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Get involved with NHS Change Day!

March 13, 2014

Originally posted on the Microsoft UK Health Blog http://blogs.msdn.com/b/microsoft_uk_health_blog/archive/2014/03/03/get-involved-with-nhs-change-day.aspx

This guest post is by Adebusuyi Adeyemi of NHS Improving Quality.

NHS Change Day 2014 is going to be the biggest day of collective action for improvement in the history of the NHS. Are you ready? NHS Change Day 2013 was a countrywide grassroots initiative that provided an opportunity to transform anger or frustration into constructive action. This year, NHS Change Day is still a grassroots movement but is going global, to be a mass movement of NHS staff, social care providers and the public demonstrating the difference they can make by one simple act to make a change.

The NHS Change Day core leadership team have applied and adapted social movement theory, skills and practices associated with community organising and made use of social media to secure voluntary pledges from NHS staff and patients to take a specific improvement or innovation action on or around 03 March 2014.

The most significant thing we learnt from NHS Change Day last year is that change of this kind and scale is possible; the most significant impact is that tens of thousands of staff have now had the experience of taking part in collective action for change. There are rich lessons about ‘calls to action’, ‘shared values’ and ‘distributed leadership’ organisations can learn from this. Leading academics and firms have already recognised this, NHS Change Day 2013 winning the McKinsey and Havard Business Innovation prize.

NHS Change Day was an entirely voluntary effort that invited staff to take action on something that they were passionate about. It intentionally drew on shared values, and in doing so, it unlocked willing commitment to act rather than hierarchical compliance.

Putting shared values at the heart of the Change Day provides an authentic ‘call to action’ to which others with a similar outlook responded. It makes Change Day not only an opportunity to do something that would be of benefit to others, but also to express support for the NHS as an institution and the shared values that it represents.

NHS Change Day creates a sense of urgency by focusing on a single day of collective action. In many cases Change Day gives the necessary prompt to galvanise and amplify activity that may sometimes already be planned and promotes the idea of distributed leadership as it has a low threshold for participation.

The design of NHS Change Day is unique and offers interesting lessons for technology stakeholders in healthcare to take away. More often than not, technology and the internet democratizes information and can lower the threshold for participation in the management of healthcare. Technology has always been poised to solve the big healthcare issues but it can be incorporating the simple lessons of a social movement that can be enough. As healthcare becomes increasingly dependent on technology, let’s look to NHS Change Day to ensure improvement continues in the NHS. Check out changeday.nhs.uk to find out more.

Battle Intelligence

February 24, 2014

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I guess it’s important to learn when to pick your battles right. What if your name’s been bastardised? As if some other person is gaining the recognition and benefit of your hard-work. Is it even worth the fuss when you work for something much greater than personal recognition?

The biggest healthcare social movement the world has ever seen [Link]. That’s something else worth fighting for. The obstacles you have to overcome in the systems you work within. The irony of being a radical in a radical team. Small skirmishes that sharpen the sword.

Late twenties is the weird age where you aren’t sure if you’re old enough to be acting like an adult. Or young enough to be masquerading as a young ‘un. In your twenties you learn that you never really become an adult, just that people start expecting you to act like one. So you start pretending to be grown up, even though you still feel like a child

The best things in life are free. The things worth fighting for, aren’t. There’s often a dear price to pay. Take the UN Association youth conference the other day. Quite a sweet affair to be honest. Until my soul couldn’t take it anymore and I had to speak out at the technocratic and elitist atmosphere I couldn’t stomach. And that’s from a Young Fabian studying for an executive MBA at the world’s most international business school!! I think that’s a battle worth fighting for. The UN is supposed to be open to all and accessible. Was it fuck?

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I don’t have many goals in my life. Find the ying to my yang. See west ham win a trophy. Simple, me. My parents visited just a few days ago, thanks to the cultural-identity-personality-complex my old man invites on me, I’m really not sure which battle I’m going to dedicate my life to. I guess it’s important to learn.

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Roll on 2014

December 16, 2013

Roll on 2014, 2013 has been a strong year. West Ham are still in the Premier League, I imagine we can win the league one day before I die. Seriously. I might just place a bet on it. I mean I took a couple of major risks this summer; quitting my job at one of the world’s biggest health consulting firms, just after getting accepted to do an Executive MBA at one the top International Business Schools… and instead of having another comfortable job to go to, I did a whole lot of random stuff instead. The office of the Mayor of London, Collabocart, Health Policy debates…this summer has been a journey.

F**K your comfort zone. It does not deserve to exist. Annihilate that bitch.

All throughout your life, it’s always been the one thing that stands between who you are, and who you want to become. Every time an opportunity has come up to step out into uncharted territory, to do something that would fulfill your soul, it’s been the invisible hand that squeezes the back of your neck and pulls you back at the very last moment.

Make a list of everything that you’ve always wanted to do, but you’ve always let fear hold you back from doing. And one by one, starting with the smallest, do them. I’m incredibly grateful to having my old man as my old man, and best friend. As a Pentecostal-Gospel Christian, my old man was always into harnessing spiritual, psychological elements of life. Unfortunately, no one told him the Uri Geller tapes (yeah, this was a long time ago kids) he bought were to be taken with a pinch of salt and his ramblings about bending spoons soon left a mark on the congregation. I love that man. He keeps leaving marks on me that encourage me to be better. Right now, he’s in Nigeria managing his retirement portfolio. My earliest life memories are staying in the battered Nissan, whilst he and my mum cleaned offices in Central London. Babysitters wasn’t really a Nigerian concept. When we got a little bit older, we then helped take the rubbish bags down the stairs and remove the expired milk from the back of fridges. Fast forward and I’m calling him from one of these London offices having just discussed the agenda for influencing policy on A&E with key stakeholders.

I remember coming home from school to see him transfixed at the TV screens immediately after 9/11. He told me in 4-6 years time, Islamaphobia would increase as a result of this and we had a discussion about immigration policy. My mum worked in the housing sector of Tower Hamlets, her stories about public housing policy were just as interesting. In and around all of these discussions and thoughts were obvious connections, well to me at least, about the role and effects these things have on our health.

Destiny   Define Destiny at Dictionary.com

Some people say that we choose our Destiny.  This can come about by an act of steel will or by unattended default. By action or inaction, we all arrive at a Destiny.  One may see Destiny as a destination but it’s really a manifestation of the journey and the arrival, the crystalized understanding of your purpose. It doesn’t half help when you have a spiritual God-given theology to drive home the message either but my fortune of late hasn’t been half bad, I think.

I don’t know what the inevitable course of events for what someone like me is. Some people seem to have an idea and won’t hesitate to foist it on you. I’m grateful when people divert me away from journeys they (and I, initially) don’t realise aren’t irresistible course of events for myself. And when a path initially looks closed, I go back to the drawing board, read from others and sharpen my instruments to chip away at the block in my path.

I wish I knew what my ‘love-destiny’ was. I have a rough idea, but would like a definitive one… How does love really work?

When you have problem-solving skills that work wonders for your clients, helping them figure out how to satisfy shareholders and patients, whilst solving healthcare problems… is satisfying. Giving advice to health policy experts over dinners next to the Thames is equally satisfying. Helping support people getting engaged in positive change, just as satisfying.

Whenever you’re at a crossroads, feeling uninspired or lazy – do what the person you want to be would do. You have a purpose, you have a vision and no matter what, you have a Destiny. The course of action adopted and pursued by a government or political party can be said to be what ‘policy’ is. Luck has little to do with anything, but rather the strength of our imagination… and if I believe West Ham can win the league one day, well you know what sort of daydreamer I am then don’t you? Roll on 2014, 2013 has been a strong year.

Reform the contract between NHS and the people

November 23, 2013

I’ll dare to say it: amid concerns that the government is selling off parts of the NHS and privatising the service through the back door, the NHS has become the best business opportunity in Britain today.

The National Health Service is a behemoth of a machine, the fifth biggest in the world in fact. There are £millions per year in shareholder value just waiting to ooze out and it’s never been in a weaker state. And the need to win the ideological argument for public ownership of the right to healthcare has never been greater. Take the recent privatisation of Royal Mail, for example, which generated £1 billion for the market as public ownership supporters lost out to Royal Mail’s thirst for private capital.

Since victory favours the brave and all that, it’s worth thinking about the fearless ideas that might be needed to save the NHS from a similar fate.

This week, there was a report by the Academy of Royal Colleges which concluded that current NHS practices where consultants don’t visit patients every day of their admission was “ethically unjustifiable” and that “it is not acceptable that over weekends and bank holidays, patients receive a lower standard of care than they would during the week.”

So, everyone should continue to have the right to receive the same standard of care, any day of the week. But why do some people feel uncomfortable with the birthright to free healthcare?

If you argue that health/healthcare is a ‘right’, you make the assumption that everyonewants to be healthy. But if we’re daring to be brutally frank, not everyone wants to be. Some people smoke, others fail to exercise and consume high levels of sugar, and some don’t take their medicines properly. Some people choose to be healthy yet are still obliged to pay for the care of those that don’t.

It’s a crude generalisation of the lifestyle determinants of health, but it can be a starting block to help understand why some people don’t believe in public ownership and state intervention of a free-at-point-of-access healthcare system. So what kind of ideas can convince more people that public (non-market) ownership of the NHS can still work?

Let’s first briefly remind ourselves about negative and positive rights. Many things, such as freedom of speech, are actually negative rights because they’re declarations that no one can stop you from doing a specific thing. Positive rights are a right tosomething, where something needs to be created before the ‘right’ can be fulfilled.

And the 21st century challenge of facing positive rights is quite obvious; they cost money.

Those who feel uncomfortable with a birthright to free healthcare see the apparent disconnect between giving positive rights to people who chose to abuse it. Now, rare genetic diseases, mental health issues and many other ailments are not the result of people’s choices, but the issue of health is – for most – deeply intertwined with the issue of lifestyle.

If Fabians aim to promote the value of collective action, maybe ideas about a fairer contribution from the public are necessary to bring the rest of the population onboard with a 21st century idea of positive rights to healthcare.

As it’s the 50th anniversary of US President John F Kennedy, I’m reminded of something he said to journalists at the Department of Health, Education, and Welfare in 1962:

“A nation that is afraid to let its people judge the truth and falsehood in an open market is a nation that is afraid of its people”

People who believe in a leaner state aren’t evil (well, at least most of them aren’t). From where I’m standing, they just prefer neoliberal health policies like commissioning, outsourcing and the free market because it prevents abuse of sovereign rights. The fact that markets impose competition, and so finance dominates over social values, to them, is just a consequence of preventing what they call injustice.

The NHS (somewhat like the Royal mail) will truly be one of the best business opportunities in the UK if the left can’t come up with ideas that demand a new contract between the NHS and the public. Commissioning services splits the client (who identifies needs, plans and pays) from the contractor (who delivers) and creates an ideological divide and different vested interests.

It might be too late to ever bring the NHS 100% back to public ownership, but it’s not too late to come up with ideas, away from the politicking, that help win the popular ideological argument.

Promoting healthy behaviour is ambitious and requires a long-term commitment to change complex behaviours. What works for one isn’t always likely to work for another. But ideas such as making sure that health promotion is fully embedded into national and local policies and hospital performance indicators are the types of ideas that support the creation of a sustainable contract between the public and the NHS. Even braver still, we could ensure health promotion is also close to the heart of policies in other governmental departments like housing, policing and transport. The bravest thing would be to mandate it.

No one likes the legalistic requirements of law but ideas that penalise smokers or people with unhealthy lifestyles (e.g. a sugar tax) have proved problematic. More airlines may soon start to charge people according to weight, proving markets might address these issues eventually.

Markets have been eyeing up the NHS for a while now. Let’s reform the contract between NHS and the people, instead of reducing universal healthcare into a lucrative business opportunity.

Adebusuyi Adeyemi is on the Young Fabians Executive and Chair of the Young Fabians Health Network

Labour must support the drive to help Africa produce its own vaccines

October 19, 2013

Originally first posted @ http://www.leftfootforward.org/2013/10/labour-should-help-africa-vaccines/

 

“What are the lines then, Jim?”.

One can imagine Ed Miliband asking MP Jim Murphy, the new shadow secretary of state for International Development, this question.

Sitting in one of Parliaments’ gilded, judge-like thrones, Ed might be expecting ideas to address the failure of British banks to comply with money laundering-prevention laws. Or maybe an attempt to put Jim Murphy’s fingerprints on the Ivan Lewis/Tessa Jowell campaign to invest in early childhood?

What could his bold and radical idea be?

How about investigating why African states don’t appear to grapple with their health problems more directly and provide more of their own vaccines?

Let us just note – to begin with – that there are a number of domestic programmes and native providers of vaccines in Africa. However, taking a broad economic look at the problem, a more Labour-inspired approach could be sourced; one that signals a 2015 Labour government as bold and globally leading on the values of social justice.

The past 20 years have seen a massive redistribution of economic power to the emerging world and, thanks to an increase of generic medicines and globalisation in general, it is arguable that we don’t have to be so protectionist of our pharmaceutical industry anymore.

The notion of ‘International Development’ is a multifaceted and inherently complex concept, which varies according to the specific country conditions and the donor governments one is referring to. The notion of ‘International Development’, particularly when it comes to donating vaccines to Africa, could do with an injection of boldness and new ideas.

Handing out the leftovers of a pharmaceutical companies’ drug portfolio is not enough – by a long stretch.

Some are waking up to realise that the western-donated-vaccine model, with vaccines that aren’t originally designed for Africans countries and that cost too much, is not sustainable. Working on the frontline in some of the more resource-poor African states, Médecins sans Frontières (MSF) argues that vaccines from the Western taxpayer’s purse cost too much and are not designed for the needs of hot countries like Africa.

Dr Manica Balasegaram, executive director of MSF’s vaccine-access campaign, says:

“It [donated vaccines] looks to us like a big subsidy for pharma – there is no other way of saying it really.”

With the World Economic Forum’s Global Competitiveness Report ranking 13 sub-Saharan African economies among the top 100 in the world [2012], African leaders are seeing that their macroeconomic policy and fiscal reforms are working.

Yet when it comes to closing the financing gap for vaccine programs, a number of governments have not been innovative or brave enough.

African leaders can and should follow through to bring reforms to their healthcare markets. The time is right for this to start changing; and if a Labour government doesn’t guide this change, the Chinese government will and will reap the rewards.

Currently, the foreign Advance Market Commitment (AMC- a global vaccine funding mechanism) gives drug companies an incentive to offer vaccines. The ideological argument that was once put forward was that with time, as African becomes more prosperous through a healthier work-force, local markets will be able to compete.

Ideas such as the one that birthed the AMC are laudable; for while donations and the motivation vaccine funds embody are extremely humane, issues of absolute country ownership and long-term sustainability still exist.

In closing, there are two important things to consider.

Firstly, there is a growing African middle-class that is driving demand and organically creating market capacity and opportunity for a different response to donated vaccine programmes. Secondly, Gambia’s departure from the Commonwealth may or may not be the start of a trend.

From his gilded seat, Miliband could eye the opportunity to take on the global leader status his old teacher Gordon Brown benefited from.

By proposing something truly progressive and economically forward-thinking, along the lines of true development (i.e. Africa producing its own vaccines), Labour could also win over those to the right (limiting foreign aid) and ensure the BME vote isn’t truly neglected.

Maternity cuts widen the equality gap

October 2, 2013

Originally posted @ http://www.fabians.org.uk/maternity-cuts-widen-the-equality-gap/

Ok, let’s just put it out there: fringe events first thing in the morning are about as attractive as Danny Dyer films and sometimes, as tiring and predictable to sit through. Still, Danny Dyer has just joined EastEnders so there is an appetite for these things and Brighton delegates did turn up in good numbers early Monday morning, so what do I know? Well, I do know the Fabians Women Network were proud to join with the Young Fabians Health Network to serve a tasty discussion on the future of maternal health in austerity Britain. With the Royal College of Midwives (RCM), NCTMaternity Action and a good number of delegates feeding into discussions, the agenda to address gender equality focused on maternity services in the UK.

In tough economic times, women not only bear a heavier burden, but policies to close the gender gap generally fall by the wayside. Professors Francesca Gains and Claire Annesley from Manchester University’s School of Social Sciences have proven as much1,2, investigating when policies to promote gender equality managed to capture government attention during economic downtimes. They have shown that government attention for gender equality issues is higher when economic indicators are positive and unless you work for the Chancellors’ office, you would be hard pressed to describe recent economic indicators as ‘positive’. Indeed, it takes high public confidence in the economy to secure government attention for gender equality issues and other studies support the conclusion that costly gender equality policies only get attention in response to legal or institutional challenges. That’s why for the benefit of British women, we’re proud to align with institutions like the Royal College of Midwives to combat the lack of investment in Maternity services over the last 3-4 years.

So, early Monday morning, our panellists kicked things off by serving up details on the lack of investment and the trouble it is causing. Jon Skewes, Director for Policy, Employment Relations and Communications at RCM remarked that because of a dearth of midwives, new mothers are sent home too early. New mothers find feeding difficult and aren’t getting enough help. They’re in pain, or unsure of how to care for their babies and Midwives & Maternity teams feel frustrated and helpless under the increasing pressure.

Some academic studies have shown the economic progress of women has stalled3. Evidence [e.g. gender pay gaps] is strongly suggesting labour market outcomes won’t be the same for men and women and the earlier debt crisis has compounded the reluctance of some on the right to recognise that society depends on the state. An equal society for men and women is the ‘great war’. The 2015 battle for women’s votes has been set: Labour’s childcare call, free school meals from Lib Dems, Tory married tax breaks. Improving maternity services can be a deadly and effective weapon.

Director of Maternity Action, Rosalind Bragg explained how cuts to NHS maternity services are impacting on care, saying “there is a growing sense of frustration at the short-sighted nature of cuts to NHS maternity services”. In fact, the Care Quality Commission and the RCM have each raised the alarm about midwifery numbers. The UK has been experiencing a baby boom. Between 2001 and 2010, the number of babies born each year has increased by 21%. During this time, midwifery numbers have increased by just 15%. Recent birth rates have not declined.

Furthermore, in 2005, an estimated 30,000 women each year lost their jobs as a result of pregnancy discrimination. Pregnancy discrimination has increased since the economic downturn and latest figures put this number at almost double. Women who lose their jobs as a result of pregnancy discrimination tend to experience a significant drop in income. Of those women who lost their jobs as a result of pregnancy discrimination, 8% pursued formal action and only 3% took their claims to the employment tribunal. That’s dismal. Women face significant barriers to exercising their rights including: competing demands of motherhood, access to advice services, employment tribunal fees and negative attitudes towards maternity rights.

We think we’ve got clear election-winning solutions to address pregnancy discrimination (i.e. gender inequality) following the economic downturn; adequate funding for advice agencies; dropping planned employment tribunal fees; and clear statements from Government on the value of maternity and parental rights to families and the economy.

All our panellists, including NCT’s Senior Policy Adviser Elizabeth Duff conceded that the Government’s response to the growing problem within maternity services did not inspire confidence. Although the then (May 2012) Minister for Health announced that women will have one named midwife to oversee their care during labour and birth, there has been no mechanism to support this announcement: no new money, no stipulation in commissioning arrangements, and no monitoring process to assess compliance. Without any framework for implementation, that announcement looks on the floor. That’s Danny Dyer cockney rhyming slang for ‘poor’ by the way.

Women deserve a stronger voice, particularly when they are giving birth. The hunger for this deserves to be addressed. Without a Brussels Sprout [doubt], we can do grandma sweater.

Adebusuyi Adeyemi

1 Whistling in the dark: The Conservative’s strategy for winning women’s votes is optimistic and directionless | The Political Studies Association (PSA).

2 Annesley, C. and Gains, F. (2012) ‘Investigating the Economic Determinants of the UK Gender Equality Policy Agenda’ British Journal of Politics and International Relations

#BerlinGang

September 25, 2013

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