Paddles and Privilege

I’m delighted to confirm that I’ll be joining Glasgow Watersports as Chair of the Board. This opportunity represents an interaction between two of my interests: outdoor pursuits, and health inequality.

Growing up, I was never really a ‘sporty’ child. Whilst my twin brother excelled at football, I struggled from sport-to-sport trying to find my game. I remember one awful Sunday morning as I cheered my brother on from the sideline, an injury occurred and I was called on as a sub – I could have died. After less than two minutes I was being stretchered off with a pulled calf muscle. I think the only person there more embarrassed than me was the manager whose bright idea it was – despite my protest. “You’re a Charlton, of course you can play football…”. Well, I showed him…

Football, basketball, hockey, and rugby, I tried them all but none of them worked for me. (It’s a shame that I grew-up pre-Quidditch, as I think that was probably my calling…). All of the sports that I tried were too rigid, too organised. I liked being free, going where I wanted, when I wanted. I was fortunate to grow up next to a park with a spinny – a group of trees that was as close to a woods as I was going to get. It was in the spinny where I ran, walked, explored, sat, and escaped. I wasn’t really doing anything in particular as such, just exploring the woods, collecting leaves, sticks etc. Looking back, I guess you could call it exercise and mindfulness, but it was effortless. I knew then that I enjoyed being amongst nature, and that being in nature was as good for my mind as it was for my body. I didn’t give it that much thought, I think because nobody else did. There were no medals or award ceremonies for finding the stick most like a gun, or best adventure in the woods, and the concept of ‘mindfulness’ hadn’t reached me yet.

My experience of open space providing happiness is supported by a King’s Fund report. The report highlights that the proportion of open spaces is linked to self-reported levels of health, including mental health, and that this is true for all ages and socio-economic groups.

A few years later, there was an opportunity to join a school trip for a skiing break in France. My heart lept at the thought of experiencing nature at this extreme. But it was a short leap, more of a hop, at the end of the announcement came the price of the trip. With Mum working three jobs and with me as one of five children, there was no way that we could afford for me to try skiing. Mum was great, and instead we took a trip to a dry-ski slope (imagine a 45 degree slope clad in astro-turf), but it wasn’t the same. In the end, the proposed ski trip at my school had to be cancelled. Not enough parents or careers could afford the cost. This was the first time that I experienced the inequality of ‘elite sport’.

A recent BBC Scotland Investigates programme, The Medal Myth highlighted that little has changed since my experience. I was shocked to discover that approximately £350 million of public money has been spent on Olympic Sport in the last four years, but I wasn’t surprised to hear that 90% of performance athletes had attended a fee paying school, or a state school that served an affluent population. This is a massive financial investment where there is already a degree of wealth. What about the me’s of today? How can we make these ‘elite sports’ more accessible to the majority of citizens?

Glasgow Watersports primarily operates as Pinkston Watersports, a community paddlesports centre and Scotland’s only artificial whitewater course. Pinkston is situated in North Glasgow and is part of the communities of Sighthill and Possilpark. According to the Scottish Index of Multiple Deprivation, these neighbourhoods are ‘deprived’, though like many other communities that share this label, and like the community in which I grew up, they host a wealth of assets. Despite generations of structural and systemic challenges, Possilpark and Sighthill are thriving communities that are home to numerous peer groups and volunteer-led activities and services. They also benefit from close proximity to a number of green and open spaces, including the Forth and Clyde Canal, yet these communities have some of the poorest health outcomes in Scotland.

It’s important to recognise that having access to green and open spaces doesn’t necessarily mean that people will use them. Through my work with the National Links Worker Programme, I hear lots of reasons why people can’t or don’t access some of the resources available to them. Some of these reasons are structural or systemic, and require statutory intervention to be addressed, whilst some are personal and might be overcome with some encouragement, enablement, and support.

Like my spinny, the Forth and Clyde canal and other open spaces in North Glasgow offer citizens the opportunity to try a new activity and can help them to discover an unknown potential, and Pinkston can meet the needs of those feeling more adventurous. In adulthood,  I’ve been fortunate to advance my early experiences with nature, and now enjoy holidays where I hill walk and kayak. In fact, my positive associations with nature are so strong that I originally planned to propose to my (now) husband on a kayak – a bit of  risk assessing saw the ring at the bottom of a Norwegian fjord and so that plan was re-thought. If I hadn’t had access to that spinny, and enjoyed the first-hand benefits of spending time there, perhaps I wouldn’t pursue and protect nature so much in adulthood.

The confidence that comes from trying kayaking in still waters for the first time can quickly lead to the confidence to try whitewater rafting, or other new activities. Participation in any type of activity can unlock a previously undiscovered self-belief.

Through working with the team at Pinkston, I’m excited to engage with our neighbours in Sighthill and Possilpark and to hear what they would like from the unique facility in their community. Who knows, maybe a local resident will discover that one of the many watersports on offer is their game…

Q. or A? – Reflections on the Q Initiative

In May 2015 I was invited to apply to be part of the founding cohort of the Q Initiative. Described as an initiative to ‘connect people skilled in health care quality improvement across the UK’, I was intrigued to learn more.

Like many of my colleagues, I’ve worked in the field of public health long enough to see apparent ‘new’ initiatives repackaged, rebranded and pitched as another example of innovation. Imagine the new must-have toys at Christmas. The once new and exciting Tamagotchi became slightly more sophisticated and later evolved in to a Furby – arguably pretty much the same idea as a Tamagotchi but with a new fluffy outer-layer. Other must-haves then filled the gap for a while (Tracey Island (again!), Bratz Dolls (Barbie with pals), pretty much anything from the latest Disney animation,  before low and behold, the Furby was back – and this time it wasn’t even repackaged or rebranded- it was the same old Furby, only aimed at a new and previously unaware audience.

Clothing, music, toys – you name it and chances are that there’s very few examples of purely original thought in the market place. So it was with a slight caution that I applied to be considered as part of the founding cohort of the Q Initiative.

One of the features of the founding cohort of the Q Initiative that attracted me to apply was the opportunity to shape the future of Q. That candidates would have the opportunity to shape and influence an initiative that has the potential to transform improvement within the NHS. As Professor Don Berwick states;

“If this succeeds, the NHS in the UK will be leading the world in creating, at national scale, system-wide capacities for improvement. This is an appropriate, indeed thrilling, next step for an NHS that already has a heritage of sound investments and a proven track record in quality improvement”.

I completed my application honestly, communicating my anxiety and expressing my hopes and how I felt my experiences in learning and development could contribute to this unique opportunity. I sent it off and waited. In June I received an email confirming my place as a participant in the founding cohort. I braced myself to be inundated with reflective exercises, pre-course reading and plans for the first residential course. I waited. Nothing. I scanned the list of fellow participants: mostly clinical, mostly based in England, mostly statutory, mostly acute, mostly senior management. Uh-oh, the fear started to creep in. Might this be just another well-intentioned, well-resourced talking shop at an enormous cost to the tax-payer? After all, if we’re aiming to connect people skilled in health care quality improvement across the UK, surely one of the first places we should look is to the third sector? And surely, if we’re building a learning community shouldn’t we be reflecting  this from day dot, and adopting a blended learning approach? The course hadn’t even started and already I had donned my ‘black hat’. De Bono proposes that there are six ways of thinking, and those who wear the black hat tend to be critical and focus on the risks. I must admit, black suits me and I find the black hat very comfortable. I’m conscious not to wear it too often though, and took some time to reflect on this initial reaction.

This reflection led me to revalidate my concerns. Often the third sector is indeed third (and last) to be considered: health first, social care second, and us third. That’s one of the reasons that I prefer to talk about the social, or civic sector – but that’s another blog in itself. Some people see the third-sector as a group of people trying their best, but not quite as good as the statutory services. They fail to recognise us as the £4.63 billion industry (in Scotland) that provides over a third of social care services and 5% of Scotland’s workforce. If we don’t look to the third sector though, then we risk not seeing brilliant examples of innovation that are not only delivering care in a person-centred and co-produced way, but can also improve clinical outcomes as a result. Specialist nurses such as MS nurses and Macmillan nurses, links workers, Diabetes UK’s Advocacy service, dementia-friendly cafés, Men’s Sheds,, and countless condition-specific advice lines are just a few examples.

With these concerns live in my mind, and being mindful to pack more than just my black hat, I head south to Birmingham for the first deign event.

Even when queuing for the registration desk there was a buzz of excitement and energy. The welcome pack included a learning journal (woohoo, this might actually be different!) a Twitter hashtag had been provided, (see this Storify for an overview of the Twitter chat during the event), and there was some very intriguing props and visuals around the venue that left me with a mixture of emotions ranging from excitement that this really could be different, to dread – they’re not going to make us role play are they?!

The day started with an overview of the theory of Q and an exploration of what success might look like. The first audience poll (check out indicated that the vast majority of participants felt excited and I counted myself amongst them. After lunch the participants were introduced to the design process and were then invited to participate in a number of activities that explored three main themes: Understanding us and our world, Exploring how we will work together to design Q, and Exploring our hopes, aspirations and fears for Q. Almost 30 activities using various creative methods to explore these themes had been set up at stations throughout the venue and I started to feel the black hat creeping back on to my head. Given that we had been tasked with exploring fears for Q and wanting to remain open-minded, I comforted myself that perhaps a wee black fascinator could be appropriate millinery for the afternoon…

The venue became reminiscent of the Next Boxing Day sale, such hustle and bustle and a mixture of anxiety and excitement in the air. The passionate participants were eager to pin their speech bubbles on to the cardboard man, pin their knickers to the washing line, or scribble on the graffiti wall… I considered if this could be considered ‘accelerated learning’ but with a scheduled 17:30 finish and the evening drinks reception began at 19:00 I was concerned that I wouldn’t have time to reflect on and digest day one before the start of day two.

The plenary session identified day one as an ‘information dump’ and a second poll indicated that again I was not alone. The majority of participants identified as feeling overwhelmed or tired. I chose to trust the course leaders, embrace the unknown and hoped that day two would bring more focus and maybe even some outputs.

Day two came and despite the 15:30 finish, I was even more exhausted and overwhelmed than day one. The day consisted mainly of break-out sessions that explored different topics e.g. “What do you hate about networking (THIS!)”, and “What are the barriers to Q? Choose 12 barriers and explore how to overcome them in eight minutes”. NO! ENOUGH! Eight minutes to address 12 barriers to Q?! NOPE! Surely by participating in this activity we would be colluding with the idea that we (the health and social care workforce) can achieve what needs to be done in the limited time available to us if we just work harder. Our table agreed to choose one challenge and explore ways to overcome it properly. We did and we came up with some great innovative ideas in the limited time allowed. It was at this point that I began to question the role of anarchy in Q. I went to the graffiti board and drew on the Q logo overlaid with the Anarchy A as this was my over-riding thought for the two-days.

We could (and probably will) develop the best learning network and improvement materials for the workforce, but what is our role as Q fellows in challenging the increasing pressures that we face as a workforce to enable this network and tools to be effective?

Let’s go back to the Tamagotchi and Furby. Should we tweak the system and facilitate its evolution, or should we use the shared voice of 5000 Q fellows to radically change the way in which services are delivered?

I look to the private sector for inspiration.

The private sector is filled with innovation, and latterly innovation only made possible by technological advances. Skyscanner is a leading global travel search site and yet it does not own any travel agents or airlines. Air BnB does not own any B&Bs and Uber does not own any taxis or employ any drivers yet all are leaders in their field. What these companies did was think differently, they looked to transform and not to tweak, and they transformed with the experience of the end user in mind.

Improvement science is great for helping the Tamagotchi to evolve in to a Furby, but I question whether these incremental gains will be enough. What good is an established learning network and brilliant learning tools if the workforce doesn’t have time to use them? “Revalidation will sort that” answered a fellow participant. Will it? As a manager looking to release staff from the ward, what do I need to know about Q to support this decision – how will becoming a Q fellow be worth time away from the ward when you could also meet revalidation requirements with an online learning module? How much resource should we spend developing the network and how much in challenging the system? What existing infrastructures can facilitate this conversation to continue and what will the workforce require in order to utilise these?

It was these questions and others that kept me busy in my journey back to Glasgow and for the following days. The Q conversation continued amongst dwindling numbers of travellers as we shared our journey home. Some participants shared my concerns and others shared my enthusiasm. Whatever feelings we left Birmingham with, whatever opinions and judgements we shared, one fact remains. It is with us, the founding cohort of the Q initiative, that the power lies to make sure that this is not ‘just another improvement initiative’, that the Q initiative achieves its full potential. I draw parallels to the Links Worker Programme, The ALLIANCE’s Randomised Control study that seeks to transform Primary Care, and not just to tweak it.

The Q Initiative is not a ‘programme’, it’s a community. Like all communities it consists of a complex matrix of relationships and will face many challenges, but we will face them together. Successful communities thrive when they have a shared sense of purpose, a culture of sharing, a mixture of skills, commitment, and communication. I witnessed all of these in the first design event and it’s with a renewed energy that I don my black hat, and look forward to continuing the conversation…