Conversation starter: Ian Smithies (City of York Council)

Ian wanted to know our thoughts on smart technology – what do we define it as and how do we see it fitting into our lives? 

What is smart technology? Is it the data we use, is it our transition into a digital world, is it AI?

We spoke about those users who aren’t ready to embrace smart technology. How do we reach the generation who aren’t confident going online? How do we support them from a digital perspective? 

We looked at the example of LiveWellYork, who used a human support system to help users engage with their website. They also used partners who had regular face-to-face contact with this section of their audience to help integrate their offering and encourage access. 

We talked about data and making the most of it. We looked at the data gathered by LiveWellYork and how it can be used in multiple ways. It’s a waste of effort to gather research for one purpose and then discard it – data needs to work hard. We could use it to find out where the city is rich and where it is poor. Who needs more arts and crafts groups? Which areas need better access to care?  

The gathering of data like this relies on trusted relationships, like those with the partners mentioned above. These sources need to be nurtured and built upon. 

Later, the discussion turned to the application of new technology in health and care settings. New tech can be appealing (the allure of the shiny new gadget!) sometimes we want it but only use it once. We need to understand its application better. What can it do for us? How can we get the best out of it? How should we use it to improve our work and lives – and those of our patients and service users?

The group also discussed the growing awareness of aesthetically pleasing wearable tech for patients. We are leaving behind the days of clunky clinical aids. We want tech that looks as sleek as the rest of our lives. 

Conversation starter: Nicholas Dugdale (Hapnin)

Nicholas wanted to discuss ways to bring people together to improve their quality of life. He is keen to draw together a community that wants to put on their own activities and support them to do it. His fledgling social enterprise, based in York, is called Hapnin. 

Denise shared her own experiences working with people on the edges of society, the challenges they face and how little support there is. We talked about initiatives already running that support these people, e.g the carers Christmas Dinners, started by Lemn Sissay MBE. Wouldn’t it be great to have one in York too? 

Denise shared her experience of fundraising and running a large event for care leavers in Liverpool and how well received it was by the participants.  

We need to facilitate the building of networks and communities for those who have little support of their own. If only society could be like a big family for everyone, especially those who are vulnerable and need it most. 

Conversation starter: Mike Richardson (City of York Council)

This discussion was borne out of the concern that patients and service users are treated as their presenting condition rather than as individuals with complex needs.  

Shoehorning patients/service users into services that do not properly fit their requirements is an inefficient way of dealing with people’s problems. It costs money and leads to individuals failing to receive the care they require. Could we flip it around so that we treat the human first, instead of the condition? Take a more holistic approach? 

Perhaps there isn’t a pre-existing service or piece of technology that can solve their issue, but then we can think constructively about a solution that really works, instead of simply passing the buck. 

Mike gave the example of an individual with multiple, layered issues such as a homeless person who may also be dealing with addiction and mental health problems. All these issues are interconnected. It is difficult to treat any one in isolation. Consequently, this individual is likely to end up trapped in a cycle where nobody is really helping them, so they never get any better. 

Another example was given of an elderly woman whose initial complaint is that she can’t get out of her chair. Our current model will identify a frailty issue, possibly send a carer round who will help her in and out. However, if we look at the desired outcome – the woman wants to get out of her chair to do what? Can we help her achieve that final aim? This will help more with her quality of life, retain her social connections, as well as keeping her more mobile.

If we treat people as individuals rather than conditions, we give ourselves permission to think more broadly about the solutions they may require. 

Conversation starter: Chris Bailey (Guild of Media Arts)

Chris opened by saying the results of research on life expectancy in various wards of York had been particularly shocking. What can be done to make use of public space to bring communities together and begin to close the gap? 

We discussed holding events in public space that deliver education but under the umbrella of an activity. For example, you could hold a football tournament, and use it to deliver information around nutrition and exercise. The events become a hub for the community, but also a means of communicating with hard-to-reach groups.  

The group agreed that people attending these events often have as much to give as they receive, so we need to be aware of that and harness it. Empower people to be a part of the events they are attending. It should not be simply a passive experience. 

Denise commented that she sees a lot of community events where the majority of attendees are middle class. How do we engage working class people? Can we be more creative about the type of events we put on, get input from different backgrounds about what they would like to see? Could we then use that information to shape events around the needs of working class people, or support them to create their own? 

Conversation starter: Griselda Goldsborough (York Teaching Hospital)

Griselda’s experience of working with teams who work in end of life care,  made her wonder if there was any way virtual reality (VR) could be used to revisit old favourite places or memories. Are there any other ways we can use VR creatively in health and care settings? 

The answer seemed to be a resounding “yes!” particularly from two members of the group who work in UX for Health Education England.  They have experience of commissioning VR projects in healthcare settings. 

Their first example was working with a trust in Torbay to rehabilitate a patient who was partially paralysed. He was a keen cyclist, so the team created a film of one of his routes, then using VR and a specially adapted bike, the patient could ‘cycle’ along his normal route using just his hands. The project was a success. 

With regards to practitioners, Nick Perez was mentioned, a former cameraman doing great work in VR. However it should be noted that his availability is currently limited to one day a week due to other projects. 

Griselda asked how long these projects usually take to complete? We learned that it really depends what the scope is. Complex projects can take some time. For example, a VR experience that allows you to approach a road traffic accident as various different emergency services, respond, have conversations etc requires the creation of multiple perspectives and timelines. It would take much longer than Griselda’s proposed trip to the seaside, for example. 

Discussion turned to other ways we might use VR for training staff. We learned about VR experiences that allow users to go into the homes of elderly people, play out a normal interaction with the patient whilst looking for areas of concern (e.g. empty fridge, lightbulb not replaced). It’s a great way to help people learn how to spot signposts in a more visual, realistic way. 

There is a huge uptake of VR technology and demand is increasing. It’s very tempting to embark on a VR project as it’s such exciting tech. However, we need to assess the value carefully. What are the learning outcomes? Could they be achieved just as well in other ways? Or will the VR technology enable you to achieve even better results? 

 Conversation starter: Jake Freeman  (Secret Helpers of York)

The group discussed the ever-lengthening waiting lists for mental health treatment under the NHS. Instant responses are only for the critical and most GPs are not trained to deal with patients who are suffering. For some people the wait is simply too long. What can we do to give support during the waiting period? 

The group came up with a “buddy up” system, a safe space where people can go and talk to others who have been on their own mental health journey. This sort of community support could be lifesaving. We agreed that many people who had struggled with mental health issues would be happy to step in and help others.  

Who would organise the efforts? We decided charitable organisations would be in the strongest position to do this. 

Conversation starter: Rebecca Carr (Kaizen Arts Agency)

We discussed the factors affecting the success of community and social housing. We agreed that simply having a community building doesn’t automatically make a community. Systems need to be in place to help groups cohere.  

We discussed how shared space in the building, free to use, bookable for community benefit, can be a good way to bring residents together. But is that space ever really free? Perhaps a co-op model would allow the extra money to pay for it. 

However great your community is, there is always the chance someone new will come in and upset the dynamic. It’s just human nature. That’s why similar social groups are often put together, because there’s more chance that they will gel. 

Discussion turned to affordable homes, and giving residents the chance to own their homes. Both ultimately lead to the loss of affordable housing, as houses are sold on for increasing amounts of money. Houses by York University, which were once affordable properties, are now worth significantly more. Many have been turned into flats, leading to a lack of family homes in the city centre. This is a pattern we see repeated in many cities. So how do we keep a flow of affordable property available for those who need it? 

There was a general feeling that this issue is somewhat inevitable. Most people will opt for money over community. And you can’t change people. Not a cheerful thought, but perhaps realistic. 

Conversation turned to independent living schemes, of which there are nine here in York. All will have communal areas. But do they really feel like home? Can we give people more ownership over their space? How would we do that? Could they have more input into how the spaces look, the events that take place? 

I returned to the group later to find them talking to architect Lauren, who was interested in finding a way to make the design of care homes more people-centred. Currently they are being built by developers who have little understanding of their function. The system is very disjointed.  We need to find a way to give the operators some input, so the design is more suited to the running of these homes. But how to do it when the operators don’t hold the purse strings? 

Rebecca suggested crowdfunding a community share so that the model could work from the ground up, rather than top down.

Yet another example of space that might benefit from being put back into the hands of the people who live there – or work there, in this case – rather than those simply providing capital. 

Friday 13th December – SPARK, York

So it was the morning after polling day that we got to host our second Thrive Together Event in York.

No doubt for many of the folk it was a morning full of hope and possibility.  For others of fear and sorrow.

But we all gathered together to meet people with passion, responsibility and sometimes both to talk more about what might effectively transform our experiences of health and care in York.

A group people from a range of backgrounds, and all over the north of England, came together to take part in the ‘Open Space’ afternoon to explore how technology might be used to transform health and care.

We held a total of 8 conversations over the afternoon.  These are listed below and each is accompanied by a short write up and some graphics too.  Just click the links on the ones that interest you.  And please do join the conversation by using the comments to add your experiences and insights or to ask questions.

Once again, it was a pleasure to see people smiling, connecting with new people and generally enjoying the work despite the divisive circumstances of the election.

Here are the conversations…

1. 1. Rebecca Carr, Kaizen Arts Agency:  Does Community Led Housing Work?
   2. Jake Freeman, Secret Helpers of York: Mental health and everyday life: getting past the stats
   3. Griselda Goldsborough, York Teaching Hospital: How can we use VR in health and care settings?
   4. Chris Bailey, Guild of Media Arts: How can we use public space to enhance human rights?
   5. Mike Richardson, City of York Council: Humanising health and social care 
   6. Nicholas Dugdale, Hapnin: What does social health look like? 
   7. Ian Smithies, City of York Council: Smart tech: what are your experiences and expectations? 
   8. Laura Howard, Artist: Can we use healthcare images to empower and educate patients?

We’d love to know what you’ve learned, reflected on, what you feel you want to continue talking about. If you’d like to write a post for the blog, share your notes or help us connect with other people who might like to join the conversations please do let us know through the comments here…

If we can connect people with passion and responsibility around some of these conversations perhaps we can start to make a change…

Conversation starter: Laura Howard 

Laura is really interested in the power of visual images to convey information. In health and care we produce many visuals – scans and x-rays for example – but these are used solely for staff to refer to. Are we overlooking a valuable resource? If we used these images to educate people about the nature of their injuries or condition, could we improve their understanding, enabling them to play a bigger part in their own treatment and recovery? Could we empower patients with this information?

The group discussed the challenges of scalability, how a radiographer could have a conversation with each individual when they look at many images in a day. Despite these challenges, it was agreed there is an important point to be made about patients feeling engaged in their treatment and being dealt with as human beings. Patients should be active, not passive, within the system. 

I was Head of Applied Leadership at the NHS Leadership Academy for three years and was asked to sit on the ‘Building a Digital Ready Workforce’ National Steering Group.  This led to me thinking about what we needed to do to help the boards of NHS organisations in particular to lead the transformation of Health and Care Services making the most of ‘digital’ – whatever that meant.

After much thinking I started to believe that it didn’t really matter what we did to develop boards; workshops, bootcamps, maturity matrices or conferences about AI and genomics. Until we changed how they saw their world and tasted different ways in which they might be able to lead in it, they were unlikely to make substantial changes in their strategy.  They might drop a few tens of millions on a new patient record system – but would that really transform? Would that allow new patterns of power and relationship to emerge? Or would it just take some kinks out of the current system?

For me it felt like doing ‘the wrong thing better’.

But what was the right thing?  The thing that might ‘develop’ the system?

The thing that went against the habit of Board rooms, Board tables, agendas, PIDs, rag ratings and budgetary decisions?

Against hierarchical expressions of power delivered through plans and Gantt charts and (not so carefully) managed variances?

Well for those of us that have worked a lot in civic society, in community development, the place to look for some clues was clear.  Self organisation. Emergence. Transparency. Relationships, Inclusion, Diversity and Trust.

Work in the spirit of pioneers like Harrison Owen, Peter Vaill, John McKnight, Peter Block and others.  It was about leading with communities not over them or for them.

Connecting small groups of people with the passion, responsibility and power to make change happen locally and to invite the formal power structure to sit with them and listen. To be influenced and to influence. but mainly to encourage and support.  To ‘unleash’ the power of these small groups that care to do their work.

And so we started, with the support of James Freed and Maeve Black at Health Education England and Ian Macintyre from the NHS Leadership Academy, on our project to use Conversations to Transform Health and Care.  To see if ‘Leadership as Convening’  might help to really transform Health and Care.

Open Space Events were planned for York, Hull and Scarborough to see if we could find the people who might really have the passion and the responsibility to transform health and care and whether we could help them to find their power….

Just follow the links to see a short film about what we did in each location and to explore what the people that can wanted to talk about.

What is Open Space?