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So Who Cares Anyway E30 With Passion & Purpose · SoWhoCaresAnyway

• 0:04
  Hi, I'm Ruth Germaine, and this is, so Who Cares? Anyway, a podcast shaped by my deep curiosity about who cares, what do they care about, what do they do, and why does it matter? My aspiration is to build a community that listens with intention and explores care from every angle from the North Yorkshire malls.
• 0:25
  So behind clinical doors, each episode invites people to share their stories, their ideas, and talk about what matters to them.
• 0:34
  Together we reimagine what care could be and how we might shape health and wellbeing through the assets, values, and the lived wisdom of our communities.
• 0:44
  And why does it matter? Because for too long, health and care have been treated as things to be delivered, often depleting systems and the people around them.
• 0:54
  And it's time to rewrite the narrative to center everyone as a contributor, not just a recipient, to offer joy, hope, and meaningful belonging to invite each of us to shape the future of health and wellbeing with courage, with creativity, and with care.
• 1:12
  So who cares? Anyway.
• 1:15
  Hi, and welcome to this next episode with Jihad Mlai.
• 1:19
  It's a wonderful episode where Jihad takes us through from his personal story around displacement in the Middle East through to what drove him to become to his work as a gp.
• 1:31
  InterSystems leaderships are thinking about things broader and really thinking about how we can make things happen.
• 1:38
  How he saw the uniqueness of the NHS and how important that is, but also learning from other systems across the globe and talks about general practice, but particularly his passion.
• 1:49
  So do stay to the end as he starts to talk about that around mental health.
• 1:53
  It's a brilliant episode and I hope you enjoy it.
• 1:57
  Hi, and welcome to the next episode of So Who Cares.
• 2:00
  Anyway, and today I'm delighted to be, uh, joined by GHA ti.
• 2:04
  Now, GHA and I have known each other for a few years.
• 2:08
  Uh, GHA is a GP down in tha and you were also, it was also the clinical co-chair, weren't you? In tha I was.
• 2:16
  Yeah, so I know you from my ICB roles that I had, or clinical commissioning roles in the past around workforce development, and you were linking quite closely as well with the training.
• 2:26
  Hubing came to Medway, so we've linked in in that way as well.
• 2:30
  So yeah, I'm just delighted to have you on and I'm just just gonna pass over to you, just you how to introduce yourself a bit more please and tell us a bit more about your background, if you wouldn't mind.
• 2:39
  Yeah, of course.
• 2:39
  Thank you very much for having me on the podcast.
• 2:42
  Um.
• 2:43
  I'm a gp, but I also left general practice for a short time to do psychiatry.
• 2:47
  So I did a few years of psychiatry and got my section 12 and, uh, got my introduction to the medical civil service at the CCG.
• 2:55
  So I was, uh, asked to join as a clinical lead and, and that sort of civil service experience, you know, of, um, how the money works, how it flows.
• 3:04
  How to get organizations to talk to get to one another and link in and do that.
• 3:08
  System leadership work is something that I really, really enjoyed, is something that I managed to develop over time.
• 3:14
  Yeah, and as you rightly said, um, I became the clinical chair of FCCG.
• 3:19
  I did that for a couple of years, and now I work for the Integrated Care Board as their mental health lead, uh, on the side.
• 3:26
  I'm also a GP tutor.
• 3:27
  I've been a GP tutor for five years, so I keep that educational hat on and, um, I, I moonlight for the National Institute for Clinical Excellence.
• 3:35
  Nice.
• 3:36
  In, uh, health technology assessments and so on.
• 3:39
  Thank you.
• 3:39
  And you've got a lot more as well, but we're coming to that.
• 3:42
  But that's quite a good grounding of who you are, isn't it? And what you're doing.
• 3:47
  And I just wanted to come back a little bit 'cause you've already spoken and one of the things I said to you about was, you know, those leadership skills, one of the things you've said just now is about how you got organiz, get organizations to talk to each other.
• 4:00
  And I know having been in that space, that's not just something that's easy, is it? There's a lot of complexities around that and it's quite difficult.
• 4:07
  So I think that might come out as as we talk, but I dunno if you want to say anything just now about that piece.
• 4:13
  Yeah, it's, um, something that you sort of learn the hard way that organizations don't make natural bedfellows.
• 4:20
  They come from different, you know, political perspectives.
• 4:23
  They have different masters.
• 4:26
  Take for example, the council, their, you know, their system of government.
• 4:29
  Obviously they're directly elected officials and they have different pressures.
• 4:32
  The NHS, of course, is.
• 4:34
  You know, akin to a na uh, a national religion, and it's very, you know, it, it has its place in society and it has for the last 75, 76 odd years.
• 4:43
  So we have, we come from different places in, in many respects.
• 4:47
  And, um, our political masters often put different emphasis on how they fund or, you know, how they, how they ask these different services to work with one another.
• 4:57
  And, and that's the challenge really, because you've got policy at a high level, which then translates into action on the ground.
• 5:04
  Us as practitioners and as local leaders and so on, have to work with one another to try and overcome some of those barriers that sometimes are quite structural and other times are personality based, if you like.
• 5:16
  And, and that that's, and that's the heart of it really, I think.
• 5:19
  Thank you.
• 5:20
  That's really interesting.
• 5:21
  And I like the way that you say sometimes it's structural and sometimes it's personality based.
• 5:25
  And I've reflected on this a few times actually, and I sometimes wonder if it's a structure and the fact that, you know.
• 5:32
  The bit that you said just now, the NHS is a national religion almost.
• 5:36
  Mm-hmm.
• 5:36
  Yeah.
• 5:36
  Our councils are people that are being.
• 5:39
  You know, part of the electorate, aren't they part, they're elected into place, so of course they're changing probably far more quickly.
• 5:46
  'cause although the NHS is being affected by the government and we see all those changes all the time, and you and I have been through a lot of those structural changes that have happened.
• 5:55
  It's probably not quite the same as the councils I'm sure.
• 5:58
  But, um, yeah, that.
• 5:59
  But what I was going on to say was that actually when, if it's partly structural, but also partly personalities, I sometimes wonder if it's the structure that causes personalities to be in a certain way.
• 6:11
  Because it's almost like when you are in a certain system, you behave a certain way.
• 6:15
  And I know I'm digressing from the point of what we were gonna talk about, but I just found it interesting when you said that.
• 6:20
  Not at all.
• 6:21
  Not at all.
• 6:21
  Actually.
• 6:22
  Um, some years ago I was really fortunate to get, uh, a national fellowship.
• 6:26
  With the NHS Leadership Academy and Yale University, and it was a, a year long course to do with organizational and system dynamics.
• 6:35
  And the way it worked was we had, we, we came in as a group, so there were groups from all over the country, but we were a trio.
• 6:42
  One from the council, one from the CCG at the time, and a person from Kent County Council and.
• 6:49
  30 of us from all of these different organizations came together as a group and we had, you know, a series of, of really quite intensive workshops looking at, you know.
• 7:00
  Our perspective, their perspective, putting each other in each other's shoes, and then realizing actually these are, these are quite different organizations, which I hadn't quite fathom, you know, when I came in as a, you know, as a quote unquote as a doctor.
• 7:13
  Um, and there is something about organizations that, you know, you might think that, that there's one person there who's.
• 7:22
  If they just took him out of the picture, then the whole picture would change.
• 7:25
  Everything would be better.
• 7:26
  But in reality, people are embedded within organizations and it's understanding the organizational framework and having an understanding of that, that I think enables better relationship working together.
• 7:38
  So.
• 7:39
  So I, I don't think your point is misplaced at all actually.
• 7:41
  It is a lot to do with that.
• 7:43
  Thank you.
• 7:43
  That makes me feel reassured because I sometimes aware that I'm going off on a tangent and that's really helpful actually what you said.
• 7:49
  And I can imagine that must have been quite fascinating.
• 7:51
  You know, we took talk about, um, multi-professional working, but actually organizational, it is far more to it.
• 7:58
  I wonder, gee had as well, if you just give us a little bit more about what brought you into sort of working at that ICB level, that clinical leadership level and why you.
• 8:07
  Um, decided that that was the level where you wanted to be working.
• 8:11
  Um, and then I know that you've also gone on and, um, you can do these in two parts really, but I just wanna make sure we get this, that we, um, you've gone on and you've done a degree recently.
• 8:22
  In fact, you've done a couple of degrees, one after the other.
• 8:24
  I think they overlapped, but around, um.
• 8:27
  International healthcare.
• 8:29
  So I don't know if it's, that's the title of the actual thing, but I'd like to hear a little bit more about why you went into that ICB level.
• 8:35
  So moved up if you'd like, to that strategic level.
• 8:37
  And then you've actually moved it up that little bit higher into that international level, um, that you are looking at and um, you study it as studied in now as well.
• 8:47
  I've had my cup of coffee and, and I, I think I can do this.
• 8:51
  Okay.
• 8:51
  Uh.
• 8:53
  So I, I'll take you back just a little bit just to kind of frame it, it, it's, obviously I was born in the UK and, um, our family traveled to the Middle East and we lived there for about 10 years.
• 9:04
  But, and in 1990 the Gulf War happened and we were effectively displaced.
• 9:10
  So we lost everything really.
• 9:12
  And why that's important to me is that it a, it, it taught me some resilience.
• 9:18
  Because if you lose everything, you have to start from scratch.
• 9:20
  And when you do that at such a young age, I think you know, it, it's taken me years to find myself, to be fair.
• 9:26
  Um, you don't quite understand how those things happen in, in your childhood impact you as you get older.
• 9:33
  Um, so you know, we were displaced.
• 9:36
  As I say, we lost everything and that kind of thing, but.
• 9:39
  I learned how to look after myself and how to be resilient.
• 9:43
  I also learned a lot about different healthcare systems living in them and how they interact with one another.
• 9:49
  So the Middle East, we ended up in the far east, came back to the UK and, and that.
• 9:55
  Looking at other healthcare systems and comparing it to the NHS and how the NHS looked after everybody, and how he other healthcare systems had a completely, you know, they were not particularly safety netting people and so on.
• 10:07
  They weren't looking after people.
• 10:09
  That, that's one of the things that makes me think about.
• 10:12
  Why the NHS is such a wonderful organization to work in, why it really resonates with not only us in this country, but how we actually export it to the world in universal healthcare systems.
• 10:25
  And, and actually that's part of the work that I do with the, with.
• 10:28
  NHS England's Global Health Unit doing knowledge exchange about how the NHS works and so on.
• 10:33
  So that's one of the facets, um, that, that I get involved with.
• 10:37
  So that piece about seeing how other healthcare systems, you know, the difficulties that they face and comparing it with how we do healthcare here is, is such an eyeopener, was such an eyeopener for me.
• 10:52
  So that, that's one of the things really, and it also relates to why I.
• 10:56
  Continue to have a, you know, a big picture or a global outlook.
• 11:00
  I really enjoy that kind of work and that takes me back to my roots living abroad and so on.
• 11:05
  So all those things are kind of interrelated in a way.
• 11:08
  Yes.
• 11:08
  Does that make sense? Yeah, it does.
• 11:11
  So really, so I'm just gonna sort of recap a little bit as well, just for myself as much as anything G had.
• 11:17
  So you were obviously brought up abroad and then you, that displacement, I mean, that must have been an awful thing to happen, and then you were.
• 11:24
  You were a child or at the time I presume, or a young person? I was.
• 11:29
  I was 12.
• 11:29
  12 or 13 when it happened.
• 11:31
  Yeah.
• 11:31
  Yeah.
• 11:31
  So, so a young child, I'm really impressionable, I'm probably really aware of what was happening.
• 11:36
  It sounds like you were, you were a child that was aware, that was looking and taking in and understanding what was going on, or maybe not understanding, but taking those things in.
• 11:45
  Um, and that sounds quite a.
• 11:47
  A terrible thing to have gone through.
• 11:48
  But what you've also talked about is the positives that you took from that and you saw those systems and those healthcare systems, and I presume it's that and seeing that broader picture at such a young age that pitched you up into thinking, well, rather than being a GP within the GP bit, I want to, within general practice, I want to go and work a little bit more strategically.
• 12:11
  'cause I can see that there's differences that can be made if I work on that.
• 12:15
  Wider scale rather than just working within the general practice.
• 12:19
  That's not to say that that bit isn't good, but there is that wider scale.
• 12:22
  So I assume that's what brought you up to there.
• 12:24
  And then you also carried on to do that global piece and I'm quite interested in some of that global work that you've done.
• 12:32
  Um mm-hmm.
• 12:32
  I know, and we are come back to some of the work that you, Jen and Ken to Medway.
• 12:36
  Um, shortly because I know that you want to talk about that as well.
• 12:39
  But what I'm just wondering, my question is before we go, I'm gonna ask another que tell you what my next question is.
• 12:44
  'cause I think it would just help you to understand.
• 12:46
  My next question will be, why do you think it's important? Because you spoke of the, the rest of the world, learn from the NHS.
• 12:53
  'cause you talked about our safe safety netting and you talked about what the rest of the world can learn from the NHS.
• 12:58
  But is there anything.
• 13:00
  That we can learn from the other health systems that you either saw, that you talked about as a child, or that you've perhaps through your degree that you've studied and you actually think, this is what we can learn from elsewhere, that we could be doing different in the NHS.
• 13:15
  So it's what could we be doing differently first and then going on to what we might share with other people.
• 13:21
  Definitely the first lesson for me is we have something that's great, let's not ruin it.
• 13:29
  That's the first lesson for me.
• 13:30
  We have, um, just a, just to flesh out that that point, we have a universal healthcare system that's free at the point of delivery.
• 13:38
  That's the first thing to say.
• 13:39
  It's also a very wide basket of services.
• 13:43
  So when I, when I studied, I studied health economics policy and management, and I studied global healthcare leadership.
• 13:48
  Those are the two degrees, and they're sort of the yin and yang, if you like, of healthcare systems and the leadership aspect, which involves workforce.
• 13:58
  Um, you know, digital healthcare, global public health and, and those kind of aspects.
• 14:03
  And when you look at the NHS, it provides, as I mentioned, a very wide basket of services.
• 14:09
  Um, it also has a very close link to social care and how the economy relates to, you know, people who are outta work, for example.
• 14:20
  It also relates to how our.
• 14:22
  Psyche, you know, how we feel towards an organization that's been embedded within our context for the last 75 or 76 years.
• 14:33
  And I think that's so valuable.
• 14:35
  So those, so those are the things that I think we need to protect.
• 14:38
  I don't think we should stray far from delivering things for free for people if we can make the money work, if you see what I mean.
• 14:44
  And we can talk about.
• 14:46
  All of that and, and healthcare financing and so on.
• 14:49
  But, um, so, so that's the first lesson.
• 14:51
  The second thing is, you know, what, what is it we can, what is it that's fantastic about the NHS Primary care for me is the bedrock of the NHS.
• 15:01
  And I think that's been said by, uh, you know, the previous outgoing chief executive of the NHS and so many people say.
• 15:08
  You know, GP practice and primary care is the bedrock.
• 15:12
  That's another thing that I think we should be very proud of and be very careful not to dismantle.
• 15:16
  And there are elements of that, like, you know, the partnership model, you know, um, financial incentives with regards to cof digital.
• 15:25
  How we put in electronic healthcare records and how the digital AI revolution is actually running through that right now is becoming so important to everyone.
• 15:33
  Uh, we can talk about examples of, um, you know, Heidi ai or transcribers that, you know, the A VT as they call them, sitting in the background transcribing.
• 15:42
  So there are many different strands to this, what we learned from other healthcare systems.
• 15:48
  Um.
• 15:48
  Take Italy as an example.
• 15:50
  We share something, um, quite similar in terms of population.
• 15:53
  We have a north south divide in terms of a rich and a poor, broadly speaking, um, divide between the two countries.
• 16:01
  However, there.
• 16:03
  Primary care system is much less well developed than ours, and I can give examples.
• 16:07
  For example, the average pay for a gp, there is 40,000 euros.
• 16:11
  Compare that to the average salary in the UK of somebody being paid 90,000 pounds.
• 16:15
  So it's, it's quite different.
• 16:17
  And um, but.
• 16:19
  Without digressing too much.
• 16:21
  What they do have is this connection with their families, their family, ethos, and continuity.
• 16:27
  That's something we share and something that we should continue to learn from other organizations before we change our models into, into this.
• 16:35
  New general practice that takes away the thing that makes it great, which is continuity.
• 16:41
  So that's something I think that's important.
• 16:43
  Continuity.
• 16:45
  The other, um, aspects, things we could learn are community models from India or Brazil that are generally low cost, but have great inReach into communities that speak to that inequalities piece.
• 16:58
  Our coastal communities, our mental health patients.
• 17:01
  Patients with learning disabilities and patients who don't access healthcare.
• 17:05
  So, so that's another thing that we could definitely absorb and, um, you know, modify to our purposes, but nonetheless learn.
• 17:12
  And then there are other elements, for example, like, um, Singapore for example, has fantastic primary care, a fantastic primary care setup.
• 17:21
  Although our systems are really quite different, some people talk about lifting and shifting systems, like let's take a system from Singapore and place it here.
• 17:29
  But in reality, they're 5 million people versus 80 or 75 million people here, and they have a a very differently, tightly run state system that sort of.
• 17:39
  Without being unfair to Singapore, you know, is a, a type of benevolent dictatorship.
• 17:45
  So it, it's quite different.
• 17:46
  It's, you have to go back to the roots of why healthcare systems develop and that's a lot to do with, um, your.
• 17:54
  Philosophy as a country, your history and how you've grown.
• 17:58
  Other examples of that, you know, a, a clear example is how you have the Bismarckian system in Germany, uh, and the Veridian system in the NHS.
• 18:06
  So that, does that give you some outline? Does that support.
• 18:10
  Your, uh, your question.
• 18:11
  It does, yes.
• 18:12
  Yeah, definitely.
• 18:13
  You answered the first bit really well and talked about that sort of wide basket of the NHS of things that we have, but actually we, we do a lot of things and we do a lot of things for, you know, they're free at the point of service and that is absolutely, we must never lose sight of that and our primary care model that might be able to learn from other systems.
• 18:32
  Other areas, other countries and things, but it's already great.
• 18:36
  So let's, let's be careful not to lose that family model that's there, which I think, you know, you've already talked about how we're already moving primary care and primary care is changing massively.
• 18:46
  Mm-hmm.
• 18:46
  But when things will change quickly, there is a fear of losing something.
• 18:50
  That's good.
• 18:51
  You know, we want something better, but we might lose something that was already better to start with and we didn't need to lose that.
• 18:58
  And then you've talked about these various sort of things in different countries that we can learn from, you know, those community models.
• 19:02
  But I, I completely understand that, you know, different models do come from.
• 19:07
  Our country's ethos that you've just said.
• 19:09
  We can't just lift and shift.
• 19:10
  It's our history and it's our ethos as a country that develops our healthcare systems.
• 19:16
  And actually, if we go back to our ethos as a country, then actually we.
• 19:21
  We obviously, you know, it shows that we are there thinking about those social determinants of health and thinking about making sure that everybody's got the care and the health that they, and the support that they need.
• 19:34
  So there we are.
• 19:34
  A lot of good things that we've got already.
• 19:37
  One of the, um, systems that I studied when I was doing my Darzi fellowship was around the new system, which is out in Alaska, but the new system came from the fact that, um.
• 19:47
  There was a lot of, uh, poverty and there was a lot of sort of, um, society turning in and itself and wasn't going well.
• 19:53
  And actually what they said, well, what should we do? And they turned the healthcare system round and said, well, actually, we'll make the citizens owners.
• 20:01
  And so there was sort of almost like a reversal.
• 20:03
  So when you went along, you were the person that was in charge and you asked who you wanted to see in primary care.
• 20:09
  So they really front loaded primary care and sort of put, uh, which I think a lot of areas are doing now and in the UK we're trying to do is sort of have that.
• 20:16
  80% at the front door of primary care.
• 20:19
  It's beyond being a GP in general practice.
• 20:22
  We've got all sorts of people in general practice now, haven't we? And I think it's, we do too, think some of it is learning from those types of systems that are out there.
• 20:30
  Well, what that, um, what that makes me think about is.
• 20:35
  Uh, I'm always fascinated by, um, how healthcare is very interesting in and of itself.
• 20:40
  You know, looking after people and clinical medicine is very exciting and interesting, but as you go through your career, you, you realize just like the layers of an onion, that there are multiple layers that sit on top of that individual, that very important.
• 20:56
  Um, clinician to patient relationship, and obviously that forms the foundation of all of it.
• 21:02
  But then you go onto things like, you know, the primary care network or you go on to obviously the general practice and then the network, and then the HCP and then the ICB, and then the national picture.
• 21:12
  And then you go on to.
• 21:14
  There are European systems and then you go onto other systems internationally and so on.
• 21:20
  And it's, it's that interface between medicine and the humanities and the arts that I find so interesting.
• 21:26
  Um, that I think that's where you find the most interesting work, at least to me.
• 21:30
  I'm, I'm, others may not feel that way, and that's one of the reasons why I studied health, economics and policy.
• 21:38
  Um.
• 21:39
  In particular, I mean, I, I'd always been thinking about it, but I, I got, I got a real piece of motivation from Professor Chris Whitty who was talking about, he was giving his inaugural lecture to the Kenton Medway Medical School, and he put up a graph about health improvements in various, you know, in diabetes stroke.
• 21:57
  Cardiovascular and so on.
• 21:58
  And they were all, you know, incontrovertibly improving over time.
• 22:03
  But he said something that was really interesting to me, which was, this is not related to medicine or medical changes, it's to do with public health, with, to do with law or technology.
• 22:13
  And I mean, examples of that, if you think about changes in the law to do with the smoking ban.
• 22:18
  That had a massive impact on smoking rates in this country.
• 22:22
  If you think about, um, technology, we think about AI now.
• 22:25
  But let, let's go back a little bit further and think about catalytic converters.
• 22:29
  Catalytic converters saved a significant number of people from suicide because that was one of the main modes of, of, of killing yourself, you know, by placing the, the, the, the exhaust of the back into the car and so on.
• 22:42
  And, and so it made me think that, you know, health is one aspect.
• 22:46
  Then there are other aspects that you can use to combine with health to, to produce even better outcomes.
• 22:53
  And, and that's why I studied economics.
• 22:56
  Um, I, economics is, um, is quite influential.
• 22:59
  I, I think, you know, when you, every, there's not a day that goes by that you don't hear about interest rates going up or affecting your mortgage or the cost of living.
• 23:06
  Um, there's also a language.
• 23:08
  So when you, you are able to speak that language as a doctor, you can go and talk to policy makers and, and politicians and change things.
• 23:15
  That's one of the things that I found most frustrating working in tha as a clinical chair is that you, you know, there's one thing being a doctor and seeing the harm that you know, that's, that's around you.
• 23:27
  It's another thing to try and convince other people to invest.
• 23:30
  Your infrastructure and your, your, your roads and your, your schools and so on, you have to be able to speak that language.
• 23:36
  I think.
• 23:37
  So that's one of the things that motivated me.
• 23:39
  Um, the other thing is that, is that there's technical aspects to health economics and then there's also the, the big picture stuff that you and I have been talking about, about what kind of healthcare system you want to live in.
• 23:50
  Um, what, how society actually.
• 23:54
  Uh, what kind of society do you want to live in? Do you want to live in a, a capitalist, a highly capitalist society where all the decisions are made by big pharma? And then you have the poor health outcomes that you see in the United States because they invest 20% of their GDP, but have some of the worst outcomes.
• 24:10
  You know, that's one way of doing things.
• 24:12
  If you have money, you live, if you don't, then you're in trouble.
• 24:15
  And then you have a lot of the pro-social kind of countries like the UK and, and other countries like Germany and France and so on.
• 24:22
  So, so there.
• 24:23
  So that's.
• 24:24
  That's.
• 24:25
  Why I, that's why I was motivated to do those kinds of subjects.
• 24:29
  You know, it's so interesting listening to you.
• 24:31
  'cause there's so much isn't there? That affects our health and policy.
• 24:36
  Economics is a huge part.
• 24:38
  But what you also talked about there was, you know, it's not just medicine.
• 24:42
  You talked about humanities and the arts, and I think that.
• 24:46
  People don't think of those.
• 24:47
  And I know I touch on those quite a bit in these podcasts.
• 24:50
  The one that's coming out next week is very much a, the hobo poet equals himself, who he talks about poetry and how, you know, the art of health and care.
• 25:02
  And actually there's, there's a huge amount that goes into creativity because we have to be creative to think about how to do things.
• 25:10
  I'm also thinking about the fact that you spoke about the policies, but you also then went on to talk about, you know, what, what type of society do we live in? Do we live in one where it is quite maybe capitalistic? I, I can't even say that properly, so I'm not gonna try and say it again, but you know, is it.
• 25:25
  Is it where, and we focus on that medicine, but I've already had a few people saying to me, actually medicine's had it had its day or has it had its say or have we rinse medicine? I've had a few people on this podcast talking about that type of thing.
• 25:37
  And it's not to say that medicine hasn't got its place, but actually.
• 25:42
  There's other things as well, and what you started to talk about there was about the community and those community assets, which takes me straight back to Mack Russell's episode, which is about asset-based community development.
• 25:54
  And actually there's so much more that we can draw on for that creation of health rather than our focus on, which I think was probably what Chris Witty was talking about, although I wasn't there, so I might be completely wrong.
• 26:06
  Um, but he was talking about, it wasn't just the health and the medicine and focusing on the illness, but actually it was on the fact that these other things that we're doing and other things that we can do that create health in the first place.
• 26:19
  So.
• 26:20
  That's my thoughts and reflections, but yeah, it was fascinating.
• 26:24
  Yeah, it, it's something to do with, you talked, you started talking about, um, you know, the humanities and the arts, and there's something about sociology and the politics that, um, you know, leadership theory that's, you know, so important even in, you know, of course in medicine there are many, many multifaceted aspects to that that I think are so important to not only leadership, but also how you develop.
• 26:49
  Um, assets in the community, and, and I think I've got good examples of that.
• 26:55
  Take for example, the urgent and emergency care pathway.
• 26:58
  If I localize it to Kent, for example, we we're working together with the voluntary sector to build safe havens and crisis houses, and we're working closely with the Pears Foundation, and they're very, very generously invested in two crisis houses.
• 27:15
  So this is the collaboration, a philanthropic collaboration between.
• 27:19
  The voluntary sector, uh, an external philanthropic organization and the NHS trying to build community assets.
• 27:26
  And the purpose of that is we know that.
• 27:29
  Patients mental health patients shouldn't go to ed departments because they have worse outcomes for obvious reasons.
• 27:35
  There's not enough people to look after them.
• 27:37
  They get worse care, they their, their mental illness worsens and so on.
• 27:41
  So we're thinking of ways of using those community assets, those voluntary sector organizations to actually run these crisis houses and safe havens and creating a place outside of.
• 27:54
  The acute sector and bringing that emergency pathway back to the community, if you see what I mean.
• 28:00
  So the, the, yeah.
• 28:01
  So there's some really good examples of community assets, like you say, um, um, that we're working on.
• 28:07
  Yeah.
• 28:08
  I can give other examples too, in mental health that I, I feel very, yeah.
• 28:11
  Passionately about and I think that's brought us around.
• 28:13
  So we've gone in a little bit of a circle, but I said the bit that I wanted to talk to you about was around that, what you're doing around mental health in Kenton Midway.
• 28:21
  So you've started to touch on that.
• 28:23
  So I wonder if you just want to either give some examples or describe what was happening.
• 28:29
  A little bit more bit and why it was important to do that, but whichever way you prefer to do that, jihad, it would be really interesting to hear about.
• 28:36
  Yeah, sure.
• 28:37
  Sure.
• 28:38
  Let's, let's go back to the example I gave before and just flesh it out a bit.
• 28:41
  The, the urgent and emergency care pathway is to do with patients, particularly patients with complex emotional disorders.
• 28:49
  We would call them personality disorders, but it's also to do with other patients who suffer mental health crises, which are episodic in their lives, and then.
• 28:58
  When you overlay that onto a system, how do they come into the system? They come in via the police, via 1 3 6, for example, which is a section of the Mental Health Act.
• 29:07
  They might come in, you know, because they self-referred, they might be referred by their gp.
• 29:11
  You know, there might be a variety of inputs into those systems.
• 29:15
  And then you sort of think about, well, if they can't attend general practice, well where can they go that isn't an emergency department? Because if they go there, then they end up getting worse.
• 29:23
  Or some of them might get admitted to a secondary care mental health bed.
• 29:27
  Which is potentially even worse for them and causes other life changing consequences.
• 29:33
  So what we're trying to do is to build that space between primary care and secondary care as a community-based asset, if you like.
• 29:43
  And what we've been able to demonstrate through the numbers and figures through tracking is a decrease in the number of primary mental health diagnoses being registered in ed departments.
• 29:56
  At the same time looking at an increase, there's been an overall increase in footfall, an increase in.
• 30:02
  People being admitted to ED departments.
• 30:05
  So the trend for us is.
• 30:08
  We're clearly, for us, it feels like we're making an impact in decreasing the number of mental health patients going into EDS in, in spite of more people going to ED departments.
• 30:18
  So we think that's a really positive thing that's happening and we would like the, you know, system encouragement and support from everyone to try and make those more successful.
• 30:28
  So that's one example with a bit of data there.
• 30:31
  The other example was, um, severe mental illness, physical health checks.
• 30:37
  If I take you back about six, seven years ago, we were hitting single digit figures maybe around 9%.
• 30:43
  Over the course of the last five years, we've increased it to maybe 50%.
• 30:48
  So it's increased significantly over the past four or five years, and that's been due to some really interesting innovative programs using data.
• 30:57
  And, um, not just contracting with our traditional partners, but with voluntary sector organizations, community interest companies and, and, and such.
• 31:06
  So it's sort of a, a really interesting hybrid model where we've been able to.
• 31:10
  You know, try and bring that more into the community as opposed to where they might have been admitted before.
• 31:15
  They're really good examples and really interesting.
• 31:18
  And, um, what I'm wondering is, you know, you're talking about the fact that you're linking in with the voluntary sector and with those other.
• 31:27
  Sectors as well, rather than just thinking general practice hospital, um, and thinking about those spaces in between.
• 31:35
  But you also spoke earlier on, um, I'm just trying to think what, where it was, but it was a bit earlier about those people that aren't being seen and those people that we aren't reaching.
• 31:46
  I think it was when you were talking about.
• 31:47
  Either Italy or one of the other countries, you know, that they were quite good at picking up the people that were out there that whose needs weren't being met.
• 31:55
  And this is something that is always really important to me.
• 31:58
  You know, it's why I tend to try to try not to use the word patient.
• 32:01
  'cause they're the person that was lucky enough to be seen.
• 32:03
  And actually there's still a person anyway.
• 32:04
  But what about the people out there that.
• 32:06
  We are missing.
• 32:07
  And I think with mental health, that is such an important thing that we actually pick people up before they even need to go to somewhere for crisis.
• 32:15
  And um, yeah.
• 32:16
  Yeah.
• 32:16
  I wonder if maybe you could describe what's happening there a bit more or what you might be doing around that Jihad.
• 32:21
  I can see you're nodding, so I know that you're doing something and you've thought about this a lot.
• 32:25
  Yeah.
• 32:25
  This is something that, you know, my colleagues and I spend a lot of time thinking about and.
• 32:30
  In our area, we've invested in something called a community mental health framework, and that is to do with trying to bring community, uh, secondary care, voluntary sector, organizations, NHS talking therapies into one space.
• 32:44
  I think that's an evolving piece and, um, it, it's fair to say it's not been working as well as we, we think it should be working, so we clearly have a lot of lessons to learn, but aside of that.
• 32:55
  There are, you know, really interesting developments in neighborhood health and how we integrate mental health into that neighborhood piece.
• 33:03
  And I think there's, you know, there's tremendous really interesting models out there.
• 33:08
  We have, you know, a, a really good example of wbul of.
• 33:11
  A medical practice, for example, that does a fantastic job of integrating community, um, sort of out out outposts of hospital type care within their setup as well, along with an urgent treatment center.
• 33:23
  Combining that with, um, you know, the traditional.
• 33:28
  Partnership model that provides really great access and great continuity.
• 33:33
  Um, I think it, you know, that that's something that, that's something we should aspire to as well, has been mentioned in the 10 year plan.
• 33:39
  There's also other elements, other, um, projects like Bromley by Bo who've been running for the last 25 or 30 years.
• 33:47
  They're really well established and they run a community based model that relies on their community assets, like you said.
• 33:53
  And there are others like Fleet for example.
• 33:55
  I know you've interviewed, um.
• 33:58
  Uh, colleagues from, from that part of the world.
• 34:01
  So there, there are people around the world Yeah.
• 34:03
  Around the country Yeah.
• 34:05
  Who are doing some amazing, amazing work and there's so much to learn from them.
• 34:09
  Yeah.
• 34:10
  And that was, that was one of my things, you know, is that.
• 34:13
  What they tend to do is that they, those areas and bromley by BOA course, and I will just put this in, being an advanced nurse practitioner, it's it's nurse practitioner led rather than being GP led.
• 34:24
  So it was actually set up, um, and one of the first in the country, and I dunno if there are rather, but I think they took the model of being let's be advanced nurse practitioner led and then bring the, the doctors in later and sort of turned it round a little bit.
• 34:36
  So that's just a little aside there, but, um, I think that, yeah, what they.
• 34:41
  When they're working like this and these, these things do get off the ground.
• 34:45
  It really is about that co-creation and co-production and working with communities.
• 34:50
  But it, I think it's also easier said than done, you know, co-production, bringing people in.
• 34:56
  How do you find out what it is that's really important to people? How do you work with people and make that happen? And I think that there's a lot of barriers in our system to prevent that happening.
• 35:06
  And there's also, there's also this thing, isn't there? I'm just speaking from my own experience that sometimes there's a, the need to get something done.
• 35:15
  I think this is the, the political world of the NHS, if you like, or health and social care that you have to show that something's happened and you sometimes have to show it quite quickly.
• 35:25
  And actually working with people and doing that asset based community development, doing that, going out and asking people, you've gotta go a bit rogue.
• 35:32
  You know, Mark Spencer went quite rogue when, when you listened, I dunno if you listened to his podcast, but you obviously know of him anyway.
• 35:39
  You know, he was.
• 35:39
  Rogue and done some things, but that's not easy and that's not, and not everybody's got time for that.
• 35:45
  And it does vary, I think, where you are, who your cohort are, who the people are that you are working with to be able to do that.
• 35:53
  But actually that co-production and co-creation is, is sort of paramount to making those things happen.
• 36:00
  Yes, I, I agree.
• 36:02
  Just thinking about that makes me.
• 36:06
  My thoughts were that the barriers that you talk about are to do with how the NHS is structured.
• 36:13
  That's a lot to do with the political cycles and how the cycles of funding come through, which don't lend itself either to prevention or to long-term planning.
• 36:25
  Of the, all of the, I mean there, there are countless studies that talk about prevention and how you get a return, a significant return on investment.
• 36:31
  For example, if you invest a certain amount of money in children at an early stage in life, it reaps significant benefits as they get older in life.
• 36:41
  And.
• 36:41
  From a health economics perspective, just as an aside, that's to do with your time horizon.
• 36:45
  If you invest a small amount.
• 36:46
  Now, if you look into the future, you accrue those benefits in many, many different ways.
• 36:52
  So that's, that's, um, something about how the NHS.
• 36:56
  I think tried to divorce itself from the government planning and, and, you know, to divorce itself.
• 37:02
  And, and I think that's partly what Lansley was trying to get at.
• 37:06
  Um, but it, it sort of really, it led to a significant other consequences because it's such a complex system.
• 37:13
  But I think the truth or the, the, the gold if you like, is somewhere between those two things.
• 37:20
  Divorcing ourselves completely from central government.
• 37:23
  Still having a strategic link to strategic government that that doesn't allow people to, um, foster competition between small geographies.
• 37:32
  You know, so there's, there's something in there about, we haven't quite found the right mixture of management versus clinical leadership versus government policy.
• 37:43
  And, and I think that I, I don't know if we'll ever find that, but.
• 37:46
  That's something that I think about when I think about the long-term planning.
• 37:49
  So, um, I hope the next iteration does something, something new and something different and it helps us work together better.
• 37:56
  Um, sorry, I completely digressed and started talking about things that interest me.
• 38:01
  That's why you're here.
• 38:02
  Because if they interest you and they interest me, hopefully other people think that they're interesting, so that's absolutely fine.
• 38:08
  And actually, yes, and I did go onto that.
• 38:10
  Of the political agenda and sort of how things change.
• 38:13
  And so I don't think you completely digressed.
• 38:16
  I think I was digressed a bit as well before we started, but because we are coming towards the end and I just want to sort of make sure, you know, make sure that people have sort of got a picture of that they're left with, of why this is important.
• 38:29
  I wonder if there is something that you could share around, um.
• 38:33
  You, you shared a couple of stories already, but you are also still an an acting GP and seeing people as a GP day to day.
• 38:42
  I wonder if there's something that you could share that would really give a picture of the difference it's made to somebody through one of these, um, the stories that you've told so we can envisage.
• 38:53
  A person that this is affected who didn't have to go to a NE or perhaps went to a NE in the past and then ended up going through one of these, you built spaces, you said.
• 39:02
  So went through one of your spaces and what that actually meant and the difference that made.
• 39:06
  That would be really nice to hear.
• 39:08
  Yeah, sure, sure.
• 39:10
  I mean, it, it makes me think about a family that we looked after, uh, husband and wife, middle age with three children, or four children actually of, of varying ages.
• 39:21
  One really quite young, you know, perhaps a toddler and, and one that's.
• 39:27
  Was going into college or university, sort of 16, 17.
• 39:31
  And they both had, I think, undiagnosed neurodevelopmental, at least I'm sure.
• 39:37
  Um, one of them had, um, A DHD and that was undiagnosed and that was manifesting itself in all sorts of ways with family discord.
• 39:46
  Um, and.
• 39:48
  Having multiple jobs and not being able to hold down a job.
• 39:51
  Um, the, the other part, the other, I, I don't want to be so specific, but, but the wife, um, the woman in the family, she obviously had a lot of caring responsibilities and tried to keep the family together and so on, but she faced this insurmountable challenge of having many.
• 40:09
  Too many children to look after, not enough time to give to each one of them.
• 40:13
  One of them was actually going off and, and getting involved in type county line type problems.
• 40:18
  And, um, yeah.
• 40:22
  So yeah, when I think about it is sort of, um, yeah, it takes me back a little bit, but where I think.
• 40:29
  General practice and primary care is important is you provide that critical anchor that they can always come back to.
• 40:37
  And sometimes you do things that are not quite in the guidance, like you might prescribe a medication that you know, you know, that you don't quite have the competence to, to prescribe, for example, or that you might feel uncomfortable prescribing under gold standard circumstances.
• 40:52
  And, and that that bit of.
• 40:55
  Extending yourself or acting outside of your comfort zone as a, as a doctor, as a family doctor, or as primary care clinicians is something that keeps families from tipping into that really difficult situation where they go into hospital and spiral out of control.
• 41:12
  Um, so there, there's something there about the value of continuity.
• 41:18
  Primary care preventing admissions, um, being someone there to talk to that person who knows them and shares their, a bit like the village vicar in some way.
• 41:27
  Like, I mean, that's kind of disappeared now, but you're sort of the new vicar in some ways.
• 41:31
  I just hope the new system takes account of that, that we don't lose that, that relationship and that relationship building between people.
• 41:38
  I, I hope that gives you some kind of insight.
• 41:40
  I'm not, I'm not really sure if that's answered your question.
• 41:43
  The other bit was, you know.
• 41:45
  The use of that you talked about that you use in voluntary sector and other areas as well.
• 41:50
  Yeah.
• 41:50
  So has anybody accessed those that's perhaps prevented them to going to a e, I suppose, is also Absolutely.
• 41:57
  Well, well definitely.
• 41:59
  I mean, we didn't have safe havens as we knew them, as we know them now at the time, but we still had.
• 42:05
  We still had mental health matters who we could refer to.
• 42:08
  And that's actually one of the main lessons actually, that we picked up from this, from, from over the years building these types of services that if you co-locate them close to a hospital, you get much more benefit out of the system.
• 42:18
  Because then one of the key barriers that we discovered was having, um, agencies like the police or ambulance or, or other organizations wanting to refer in, but not having the confidence.
• 42:31
  To put them in a voluntary sector organization as opposed to a hospital, which is a statutory place.
• 42:38
  And, and that's one of the things, and, and our patient in particular went to mental health matters and was able to talk to a peer support worker, able to deescalate, you know, think about strategies to, to.
• 42:49
  Turn her life around, at least in, in that small instance.
• 42:53
  And that had ramifications for, for other circumstances that she came across and over the years, I think, uh, that, that I was looking after, after this lady, her husband and her family.
• 43:05
  They went to mental health matters, they went to, um, the, our local mental health trusts, um, recovery College.
• 43:13
  That's another really good one.
• 43:14
  They also accessed, uh, the DWP or, or the job center plus type services there, where they offer things like debt management, so all of these services and, and also the substance misuse services as well for, for her children, for example.
• 43:28
  So all of these services are very important and they interrelate to one another in ways that we don't quite.
• 43:34
  Understand they're so important and it's so important that we foster those links between, um, health and social care and the voluntary sector and in a way that builds into the clinical leadership aspect.
• 43:49
  So when, when at a clinical leadership at a senior level.
• 43:53
  You bring senior partners to talk about systems that permeates down to those services, and it's slow, but it's very important you do that and maintain that.
• 44:05
  That's my example.
• 44:06
  Thank you.
• 44:07
  And it's, and it's a good one as well.
• 44:09
  Thank you.
• 44:09
  Because it really gives that picture, and you've brought in that importance of that clinical leadership and how by doing that, you've just said PERM permeates down into so many different places and by.
• 44:22
  People being able to have those services and you as a clinician, being aware of those, not just aware of those services, but also working with those services, linking with those services, helping to design what that looks like, and then thinking about what your general practice looks like.
• 44:37
  And I think what this really brings back to me is.
• 44:39
  General practice is the cornerstone.
• 44:41
  You know, there's so much evidence from research, whether it's in the UK or elsewhere, you know, primary care services.
• 44:47
  Having that right is so important, but actually a lot of the time what we're doing is fire people are doing is firefighting.
• 44:54
  They're just having to try and sort things out.
• 44:56
  And it's so important that people understand that when you're being doing your GP work, GE general practice work or being a GP isn't just about.
• 45:06
  Seeing the person day to day.
• 45:07
  Mm-hmm.
• 45:08
  To be a proper true family clinician, you need to understand that everything from the schools.
• 45:15
  Through to everything else.
• 45:16
  And you need to be a part of that, and you need to be linked in with that.
• 45:19
  And that takes time.
• 45:21
  Um, and it takes good leadership and it also takes time to sit back and reflect and think, and it takes you into the arts because it takes being creative to think, well, what have we got? What can we use? What are our assets? And, and how can we perhaps use that differently so that all these people we're seeing going into a NE don't.
• 45:42
  Because actually they're gonna get better care somewhere else, which will be better for them on the day, but also have, as you would say, ramifications on the fact of the rest of their life and other people in their lives.
• 45:54
  So actually what you are then doing is you are building.
• 45:57
  Or you are part of building a better society, if you like.
• 46:02
  And I don't, I, I say that carefully because I don't wanna say society's, you know, but you are helping to build the, a better community around you.
• 46:08
  Perhaps that's the better way of saying it.
• 46:10
  You are helping to build your local community and make sure that they're building health and coming to you when they need help.
• 46:19
  Yeah.
• 46:20
  Uh, I completely agree with that.
• 46:22
  If there's anything that I could.
• 46:25
  Promote, if you like, or share that I think is, is so important for, for all of us, not only as individuals, but members of society, is to stay passionate about something that you really care about, something that's really important to you and to keep banging on about it.
• 46:41
  Just keep banging on about it until somebody listens to you, that, that's so important.
• 46:46
  Um, in your clinical leadership, you know, being an ambassador, if, if, if we're talking about.
• 46:52
  Linking in with system organizations, how health talks to social care, or how social care talks to the voluntary sector or voluntary sector.
• 47:00
  Talk to other community assets.
• 47:02
  It's so important.
• 47:04
  And for me personally, that passion, if you like, for.
• 47:09
  Inequalities, mental health, health equity, all of those things blend into one another and find, find, find its way.
• 47:18
  This, this feeling, find its way into all of these different jobs that I do and, and I find that is a kind of a unifying thing.
• 47:25
  All of them.
• 47:27
  And as a last example, I'm um, a non-executive director for a fantastic organization, a community organization called Social Enterprise Kent and Social Enterprise Kent.
• 47:38
  Do social kitchens.
• 47:40
  We've got two social kitchens, one in Ashford on Bank Street and one in Margate.
• 47:44
  Um, we, you know, the, the food is of, of high quality.
• 47:48
  It's linked in with a company called Fair Share and, and other community organizations that, you know, bring produce and goods.
• 47:55
  At an affordable price for, for people who need that kind of support.
• 48:01
  And we also do things like training and, um, uh, yeah, you know, teacher of the year awards.
• 48:08
  So there's some really cool things that we do for people.
• 48:11
  And, and I, out of all of the jobs that, you know, that I do, that's, that gives me the most joy, you know, the, the, the fact that we're doing something tangible for people.
• 48:21
  It's been amazing Gha and you are your, you are doing so much and I'm just gonna reiterate your take 'cause I was gonna ask you your takeaway thing, but you gave it to us anyway.
• 48:30
  Didn't you stay passionate about something that you think is important and just bang on about it? And you are obviously doing that, but you've made me feel better because the reason why I do these podcasts is because I'm so passionate about everything and the people that come on.
• 48:45
  And it's my way, if you like, of banging on about it.
• 48:48
  Through, through other people, hopefully listening to their voice.
• 48:51
  So thank you so much for joining me.
• 48:53
  I've really enjoyed the conversation today.
• 48:55
  Um, it's been amazing.
• 48:57
  Thank you.
• 48:57
  Yeah, the podcast is great.
• 48:58
  Keep going.
• 48:59
  Keep banging on about it.
• 49:00
  I will.
• 49:01
  Thank you.
• 49:03
  I hope you found this episode interesting and inspiring.
• 49:07
  If today's conversation has stirred something within you, please share it together.
• 49:12
  Let's build the ripple that we need to create change.
• 49:16
  And if you haven't yet, please follow the show and leave a rating.
• 49:20
  You can also find on my link tree a link to my feedback form where you can share your questions, ideas, and reflections, and talk about what you'd like to hear on this podcast in the future and what matters to you together.
• 49:34
  Let's shape a space into something reflective and purposeful.
• 49:38
  So for now, stay caring, stay connected, and stay curious.
• 49:45
  Hi, it's Ruth here.
• 49:46
  So you're listening to this.
• 49:47
  You've stayed to the end.
• 49:48
  So the first thing is how, thank you.
• 49:50
  I hope you found that episode interesting.
• 49:52
  I think it's fascinating how we went from what she had saw as a child, his own displacement, but actually he took that wider perspective that he saw right at the beginning, and it's driven him all the way through, I think.
• 50:07
  Everybody has a drive.
• 50:08
  Everybody has a passion, and really came out today.
• 50:11
  So thank you for listening.