Chaos, complexity and the space between – not knowing

It’s funny how sometimes you can be totally wrong about someone, or something. Last week I attended a lecture at my university, (University of Salford). I wasn’t sure I really wanted to go. It was pure curiosity that had made me book a place in the first place, as the lecture’s focus, ‘Introducing the Greater Manchester Integrated Care System’ was something I felt I already knew plenty about. I have been living, breathing the whole integration/collaboration approach for the past few years. I wasn’t expecting any kind of epiphany, real insight or even anything remotely new from the lecture – Presque vu. So, why was I going, you might be asking?

Well, I hadn’t physically been on the university campus since before the pandemic, and wondered what I might have been missing. Not a great reason maybe, but I have always been curious and I knew that much had changed since I had last been there. More importantly, it was the speakers that drew me in. They were all women. All were successful in their own field, and although I knew them all, one in particular I hadn’t seen for over 30 years, although she had played an instrumental part in my career. Over the years I had followed her prestigious career. Her name; Sue Bailey.  

I first met Professor Dame Sue Bailey back in 1984. She was the first consultant child and adolescent forensic psychiatrist at the world leading Gardener Unit, part of what is now Greater Manchester Mental Health Trust. I was one of the first Charge Nurses to commission and develop the service. It wasn’t always fun. Sue was (and is) a driven individual who didn’t suffer fools gladly. However, Sue was hugely determined to ensure the individual needs of some very troubled and troubling children and young people were recognised and addressed. Each child was at the centre of all her decision making.

In 1993, Sue was an expert witness in the James Bulger murder trial. James was two years’ old when he was abducted from a shopping centre in Bootle and murdered by two 10 year old boys, Robert Thompson and Jon Venables. At the trial, Sue concluded that one of the killers, Jon Venables, knew the difference between right and wrong. It was this opinion that led them both to be convicted of murder. They were the youngest ever convicted killers in the UK. Sue didn’t abandon Jon and remained his psychiatrist throughout his adolescence. Jon, now 30, remains a troubled individual who has twice been sent back to prison for further crimes.

Having not seen Sue for all that time I was intrigued to meet up with her again, albeit the circumstances didn’t feel that enthralling. How wrong could I be. Sue - now a Non-Executive Director on the Greater Manchester (GM) Integrated Care Board (ICB) - was taking part in the ‘on the sofa’ series of professorial lectures alongside Professor Sandeep Ranote, also a child psychiatrist, Charlotte Ramsden, Director of People Services at Salford Council and Dr Manshir Kumar, Chief Medical Officer for the GM ICB. Rather than giving what I expected to be a rudimentary account of what an integrated care system (ICS) was, they chose instead to reflect on their experience of the last six months; also drawing on the previous six years of GM devolution.

Sandeep started the conversation off. She loves to talk in statistics. She has a remarkable ability to draw upon a encyclopaedic and contemporaneous data store in the telling of any particular story. She does it so effortlessly. So, I was surprised when apart from some statistics sprinkled into her opening few sentences Sandeep chose instead to draw upon two artists to illustrate her reflections. The first considered a Jackson Pollock painting. He is a Marmite kind of artist, and I don’t like his work at all. I understood the way Sandeep drew on one of his paintings to show both complexity and chaos and reflected that this might be where we were in the development of our ICS. Like Pollock’s painting, in totality, the ICS is still a thing of interest and purpose, even if not everyone might see this.

Her other artist was someone I hadn’t come across before – Verity Markham. She is a poet and writer, whose words are beautifully illustrated by Victoria Rusyn. Sandeep chose to share a recent poem that struck a chord with me:  

And in this beginning,
there is every space
to let go
and embrace the chaos
uncertainty brings

For more years than I can remember now, I have written and talked about the gap between ‘knowing’ and ‘knowledge’, it’s a place of ‘not knowing’. Sometimes an uncomfortable place to be, a place of anxiety, but it is always a place of learning, and of possible understanding. It is an approach that has stood me in good order in my clinical, academic and leadership roles. Verity Markham’s words resonated as did Charlotte’s, as she in her turn talked about the GM ICS ‘fizzing’ with opportunities despite these complexities. The discussion made me think that if we were to achieve real transformation in health and social care services and truly address health inequalities then perhaps, in GM, we had to unlearn all we had learnt over the previous six years of devolution. The pandemic gave us all the knowledge and knowing of collaborative working. We need to return to that early unknowing space of how to deal with the pandemic and once again be unafraid to make mistakes, to learn to trust, and to build a new future.

I met a lot of folk I hadn’t seen for many years that evening. It was a joy to say hello and talk briefly about where people were at. In a crowded room, Sue and I found ourselves suddenly standing together. ‘It’s been a long time’ I said. ‘Hello Tony’ she replied. For a few moments, we talked about the intervening years and what I was doing and how it connected with the work of the ICS. We had a brief hug, a shared smile and then I was on my way back home feeling very glad to have been there after all.