of choice.
Dignity of risk as well.
And one of the things that many of our institutions do very well is they protect us, especially when we're vulnerable.
But the difficulty is that sometimes in the very act of protecting, we're actually isolating people.
And so one of the things, just to go back to the origin story, uh, that I shared, uh, in my own vocational journey, one of the things I really realized was you can take people outta big institutions and put them in neighborhoods, but actually all you're doing.
It's taking them from a big institution and putting them into a smaller institution, unless there's community there.
So calling it community care is just putting a bandaid over the actual problem.
And the actual problem is there isn't community and there isn't organic care there yet.
So the question becomes how not, how do we provide that? Because the irony.
Of certainly the work I do and what I've learned over life and time is that you can't provide community to somebody.
It's a bit like you can't provide love to somebody as a service.
Just can't.
It's something they have to discover and it's a journey only they can take.
Nobody can take it for them.
But what we can do is we can create the conditions and if you think about what district nurses did years ago, if you think about what Patch social workers did years ago, or beat bodies or vicars, a lot of what they were doing aside from the day job was connecting people.
Keeping people out of institutions if they could and giving them ways of actually being valued, ways of staying well and staying connected.
So it doesn't solve all problems, but it is foundational to what a good life looks like.
And my worry, Ruth, is that we've gotten to a stage where the story has become, my health is in the hands of.
A doctor or in the domain of a hospital.
My child's education and learning is in the domain of the classroom and in the quality of teacher training or head teacher leadership.
And my safety is in the response time of police.
And I think those stories are alluring because nearly everybody seems to think this way, but they're simply not true.
You know, so if you look at what determines our health and wellbeing, 85% of it has nothing at all got to do with medicine or with the NHS.
Yeah.
And yet, 85% of the investment in health is going into the NHS.
And so.
There's shifts in this.
Of course, we are now beginning to go, we really need to think about personalization, so really respecting the person.
But I think the next frontier, and we're moving there slowly away from medicalizing to socializing.
The next frontier is seeing neighborhoods as health creating.
And not just seeing the doctors having a monopoly or the nurse, uh, or clinician as having a monopoly on creating health because I don't think they do like Ni Nigel Crisp's book.
What is it? He Health is in Community Hospitals Patch you up or Hospitals are patching you up.
I think his title of his book, I should check actually make sure I get the reference right, but we can put it in the speaker notes.
Sir, we can.
In the Indeed Past, but it's a wonderful book because I think he rightly, and of course he's somebody with a lot of authority because he used to be head of NHS England for a while and he says, look, at the end of the day, hospitals don't make you healthy.
They can patch you up when you're sick, but what makes you healthy is your family, your community, your sense of.
Purpose and your sense of agency, your sense of flourishing in life, and I, I really like that.
I think that's an important reframing.
So moving away from this framing of sickness versus health to languishing versus flourishing.
Are we flourishing? If we're flourishing? There's people I know in my friendship circle, there are people who are profoundly medically sick.
And sadly, they're at end of life, or they have complexity in, they're living with a condition, it's not going to go anywhere.
But boy, they're flourishing.
They're full of life.
They're full of full purpose.
And so there's this great irony that we can be well and languish.
So we can be physically healthy, you know, by all of the measures and all of the indicators.
So our vital signs say healthy.
But our, the rest of us says me.
It's languishing.
Life is not good.
And actually it's frightening the number of young people that are fitting that category.
BBC did a survey of 50,000 people across the UK around loneliness and asked them questions about loneliness.
And often I think people think the loneliest people in the UK are older people.
Well, based on this survey, they'd be wrong.
It was actually younger people.
So I think loneliness is the a real indicator.
It's the canary in the coal mine that says we need to do more to build our communities.
It's not something that we will fix with therapy.
Loneliness needs community nuts.
More institutional interventions, therefore a different thing.
Hospitals patches up therapy.
I'm doing a conversation next week, a podcast your listeners may be interested in at four o'clock on the 14th of May.
So next, whatever.
I think that's next Wednesday, and I'm speaking to a child psychologist, Dr.
Bruce Perry, and he puts it very.
Powerfully.
He says that if you are on a journey with your mental health in terms of recovery, please understand that you will not heal at four o'clock on a Thursday afternoon in a therapist's office.
That your healing that helps, but your healing actually happens within the context of a community.
And it's all of the various, almost unscripted, unrehearsed moments of care and.
Conviviality and randomness.
So when we see things like a local rugby club, here's that Older people are afraid to go out after dark in their neighborhood where their club is.
They go and they knock on the door.
They talk to those older people say, what can we do? This isn't okay.
This is your neighborhood too.
You should be able to go out.
You should be able to go to Bingo or go to the shops after dark.
We need to do something about this.
So it's really interesting when crime is the key issue, police become the key actors.
But in that instance, the police weren't the key actors.
It was neighbors were the key actors, and the rugby club talked with older people, not as a problem to be fixed, but how do we do something together to make sure our neighborhood does feel safe after dark? And what they agreed was that the rugby club would run tag rugby evenings on a Tuesday and a Thursday actually in the estate.
On the streets and invite older people to make tea, come out, turn on the lights, cheer on the kids, and after the tag rugby training was over.
The club would escort the, their older neighbors to wherever they needed to go.
So really reclaiming the streets in a non-violent, non-aggressive way.
And what was really interesting is many of the people who you know would've been labeled as antisocial, were being recruited around the edges.
To also come in and play their part.
So this wasn't about let's alienate the bad guys and No, it was about let's, this is your community too, right? And why would you not want it to be a place of safety for older people? And you can contribute to that.
So, okay.
You may be.
Identifying as a gang member, you may be identifying a street involved or whatever.
You can be involved here and you can build relationships, and those relationships will make a difference to you too and to the kids.
So it wasn't an act of charity, it was an act of reciprocity.
But this is an example of what I'm talking about.
Now you speak to the police officers who.
Police in that neighborhood and they'll say it is a pleasure to police there because it's co-produced.
Safety is co-created with the neighbors and with the police.
The police can't do it all.
Of course they can't.
Um, but nor is it a good message to send to community that your role in creating safety is simply to call the police.
No, it's not.
Well, these rugby guys understood that they could play another more creative role and that they could be producers of safety.
And I think that's a really important insight because what it says is that communities have functions too, right? We often think doctor has a function, hospital has a function, police officers have functions.
Well, what? What's the function of community? Or is it just that we all happen to share the same zip code or postal code and just happen to sleep in within a mile radius of each other? Or is this thing called a community actually for something and our work shows that it is the communities create health.
I.
They create safety.
There are places where wonderful children can grow and where we can age, and where we can look after our environment and where we can actually make sure our economy serves local people and not just faceless multinationals or box retail outlets.
Wow.
That's absolutely fascinating.
I want to just go back a little bit without losing my, our train of where we got to, but when you were talking earlier on about that loneliness and that being young people, um, of a couple of relatives that work in schools, and one of the things that they say, and this was teenage teenagers they're working with, is that when they ask the young people, how are you feeling? So often they will say they're tired.
And they said, when we were their age.
We were all sorts of things, but we weren't tired.
You know, that wasn't an expression we used.
And I think that lack of community that you're talking about, that lack of being a part of something and maybe all the digital age and everything else that comes into that and perhaps exacerbates, that's another conversation, but that's, maybe that's part of that reason why that young people just feel that.
Tired, and maybe that's a way of explaining a, a loneliness as well.
Maybe I wonder.
I think it is just to say a word or two on this.
So what's interesting about loneliness is that it's got a twin brother or sister, uh, which is the sense of uselessness.
So to be lonely in the sense of I miss the connection with other people, or I don't feel I belong is one thing, but to experience that and also to experience, I do not feel that I'm needed to.
I do not feel that I missed on the days that I don't show up in school or in the youth club or with my friends.
I don't think that the people out there need me or that my family need me, so I become completely defined by being needy rather than being needed, and they become exhausted by just being a consumer.
Of stuff and programs that adults have defined for me, and what I'm really hungering for is the energy that's inside of me.
The gift that's inside of me needs to flow.
I.
And the container within which gifts flow and circulate is a community.
But what have we done with a lot of our young people? We've done the one thing that actually isn't community from a very young age.
We send them to a campus called a school where there's a kindergarten and many of these campuses are like fortress walls that keep community out.
The, you get to about the edge of the gate if you're a parent and you dispatch your child, but then there's all kinds of safeguarding rules that say, and no further shall you go.
And then we dispatch them into this fortress in which who do voodoo, like you do, called education happens, and then they're dispatched out and then they come home.
So, and they're conveyed maybe on a bus through the community, so they're spirited through community from one activity to the next, and then to spend, depending on the level of helicopter parenting, we're conveying them like taxi drivers from one activity to the next.
And what's interesting to my mind is that, you know what? When you say to a child, when you look at all the activities you're involved in, you look at where you go to school and so on and so forth.
Tell me where you feel you belong, and tell me in what group do you feel you're missed and what is they miss about you? Then you get closer, I think, to the gift that's within that child.
So my point is simply this.
If everything is about meeting the needs of our children, but not creating the conditions where they learn that they too can meet the needs of others and that they're needed, that they have a contribution that matters.
Then I think what we do is we exhaust them.
They not alone.
Get tired of consumption because you can never have enough of what you don't really want.
And if you're a young person, like you're an old person, what you want is someone to love somewhere to live and something meaningful to do.
This is not rocket science.
No.
And that's why I think gangs flourish because gangs are communities.
If you think about functionally what they provide, they provide a sense of belonging, particularly for young males.
Uh, a sense of purpose.
Not a good sense of purpose, but it's a sense of purpose.
Yeah.
And uh, and they say.
Um, you matter.
We, we need, you can't do this without you.
So whether it's a runner or whatever it is.
So like I work very closely with gangs and I'm of an age where I remember movies like The Great Escape.
Yes.
And some of your listeners will, your mom and dad will remember this, and there's a, at the very end of that movie.
There is something very unusual.
I don't know if a lot of people notice, but the credits, which run obviously at the end of every movie, the credits don't just name the actor and the actor's character.
They also name the gift of the actor.
So they'll give the name and they'll say the ferret.
Because of course, what it was, 50 POWs who worked together as a community to get out of a Nazi prison war camp.
So Alli Ally POWs, uh, it's just a fabulous metaphor for what I think young people want.
They want to be among those 50 characters, and that's what gaming gives ga.
Like if you look at what gaming gives, it gives this sense of I have a gift, I have a capability, I have.
And so I think.
Boy, if the competition right now is between screens and gaming and community, and community is losing, we really need to get a handle on where we're going as a society, because community is so much more to offer.
I'm not making it about being antiga or anti screens, but if you put the two on a weighing scale.
And gaming and screens is more attractive to our young people than community.
Then stop criticizing screening and let's get active about making our communities more vibrant.
Because the issue is not the problem with gaming.
It's the lack of vibrancy in our communities.
And if our kids are tired, I think they're tired because we've made them needy instead of needed.
Wow, that's given me a whole new perspective, and it feels like it's something that makes so much common sense as you're saying it yet, but actually.
You're just opening my mind up to all these different thoughts so it feels new as much as it feels like I know it, if that makes sense.
So, so yeah, that reframing that you're talking about, I've got, I'm squiggling as I go, as I always do, and I've got drawings in front of me today because all of those new things that we need to, all those new ways that we need to start to think, so call back up.
What I'd be really interested is for people that are listening is and.
There.
There are, I understand quite a variety of listeners, but what is it that people need to do, or what is it that we could all do? And just being aware that.
For those people that are perhaps in as I was in that clinical role, and I know this is bigger than that, so I'm not just asking for those, but I was in that clinical role where I was working in the hospital and I was doing something and, and this wasn't my job and was very much when I spoke to people, when I was working in general practice and it was, well, your job is to get them in and get them out.
As I've spoken about so many times before, what.
What can people do in that situation? And then what can the general person do in their general, you know, maybe that same person, but outside of work? Well, let's maybe start with the general.
So I think it's important to say that every public servant is a citizen.
Yes.
So I think it's really, really powerful sometimes to just.
Remember that and it's something that, for example, hospitals can do, is to say to their staff, if they're tired, we're gonna release you to spend a little bit more time at home and in your community because we think that's health creating and yes, so giving staff.
Five hours a month where they can just do things in their own neighborhood and then importantly share the stories is really, really powerful.
But yeah, coming back to what we could do in our own communities, I think something really small and something that is the right fit for everybody is important.
So.
There's no one size fits all here, or here is the right way to do this.
But just even beginning to think about, are there three people in the street that I live in that I could begin to connect with? I.
And just even call it friendship or whatever, but it doesn't need to be as deep as friendship, but just know at a level that often we get to know our next door neighbors if they're not tricky, but just stretching that little bubble of participation out a little bit wider and saying, I'm going to, I'm going to make it my business.
To connect a little bit more where I live, it's absolutely transformative.
We did an exercise with 30 social workers recently, and they were saying, what can we do and what should we do? And I said, okay, Kayla, let's forget the institution.
Just for now.
If this isn't true within your own personal life, it's probably not going to be true in your professional life either.
So let's try and do something there first.
And there was quite a lot of trepidation.
For some people.
It really felt like an imposition.
Well, that's my private life.
I, I come here to do training.
You're asking me to do.
I said, look, I'm inviting you.
You don't have to do anything.
You're an adult.
But you say you want to embed this in your practice.
And I'm simply saying to you a very powerful, meaningful way is to be authentic.
And to try to have consistency if you can.
So, but if it feels awkward, don't do it.
So anyway, they all eventually talked themselves into having three learning conversations with three neighbors they hadn't spoken to and that they felt safe to speak to.
That was important.
So that was their assignment, if you like, between one module of training and the next.
And they all came in really, really energized and with.
Oodles of stories and funny anecdotes and whatnot, and the frame of the conversation was really simple.
Okay? I actually even gave them the framework of a script, albeit that they went off script and I encouraged that.
But the basic questions were neighbor to neighbor.
What do you care about? Enough to take action on where we live.
And it could be any, like, sometimes it's a gripe, sometimes it's a complaint.
Sometimes it's about double parking and sometimes it's about other things.
But it, it starts the conversation flowing.
It gets into the passion space.
What strengths or resources do we have locally that we could tap into to do something about what you care about? And then do we know anybody else that we could invite in? To help with this.
So those really, really simple questions.
And they did that with three people.
And the general feedback, Ruth, from the 30 people was I.
It just gave them a spring In their step, they discovered that they weren't as isolated.
Many of them work quite hard, long hours, stressful, so they were coming home into a sort of dormitory community.
They were sleeping there, but they had no real sense of connection.
Accepting that where they might shop or whatever.
So it gave them a sense of rootedness and a sense of place.
And essentially any, anybody who knows about psychology will know that's very, very important for your wellbeing.
Um, and so then we built on that and I said, okay, so I.
Now let's think about your work, but in the context of what you've learned about neighborhoods.
So if you think about somebody who does your job coming into your neighborhood, how could they be a good guest in your neighborhood? So that was the next question I asked them, and they'd never ever thought about this question, you see? 'cause often they're thinking about, I'm a host in the hospital.
And I said, no, no, no, no.
You're we're gonna get outside the building and we're going into the neighborhood.
And now you live in a neighborhood.
So think about it from your perspective.
Somebody comes into your neighborhood and they're a doctor or a police officer, or a fire officer or whatever.
They may be a politician, they're a guest.
Yeah.
And even if they live there, they're a guest if they're trying to sell you something or encourage something or deliver something.
So they found this very useful because it really helped them to sense, oh yeah, actually, these are not passive people.
They're communities, they're active people.
They've got, they.
Ideas and contributions to make.
And so it really shifted because we would do exercises like quite a entertaining exercise where I would get them to tell horror stories about where they've had guests come to dinner parties or come to their house for a meal and behave really badly and it would, the uncle that comes to the Christmas dinner or whatever and doesn't know when to leave and offends everybody and whatnot brings too much.
And so they have all of these wonderful stories that are about.
Where public service goes wrong.
And then we start having conversations about, okay, so you're a hospice carer, you're working at end of life, or you're a police officer.
You're a social worker working in children's services.
Okay, so if we took a community centered approach and very much thought about the neighborhoods unit of change.
And then redesign what might be possible.
And of course you could just imagine all kinds of energy gets liberated because people are going, oh my goodness.
We're being freed up from thinking about things in a very siloed way.
I.
To now thinking about things in a much more expansive and much more dynamic way, and yet it's not too abstract.
It's not how could we change the world or how are we going to reform health in the uk? That's too big.
It's too abstract, and so you end up with a 10 year forward plan.
Great.
We need those to a point, but for the regular person on the street.
It doesn't mean anything.
It doesn't feel like anything actually practical is going to change.
But if somebody says to you, number one, you get a lot better if your community is stronger.
So we're gonna make sure we do some stuff around that because there's things that you can do in a strong community we can't do in a hospital.
So what we do in a sense is we're shifting the conversation.
We're like, 'cause that's what we're having right now.
I am having a conversation with you, but I'm having a conversation with your listeners.
I'm having a conversation with your mom and dad.
I'm having a conversation with goodness knows who, but it is a conversation and it's a different conversation.
It's a conversation that says, let's try to do things that take us beyond the hospital.
Because that's what a lot of, how can I do this in a hospital? You can't.
You gotta get outta the hospital, get into the neighborhood, step one, right? Decentralize.
So get, but our mindset needs to get outta the hospital mindset as well.
So it's not just a physical thing where we, our bodies get out of a building because you can put people in a neighborhood and they literally could create chaos.
So.
You gotta bring the right perspective, the right attitude, the right values, the right practices.
So when you're shifting from hospi beds, where are you shifting to when you're shifting to hospitable communities? Because if we have more hospitable communities.
Then of course we'll always need hospital beds.
That's not the point I, I'm not saying we go in, for example, we're not gonna ask community to do what professionals do best.
That would be just harmful.
I'm not going to ask my neighbor to perform a surgery on a sick child or a sick parent, but nor am I going to ask a surgeon to come and sit with me and volunteer to be my friend or be my neighbor.
So different strokes for different folks, right? This is some of what we have forgotten, I think in modern life is we've forgotten the value and the power of community and so much so that when we say it now, there's some people who go, oh, this is a veil for cuts.
This guy is basically trying to make an argument.
For cutting public services and getting the community to do it for themselves.
And I would say to them, first of all, you have every right to ask that critical question because there are people who do operate at that level.
That's not what I'm saying.
What I'm saying is that there are things that communities can do that actually there is no institutional replacement for.
Love.
Yeah.
Friendship neighborliness coming around people at a time of grief, making sure everybody has enough to eat for the few days after the baby comes home for the first time and mom is trying to figure things out and whatnot.
These are all things that sadly, in a very consumer society, consumerist, individualist society, we maybe don't value enough, but they're invaluable.
Knowing that if I'm coming home from work and I'm stuck in a traffic jam, that there's somebody I can call and trust who will collect my kids from school and that they will bring my children home and that they'll be safe.
And that social capital is invaluable and sadly, we measure and value everything on GDP, right? Yes.
Gross domestic product and it gross domestic product never measures that stuff.
Yeah, because that stuff is not about consumption.
That stuff is about production.
It's about creation.
It's about looking out for each other and look, the other side of it is.
Was the village outta which the vision of the NHS emerged, the Welsh Village.
So sometimes we have to remember our origin stories here, that the NHS wasn't hatched out of the mind of beverage.
It was hatched out of the miners who were contributing some of their wages to actually create an insurance system.
For the families of those that were bereaved because miners had died in the mines and or were sick or had lung cancer, whatever the various issues were, and they were sad times.
But also, I don't want to unco undercut the fact that there was huge agency in how they built cooperatives.
It's the same with credit unions.
Credit unions weren't built out of, let's be like banks.
They were built by people who couldn't get credit from banks.
Really poor people who said Enough of this, let's create an alternative.
So when you look now in the Netherlands, and this is a Dutch word, so there are examples of where staff are actually saying, I think I can be a better use by going out and being part of a self-managed team in a primary care context in local neighborhoods, and they're setting up what's called bert org.
Um, models, and again, there's some of those in the UK as well, but this is where our system, this is the macro piece, right? Our system has to be prepared to let go, trust our frontline staff, trust our communities, stop thinking about people like they're a bundle of needs or a bundle of sickness or a bundle of pathology or the wide population out there is just a subset of sick people.
It's not, it's also, it's that and more.
It's people who in the river of life, there are many different currents.
One current is people who are very complexly sick and they need support.
Another is people who are end of life who need a varying different degree of support.
Another is people who are living well but with complex conditions.
And another is people who are not doing so well and with multiple conditions.
And we need a system that's able to respond to all of those.
And actually there is no institution on the planet that can meet all of the needs across the river of life.
So what you have gotta do is you gotta recognize there are two tools for wellbeing.
One is institutions, the other is community.
We need both and we need them to be aligned with each other.
Thank you.
Call Mac.
That has been absolutely fascinating.
Yes, there's been so much there that you've shared with us.
Thank you for the conversation.
Partner.
Can I just ask if there's just perhaps a sentence or two that, so that when people are just listening that they finish with, 'cause I'm sure there a lot of people at this room will think, gosh, there's so much that's been in there.
That might just help as a sort of takeaway.
Yeah, no, that's a great question.
So I think a couple of key points.
One is the principle of start with what's strong not wrong within people is really important.
So there's so many strengths in people, but also the second point is if you're working with somebody and they're isolated.
Shift and do what you do, whatever you have to do to help them move from me to we, because the power of helping them get connected, helping them build community cannot be overstated.
It's really, really important.
And that kind of community building or community development approach is invaluable and there's all kinds of different ways of doing that.
But just remembering from strong to wrong.
Me too.
We, and then finally, we operate a lot in delivery mode.
We're all the time delivering programs, delivering services, and so forth.
I would say there's a shift that's needed from starting with delivery to starting with discovery.
I.
Let's discover what people have.
We cannot know what people need until we know what people have.
And often we'll find, you know that if we're trying to help people to become unable, get back on their feet, step down care, understanding their context, understanding their strengths, understanding their passions and interests, uh, discovery.
Of that is going to lead to a much better care plan and a much better recovery pathway.
So I think we have, we have to invest a lot more in discovery before we start moving into delivery.
So strong Torah.
Me too.
We delivery has to actually come after discovery.
It's a wonderful wrap up.
I couldn't have hoped for anything better.
That's really useful.
So thank you very much for joining me.
I really appreciate it.
Thanks.
Thank you.
Thank you.
Bye bye-Bye now.
Take care, Ruth.
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