Avoiding a rhetorical nod to achieving parity of esteem

I’m tired and feeling my age this morning. I found last week was long and tiring, both physically and mentally. At times it felt like I was playing catch up, but without actually catching up. That said, there were some very interesting and good things along the way. Monday was our first Board development day at my new Trust. Such days can be exhausting in their own right. There is a considerable amount of planning that goes on before the day and the delivery of the sessions can be unpredictable and demand full attention and concentration; more so, perhaps, where I’m facilitating a particular session. We did have a couple of excellent facilitators on this occasion, however, and that helped share the load. Apart from one person, we had the entire Board in the room. No laptops, phones or other distractions, everyone was physically and emotionally ‘in the room’. This helped ensure there was a good buzz throughout the day.

I described the day as a success. The focus was on developing ourselves as a Board, exploring what notions of ‘consistency’ and ‘continuity’ might mean for us individually and as a group. This felt particularly important, as the Board membership would be changing over the next six months. One outcome from the day that will go a long way to ensuring smooth transitions was being able to find out a bit more about the person behind the job title. Sounds a rather strange thing to say, but how much do we actually know about the folk we work with. I’m sure many of us might think we know something about the other, and of course things, like being married, having a long commute, being vegetarian and so on might be well known. Whilst helpful, such knowledge doesn’t always tell you much about the person.

For example, I became a vegetarian some 50 plus years ago. At the time, I had strong beliefs about killing animals just to feed ourselves, when there were so many other ways to feed populations. These days I’m less strident about such views; indeed, J cooked a rump steak for her dinner last Friday. It was something she enjoyed and which, despite my beliefs, her joy made me happy too. A simple example perhaps, but it does illustrate the complexity of our self, and our self in relation to others.

Whilst the Board development day was successful, it was somewhat predictably, top and tailed by other meetings. So, an early start and late finish to the day. Long days continued throughout the week. I had three consecutive 16-hour days, one of which involved whizzing down to London for an all-day NHS England meeting. It was a meeting between the NHS England Board and Integrated Care Board (ICB) and Provider Trust Chairs. Despite being born in London and living there for much of my childhood and teenage years, I don’t like particularly like the place. I find it crowded, noisy, dirty, expensive and often unfriendly.

In contrast, the meeting was a great opportunity to both nurture existing relationships and to build new ones. It was a chance to share experiences and challenges, and of course to meet with the NHS Board members. And in the midst of some doom and gloom presentations, there was a threshold moment of change in tone and approach by the NHS England Board. Frequently, by which I mean always, the focus is on the acute sector. Most presentations are framed around waiting lists, urgent and emergency care, reductions to cancer diagnostic waits, reducing costs and increasing productivity.

This focus is unashamedly often defended on the basis that such concerns are what forms the subject of today’s existential political gaze. It’s a fine example of the Foucauldian assertion of the impact that State intervention can have on what shapes our everyday lives. It also, perhaps, says something about how much our current politicians actually understand about the reality of health and care services.

The threshold moment? Well, a colleague from a mental health Trust cut across a speaker in mid flow and said ‘Enough! Where, in all of this, is the parity of esteem with mental health?’. A somewhat pregnant pause followed, before the speaker resumed, this time acknowledging the skewed focus of her presentation. Thereafter all the speakers apologised, at the start of their presentations, that their focus was exclusively on the acute sector. Although it was great to witness, and be a part of, I hope the change in tone was something more than a rhetorical nod in the direction of mental and physical parity of esteem.

A lighter moment came as the ‘Prophet of Doom’, Julian Kelly, Chief Finance Officer for NHS England, declared that the Mental Health Investment Standard (MHIS) would continue to have ironclad protection. MHIS was developed to ensure an increase in the investment in mental health services across England recognising the historic underfunding of this sector. It was previously known as the ‘parity of esteem’.  He also noted that the one area of health care where he didn’t expect to see a reduction in the workforce was in mental health services. He got a hearty round of applause for these declarations. It was noted that, prior to this, Julian had never been given a round of applause for anything he had said or announced. Recognition that there was no health without mental health remained a consent theme throughout the day – I hope such recognition continues and is truly translated into actions too.

As for my tiredness. I need to take my own advice and try and have a rather more slowed down pace of life, perhaps to say ‘no’ more often to requests for my attention or help, and definitely, the next time I go to London, to book a hotel for the night before the meeting! However, I also know booking a hotel is the easy thing to do, changing other things impacting on my work-life-balance might be much harder to achieve.