Things to do while waiting on the obesity strategy…

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So government has delayed the Child Obesity Strategy till Autumn. It’s easy to greet this with dismay, but I think the tone struck by the Local Government Association – a reminder of the importance of this strategy being produced soon, with an equal reminder that it needs to be radical, worthwhile and effective when it does appear- is one that pretty well sums up my views on this.

Hence I refuse to be dismayed by this delay.  Moreover, I can’t honestly say I’m surprised. Strategic delay is something we’re used to from the Department of Health.(Remember the ever coming, almost never arriving guidance on Public Health transition?)  I’m not excusing it, I refuse to be dismayed by it, and I refuse to be derailed by it, either.

But it may well not be this.  Hugh Pym of the BBC says that the Prime Minister wants to lead personally on child obesity because he believes in it, but given other things on his mind (something about Europe I seem to recall) he might be rather busy for the immediate term. http://www.bbc.co.uk/news/correspondents/hughpym

If what Hugh says is true,  then we should definitely be encouraged by this, not dismayed by it, because it gives opportunity.  We mustn’t be derailed by this delay.

Generosity or suspicion?

So I’m going to view this delay with generosity, that government wants to get it right, that this is a time to do so, and that we will get a strategy at the end of it that has a number of measures for national government, and a number of things for local agencies to do. And if I’m wrong, well, I’ll cross that bridge if I come to it.

Turn the noise off and breathe

In any case, the debate has become so shrill or polarised in some places that it’s probably useful to have an opportunity to think and reflect and remind ourselves calmly what it is we really need from a strategy.  The delay provides us with one, it provides government with one, and that’s often a welcome sign in health policy.  And yes, you know by now that I’m going to say we need a systems approach to really address obesity. I’ve heard very little of that and far too much about sugar tax from every side, as if that’s the only thing that mattered.  Why don’t I want a single answer strategy? Easy, we could be derailed by it.

During the breathing space

I don’t know about you, but this last financial year has turned out to be a very different year, and to an extent my job is becoming a very different job, from the one I started the year with. £7.8m of cuts from a £50m budget that will undoubtedly hit the NHS and will almost certainly be counter-productive, with a degree of short-sightedness and bad economic sense that could reinforce the default of being ever in reactive mode in health and never in preventive mode.  I have work to do on that in short term. I refuse to be derailed by that or the strategy delay.

But, I have work to do on that now, to plan for the long term. I am prepared to admit that while the delay in the strategy is unhelpful in terms of planning what budgets we save and protect and what budgets we cut in public health, it also gives me an opportunity. What? To focus not just on making cuts to the budgets, but on working with partners to decide where we want public health to be, what is possible after the cuts, what is possible without money, and to start to plan to put us there. And when the strategy does come out, well, we have to fit that in. I can see how we can avoid being derailed by all of this.

Anyway, who says government has to do all the thinking? What the residents who pay me expect me to do hasn’t change. They and government still need me to help implement a whole system approach to Obesity, and with the best will in the world government won’t be able to think of everything even if they want to.

We in public health still have plenty of scope for leadership. I came into public health to apply science to problems, not for others to do my thinking for me. Working hand in glove local with national is what we need. Will we get it? Well, I don’t know. Even if we don’t I won’t be derailed from doing what I can while continuing to advocate with government for better.

We also expect this year a new strategy or plan to deal with worklessness and a new strategy on drugs and worklessness, or that’s the widely trailed news in Whitehall. So altogether it’s not like we won’t have enough to keep us occupied.

That doesn’t mean we stop advocating for what we feel will work. But we need to advocate in a different way, I think.

There is a time for campaigning – the loud, public campaign, and a time for lobbying – the quiet, open conversation about the nuance, the need, the art of the possible and how proposed or existing measures affect people well or badly. Campaigning can be useful but at the same time can bring too much noise and heat and too little nuance.

Lobbying can allow for quiet, sensible, and nuanced conversations but obviously carries the risk of compromise becoming the end rather than the means to achieve something. But sometimes campaigning – however well intentioned – can snatch from us what lobbying might achieve. We must continue to articulate, calmly and sensibly, what we would like from this strategy. Time to lobby, not campaign, now. We could stop the strategy from being derailed by this.

That sugar tax thing

I’m already hearing people say with some panic “the sugar tax is dead.” Well, we don’t know. And I cant help thinking that the loud (and let’s be honest, occasionally rather shrill) noise around sugar tax has sometimes obscured the nuanced debate we need to have around obesity: it isn’t simple, there is no magic bullet, we need a range of measures at different levels, and the real prize is for local and national measures and action to work together.

If the strategy delivers national measures which we can wrap round with local action, wonderful.  If it gives a steer to both, that might be to the good. If it contains a sugar tax in addition to other measures, then that may work. If it contains a sugar tax alone, then that’s not a rounded strategy and won’t be effective. If it doesn’t contain a sugar tax, then it’s not the end of the world. A sugar tax is not, to me, the absolute acid test of a rounded obesity strategy. Please don’t mistake this for complacency, it’s a commitment to work with what I’ve got to do what good I can, rather than demand everything must be perfect. It’s my way of refusing to be derailed from the ultimate goal of better, healthier, happier lives for everyone.

Some other stuff to do while waiting on the Strategy

Here’s a list of some of what I plan to do while waiting on a strategy:

  1. Make the cuts, but try to plan for where public health is going to be, and what the public health footprint should be.
  2. Articulate the next generation of our strategy, especially what we can do as a system to improve and protect health and our population
  3. Attend the LGA child obesity seminar on 17th March and see whose good ideas I can shamelessly steal for my local area. And, yes, it’s still going ahead. It’s before the strategy release, now, not after. Well, that lets us share what we’re doing already and advocate for what we think could go in.  Have you noticed how the LGA are refusing to be derailed by this?
  4. Start really thinking through the whole systems approach to obesity and what can be achieved before and after the strategy
  5. Stock up on summer reading
  6. Eat Less
  7. Move More
  8. Improve my barbell form
  9. Stop watching the letterbox.

There is lots to do. Strategic focus is the key. I will not be distracted by this delay.

Have I said I refuse to be derailed by this?

 

 

 

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When someone asks you about setting up a new organisation….

I don’t know about you but over the past three years I have been approached at least fifteen times to advise people who are considering setting up their own new charity in the field of health.

And I regularly get asked by existing charities about their strategic direction and mission. I’m a trustee of a number of charities (none of them local, so I make sure there’s no conflict of interest), act as a sounding board at a distance for others and a volunteer in several, so I love and am committeed to what the great spectrum of voluntary and community and NGO bodies can do, whether charities or not. (And I never know which bit of VCS or 3rd Sector jargon is in these days so I’m not going to use any consistently.)

Three such requests have come in this month alone. All of them local. And now I notice fellow Public Health professionals say they’re being asked the same questions. So this is my attempt to say “here’s what I do whan I get asked this. If it helps, use it.”

Motivation

Firstly, I think it’s laudable to want to help  people through serving them. That’s the reason I do my job, I want to make the world a better place. Naïve? Maybe. But Energising, definitely. Values energise us.

But values can also distort us and lead us down the wrong path. And our motivations can sometimes, despite our intentions, lead us into places we should have sought to avoid. Leaders and founders of new agencies bring help and energy if they get their strategy right, but they also bring a shadow, even when the strategy is right. And so it is sometimes with any field of life. We can work on setting up new enterprises and sometimes they deliver. At other times we realise we’ve been tilting at windmills.  It’s right to think about our motivations in creating something new. That’s not in any way to downgrade them or call them into question. It’s about discerning whether what I am doing now is right. It’s also right to recognise that many of us who do work like this need to be needed or useful at some level. (It’s part and parcel of being human.)

All sorts of things motivate us. Some of us are motivated by religious values – the great set of agencies set up inspred by St Vincent de Paul (for which I sometimes am in danger of putting my back out when carrying white goods up flights of stairs for people in need) – has as its most Caritas Christ urget nos – the love of Christ energises us. From religious orders to the DePaul Trust and SVP society delivering food, fridges, cookers, furniture and paying utility bills for people in need, that’s the source of service.  Some are energised by grief at the loss of a loved one.  A husband who died of a heart attack generating funds for defibrillators, a beloved spouse spurring on anti-homophobia work or a precious child energising a bereaved family to seek to prevent suicide or keep our young people mentally healthy.

These motivations are precious. But we need to make sure we care for ourselves to continue being of use, and we need to make sure the energy from these is used in ways which help us and others flourish. There are risks from all motivations, wherever they come from.

But when a social need, the motivated and energised person, the right skills sets and the means of addressing that social need come together, something brilliant can be born. That’s an art, not a science. And it can go awry if we don’t think and discern carefully how to respond to this kairos moment of opportunity.

Community agencies and charities abound, and just as many seem to be set up every year as fold.  Over the past three years I have advised six sets of people on setting up a charity or new body, advised three against it at any cost (two of whom took my advice), and linked several others with existing bodies to help stop them needing to set up the administrative joy that is a new voluntary agency.

I no longer ask “why do you think I have expertise to help?”, when someone comes. I just take it as one more opportunity to apply public health principles to a world very much in need of them, and probably in need of the judicious application of the energies of the people in front of me, who have decided to serve their community. The issue is discerning how best they can serve in terms of outcomes, impact and need. Now that is, I think a public health question. The privilege is watching them serve, and having a very tiny role in helping. Being asked to advise or help is a privilege. And with that comes a responsibility to give the best advice I am able to.

So, what can a public health mindset add to the setting up or not of a new organisation?  Well, here’s the questions I ask people to think through, and often sit with them over a cuppa while they start the process of doing so.  It usually helps them.

The Discernment Exercise: Is this needed?

  1. What’s the need you are trying to meet?  Can you write this in a sentence? Can you back that up with evidence such as from the local JSNA?
  2. Who else is in this space?  Can you work with them?  If not, why not?
  3. Are you really sure a new separate agency is the way to go?  Could you piggy back off another one to start off with or even join someone else’s efforts?
  4. How will you make sure you add value and don’t duplicate?
  5. If you are setting up a charity because a loved one has died, and you want to help in their health condition, then you need to think very carefully about how you will manage your grieving and not throw your energy into the charity in a way which exhausts you?  How will you care for and have some time for yourself and to grieve? Is working with another existing charity a better way to remember them with something concrete like fundraising or a new product or service?  It may not be, but do think about this
  6. What is it you really want to achieve?  If it’s expanded health care, then do you want an agency which does the delivery or would being an agency which raises money then funds or commissions others to do it be a better and easier way of achieving what you want to do? Could money you’d spend on things like insurances and offices if you ran your own service be better spent fundraising and commissioning others?
  7. How do you know what you want to achieve can be done? Do you have any evidence of this?
  8. Where will you get expert advice from on the care/clinical/health aspects of your work?
  9. What can you learn from others in the same field
  10. Do you want to focus locally or nationally?
  11. Who will you get to work with you to set it up?  Have you explored the issues of a) setting up a small agency and then b) registering as a charity and how to go about that. How will you sustain the administration and governance? Registering a charity is not simple.  You need to think about what structure (incorporated, unincorporated, Trustees with a deed, association with committee, company, charitable incorporated organisation, etc) There are rules and processes. You may spend more time doing paper, accounting, governance, DBS checks, safeguarding and probity than delivering your aims. Your Local CVS (Council for Voluntary Service) or Community Foundation may be able to help.
  12. Where will you get expert advice from on this? Lawyers and accountants are expensive
  13. Have you taken advice from your local Council for Voluntary Service, or Community Foundation?
  14. Where will you get funding?  You will need some start up funding initially.  In this financial climate, how will you secure ongoing funding? How will you ensure you don’t close or end up merging five years down the line?
  15. If you want to fundraise and give grants, how will you make that process fair and robust? How will you check agencies can deliver what you fund them for? How will you check that what you’re doing is needed and works? How will you schedule cash flow and payments?  Could using someone else who’s good at this save you time, effort and money?
  16. A new charity and organization needs a group of people to nurture it. It needs a life cycle, stages of development. How will you achieve this?
  17. How will you avoid being overprotective of “your baby” in order to let others help you grow and develop it?
  18. What about contact details, website, email and meeting space for the committee/trustees?
  19. Are you expecting your agency to have a long, short or medium shelf life? Sometimes it’s ok to come together to do a specific thing and then disband. But could you piggy back off another agency rather than do it all yourself?
  20. Let’s go back to what you you want to achieve over the next five years?  What are the ways you could get there? Are you absolutely sure a new organisation is right?
  21. How will you make sure you have at least some time for self-care?  downtime, etc?  If you burn out, you’re no use to yourself or anyone.
  22. Who will help?  Are you expecting already over-committed people to give more
  23. What’s your rescue strategy if you or someone else burns out?
  24. How will you exist from the charity if it fails?
  25. And how long are you in this for? Some charities get founder’s syndrome where if it isn’t the founder’s idea or approval it doesn’t get done. The founder can move from being a source of energy to a block.  How will you make sure that doesn’t happen and that new energy and ideas and blood which thinks differently to what you want is used and not put off?

These questions may appear blunt. But from my own experience they need to be asked, and asked again.

I say to people “think through these, see who can help you, work up a strategy and I think you’ll have some direction.  The very worst thing you could do is not try to answer these.” I’m not trying to put people off. I’m offering these as a way of discerning what you are going to do – new agency or not – and how you are going to achieve it.

These are the questions I try to get people to work through. Some come already having worked through them. Some find their new agency is the right thing to do. Others often find they can work with others.

One agency, for example, which is very good at fundraising wanted to expand into health service provision. In talking we decided what was best was for them to keep pulling in the money and commission other existing agencies to do it. It worked out cheaper when you considered insurances and staff costs. And the two logos appeared nicely together on the publicity. They’re doing great work.

I hope this helps. And welcome your views.