Harvir Braich had the absolute pleasure of chatting with Dr Andrew Snell,  a jack of all trades: A&E consultant and public health doctor. Andy and Harvir have a chat about the great work he has done abroad and his thoughts on how best to tackle health inequalities in this country. 

They had a brilliant conversation and discussed….. 

• What inspired Andy to dual train in public health and A&E (1 min) 
• The lessons we can learn from other health systems to reflect on our own (4.40mins) 
• Any atypical examples seen abroad that Andy found insightful (10mins) 
• The health inequality themes seen at policy level and at the front door of A&E (15 mins) 
• What work Andy has been helping with in Barnsley regarding health inequalities and the three tiers (22mins) 
•  What Andy would change if he had a magic wand in order to address health inequalities (31 mins) 
• What resources and books inspired Andy along his journey (33.30mins) 

References 

Copenhagen and cycling (13 mins): 

 Greenfield, John (9 December 2012). "Danish History: How Copenhagen became bike-friendly again". 

Foresight report on obesity (13.40 mins): 

Health foundation podcast (34mins) 

One Hundred Years of Solitude (35 mins)

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I had the absolute pleasure of chatting with Deborah Wilmot, a passionate GP with over 20 years' experience with the substance misuse service. She shares such a unique personal perspective that has really helped someone new to the arena such as myself. 

We had a brilliant conversation in the new year and discussed...

• Deborah's work as a GP and her amazing journey in working as a substance misuse lead in her region. (1.40mins)

• The changing pattern Deborah has seen of substances misused over her 20 years of experience (3mins)

• How Deborah started her journey into this area of work and what has motivated her to continue in this field (4mins)

• How Deborah has been able to keep such enthusiasm and passion for her work and prevented burnout (10mins)

• What Deborah finds the most rewarding part of her job (12mins)

• How we as clinicians and advocates can break down stigma and encourage patients to seek treatment and support (17mins)

• What advice Deborah would give to inexperienced clinicians or those wanting to better their practice with dealing with patients suffering from substance misuse (22mins)

• Being mindful of yourself and your current state of mind (27mins)

• What an ideal substance misuse service would look like in the eyes of Deborah (28 mins)

• The importance of lived experiences to develop ourselves (35mins)

Further resources:

Reduced mortality if in treatment compared to not in treatment (15mins)

Adult substance misuse treatment statistics 2020 to 2021: report

The "ripple effect" of substance misuse and hidden costs (16mins)

Benefit of peer support in substance misuse (29mins)

Doctors make mistakes (33mins)

Cautionary Tales (34 mins)

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In this heartfelt and energising episode we discuss;

• Aarti’s current roles (2min)
• Where Aartis drive for Greener practice and sustainability comes from (3mins)
• What can we do as health professionals to minimise the impact of climate change (7mins)
• Four pillars of sustainability (8mins)
• Prevention and examples of this (10mins 30s)
• Sustainability as a social determinants of health (15mins)
• Greener practice and how it began (19 mins)
• Bringing new people onboard to a rapidly expanding network (28mins)
• What Aarti has learnt about herself in forming Greener Practice (29mins 30s) her thoughts on leadership (31mins)

And to finish…

• Aarti’s leader she most admires and why (34mins)
• Top tips as a leader (34mins 30 seconds)
• Top learning resource (35mins)- Active Hope - How to face the mess we're in with unexpected resilience and creative power by Joanna Macy and Chris Johnstone
• Aarti’s one magic genie wish to support equity and sustainability (36mins 30s)

Further resources

• Greener Practice
• First follower You tube video
• Nancy Kline –Time to think
• Next Generation GP and Next Gen Cast

Thank you Aarti for you time in recording this episode and her continued dedication to Greener and more sustainable General Practice.

Thank you also to Dr Nish Manek, Founder of Next Generation GP for this collaboration. If you are an early career GP please do visit their website here to find out if their is a leadership programme running near you and/or check out some of their amazing resources - blogs, podcasts, webinars and more!

If you would like to hear more from Aarti... Next Generation GP did a webinar with Aarti and colleagues on Leading in Greener Practice - Check it out here. Please also check out Nish's podcast the Next Gen Cast which has a rich catalogue of incredibly inspiring podcasts from leaders in and out of healthcare

We hope you enjoy the episode.

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We caught up back in the Spring and discussed…

·      Working for Bevan Healthcare and bringing together services and people to help others in the centre of Leeds (2mins)

·      What Dom does and what is so special about his role as a street outreach worker (2mins)

·      Challenges along the way – Covid, rolling into a post Covid world, and collaboration and funding of services and funding (5mins)

·      The beauty of being able to have a wrap around service and working with colleagues (9mins)

·      Experiences of patients in the system and rough sleeping (11mins) – Dom gives his ideas on how to communicate and how to meet patients in their reality of where they are (13mins)

·      Dom share’s his own personal story (19mins) and how this influences his role. As part of this, we explore stigma and navigating the health care service (23mins) to finally get the help he so needed (despite the barriers along the way)

·      Addiction (30mins) and consultation skills around this (32mins)

·      Adverse Childhood Experience (37mins) and the Self care (41mins 30s)

To finish…

Dom’s favourite resource- (46m 30s) The internet – get searching on the topic of inclusion health see what rabbit hole it takes you down

Dom’s Genie wish (47mins) 

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Finding fairhealth through integrated care systems

 I am going to be honest here and let you on to a bit of secret… I find it really hard to get my head round system level change when it comes to tackling health inequalities. Being a GP it is quite relatable when you hear and learn about stuff happening at grass route level and then all the big picture marmot stuff including funding and resources is talked abut all the time. It is the system level stuff that I wanted to learn more about. Sarah Smith, public health consultant in Wakefield has broken this all down for me. I found this conversation super helpful and hope you do too.

We talk about…

-         Different patient populations getting different outcomes and different access to services- What drives Sarah? (2mins)

-         Working across a large system and working out what we can all do to try to tackle HI (5mins)

-         Integrated care systems - what they are and what they aim to do? (7mins)

-         Three tests to try and identify what projects might work at scale in the system rather than being more locally focussed (9m 3s)

-         What data we might use to help us with this (11mins)

-         How governance might help or hinder her ambitions (13mins)

-         Brokering the gap between the national ask and what this means for the local population and being ‘servants of the local place’ (14mins)

-         What the CORE20PLUS5 means in Wakefield and giving a practical application of how this works at system level (15mins)

-         Having a public health team within the ICS and the challenges this sometimes raises (17mins)

-         Systems leadership (19mins)

-         Trying to include everyone in the system (21mins)

-         Practical steps (using frameworks, toolkits and pathways) to try reduce inequalities (26mins). Example of this – Access programme Bradford (28mins)

-         Social determinants of health (32mins)

-         Tips for emerging leaders wanting to find more about this (35mins)

To finish

-         Sarah’s best book (37m 30s) - Radical Help by Hilary Cottam

-         Sarah’s Genie wish (38m 30s)

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Episode breakdown

-         What is meant by the collective ‘Decolonising Contraception’ (1min 30s) what is the meaning by decolonising(4mins)

-         How the ideas of this have developed from the history of contraception (8mins)

-         How has knowing all this changed the way Annabel practices (10mins 30s)

-         Supporting patients to make decisions around contraception (14mins)

-         The importance of getting contraception consultations right (18mins)

-         Details of the events and workshops run by the Decolonising Contraception team (22mins)

-         Research around decolonising contraception (27mins)

-         Annabel’s insights into managing all the work she does (28mins)

-         Her book planned to be released next year (30mins)

-         Politicisation of medicine (32mins)

-         Advocacy (33mins30s)

Books (42mins)

Genie wish (44mins)

We hope you enjoy the episode!

Julie and Rachel

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Episode content

·      Why Najeeb gets excited about tackling health inequity (3mins)

·      Should secondary care and emergency care colleagues share Najeeb's drive to tackle health inequity? (5mins 30s)

·      Commonalities across primary and secondary care (8mins)

·      How hard it is to inform our interventions with data and evidencing what we are doing (11mins) and how we actually go about finding solutions to this (12mins) e.g. Core20Plus5, localising data.

·      Najeeb talks about developing teams to implement these interventions e.g. Emergency department youth navigator programme (15mins)

·      Building the evidence, case examples and sharing the learning (18mins)

·      Stakeholder engagement (20mins 30s) and who we get on board with the goal of tackling health inequalities... the power of evidence and patient stories.

·      Changes within secondary care to create more continuity of care (24mins)

·      Bringing people together to try and tackle health inequalities (28 mins)

·      Lessons and learning from other sectors (incl humanitarian aid sector) (32mins)

And to finish...

·      Najeeb's best authors and resources (44mins)

·      His Genie wish (47mins 30s)

Further resources

·      The Frontline Collaboration against COVID-19: Briefing to Health and Social Care Committee Introduction

·      The sphere handbook 2018

·      WHO – The cluster system

·      Classification and minimum standards for emergency medical teams

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We are so excited to be sharing this conversation. Why haven’t we made much progress in tackling health inequalities up to now? We hear from someone trying to change this at a national level. Someone who is leading a team to try to make a difference in tackling health inequalities at scale. Bola Olowabi has an abundance of energy and enthusiasm, and her team are setting the national direction and vision to help support making a difference on the ground. This is a not to miss episode…

Episode breakdown

-         Bola’s role in NHS England and improvement (2mins)

-         Core20Plus 5 – what is it about, why now and what’s different to previous national strategies to try to tackle health inequalities? (5mins)

-         What can we do at a primary care level to put Core20Plus5 into place? (10min 30seconds)

-         What Bola and her team are trying to do at a national level to tackle health inequalities (14mins 50seconds)

-         How to engage and work with stakeholders in tackling health inequalities(19mins 30s). Bola highlights the need for time, energy enthusiasm and humility.She talks shared purpose and shared action and emphasises the importance of investing in the quality of conversations rather than the number of conversations.

-         What does success look like for Core20Plus5 in five years’ time? (24mins) What challenges she sees in achieving this success? (26mins)

-         How can GPs support the Core20Plus5 effort? (29mins)

-         Bola shares how she feels about being a role model for tackling health inequalities for women, BAME groups and anyone wanting to tackle health inequalities (32min 30s)

Bola’s learning resources (35mins 30s):

Michael Marmot ‘Build back fairer’

‘Fair society, healthy lives’ – Marmot Report 2010

Marmot report ‘10 years on’

You can hear more about the ‘10 years on’ report in our Fairhealth podcast episode with Professor Michael Marmot

Bola’s genie wish (37mins)

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How do we involve our patients in tackling health inequalities? Such an important question and fundamental in thinking about how we work better with our patients and communities.

Jess and Martin start off by telling us what got them interested in patient participation (3mins) and then what patient participation means to them. We hear from them both as to why patient participation doesn’t always happen and why it might not be a priority at the moment (9min 30s). We also discuss what good patient participation can achieve and why it’s important to do it (12min 30s). We then go on to talk about whether a patient participation group (PPG) needs to be representative of a practice’s patient population (14mins), the value of what different patients can bring to a PPG (15min 30s), and who might join a PPG (17min 30s). The conversation highlights the importance of acknowledging the power dynamic between health professionals and members of the public and the importance of simple things like meeting around food or in an accessible, non-threatening place in the community.

Jess works in a deprived part of Bradford and tells us her insights of what is different about patient participation in her practice area compared to more affluent settings (19min 30s). We discuss lack of trust, hope and confidence in her practice population and how this effects engagement in her PPG (22mins).

Jess and Martin give their insights into different ways patients can participate within the system, what this might involve (26min 10s) and where participation should sit in the system (28mins). Patient participation can often feel quite daunting and it can be difficult to know where to start so Jess and Martin give their advice on how to get started (29min 30s). Jess talks about trying to find someone who can facilitate and provide challenge (not just listen and be defensive) (30min 30s). We discuss who can and should participate in patient participation (33mins) and how this might not always be obvious. Before moving on to our final questions, Jess gives us her golden top tips when getting started with a PPG (35mins).

As always, we finish with books and Genies…

-         Jess’s Book (39mins) Purpose of power- Alicia Garza

-         Martin’s book – (40min 20s)- A radical practice in Liverpool – Katy Gardener and Susanna Graham-James

- Genie wishes (40min 40s)

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We discuss loads including;

• The Inverse Care Law (3mins) - what it is and why we should be interested in this in primary care. Becks’ work at The Health Foundation has shown that once you adjust for the extra need in areas of deprivation there is less funding, fewer GPs and the quality of care suffers in areas of deprivation.
• Funding of General Practice - Becks tells us about The Car-Hill Formula (10mins) and why funding isn’t currently and hasn’t been previously distributed to where it is needed most. Becks gives us her insights into possible future funding solutions in General Practice to try and shift the inverse care law (16mins). We discuss personal values and how we bring our colleagues and policy makers with us in trying to support (and fund) health equity (19mins).
• Recent politics and government priorities - We ponder potential optimism (23mins) in trying to demonstrate the persistence of the Inverse Care Law at a national level.
• Banging a health inequality drum (26mins) - Becks gives her insights into rationale and strategies for making reversing the inverse care law a bigger priority.
• Becks' personal interest in health inequality - We dig deeper into why Becks feels so strongly on this topic. (28m 30s)
• Juggling two roles and what each role brings to the other- What Becks brings to her policy role from her work as a GP (30mins 30s) but also what she brings to her role as a GP from her work at the health foundation (33mins).

And of course, we finish with:

• Becks’ resource/book recommendation (35m 30) – Julian Tudor Heart – Inverse Care Law
• Becks’ genie wish (37mins) 

Want to find out more...

• The (very recent) Health foundation Report- Tackling the inverse care law. Analysis of policies to improve general practice in deprived areas since 1990
• Also..Comparing General practice in high and low socioeconomic deprivation in England

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After hearing from Ollie you can’t help but feel full of enthusiasm and I couldn't wait to share his energy with you all.

Ollie fills us in with his journey he has been on leading to managing patients using person centred care (2mins). We discuss what person centred care actually means for both the doctor and the patient (4mins 30). We talk about the practical application of person centred care as a GP (5mins 50s) and he gives an example of how this has worked specifically for one of his patients (8mins 30s). Ollie tells us about patient activation (10mins) and how important knowing a patient's level of activation is in supporting them to decide the next steps in their care. We discuss how we manage patients with a lower level of activation particularly in the context of complexity, deprivation and tackling health inequalities (12mins 30s). Ollie highlights the importance of building trust and rapport and avoiding blame (14m 30s). We discuss managing the GP consultation in respect to a patients's individual context and the social determinants of health(16mins 30s). Ollie also mentions the importance of building relationships with his patients over time (19mins) and we also discuss how it makes us feel as clinicians when managing patients who are lower in activation (21mins).

Ollie works in leadership roles locally and nationally and he explains how he brings in his experience as a health coach (24mins 30seconds) into these roles. He also explains how the health coaching approach can take the pressure off clinicians, boost staff morale and help us in looking after ourselves as health professionals (28mins). Before moving on to his best book and genie wish, Ollie gives us his run down of the challenges going forward in 2021 (30mins 30s). He stresses the importance of involving communities and acknowledging different patient contexts in how we weave in tackling health inequalities in everything that we do. 

Ollie’s best books and resources (35mins 40s) 

• Realising the value- Nesta and The Health Foundation
• Good help bad help- Nesta
• Book- Why we revolt- Victor Montouri
• Film- Educating Rita
• Development as Freedom - Amartya Sen

Ollie’s genie wish (39mins 30 seconds)

Further resources

• Peak Health Coaching
• More resources on the Peak Health Coaching resource page here
• Patient activation measure

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The amazing and inspiring Dr Farzana Hussain fills us in on her busy year in General Practice in one of the hardest hit areas for Covid-19 in the country (2mins). We discuss the silver linings in a challenging year (3mins) and why she loves working as a GP in Newham (7mins30). We talk about the challenges she finds working in an area of deprivation but also the feeling of meaningful work and achievement that she feels she wouldn’t get elsewhere. She champions human-to-human interaction and seeing each of her patients as the individuals that they are (10mins).

Farzana has created something very special with her team at The Project Surgery in Newham. We discuss practice culture (18mins 30s), community and how she has created the amazing team she works so closely with today. We discuss the importance of autonomy (21m 30s) for her in managing her busy week and how still manages to make time for herself and her family.

Farzana explains her experience as prominent BAME woman working in General Practice at the moment (23m 40s). We discuss her role as primary care network (PCN) lead locally and co-chair of the PCN federation at NHS confederation. We discuss getting the balance right between making a difference at a national and local level (25mins) and an insight into the communication channels and challenges for her across the system. We also discuss some of the opportunities going forward to tackle health inequalities that PCNs can bring (29mins).

As always on the podcast we finish with Farzana’s magic genie wish (37mins) and her book/resource (38mins) recommendation.

Farzana’s Resources

The Marmot Report 10 years on

RCGP Annual General Conference 2019

Further resources

NHS confederation

Farzana's session with the Trailblazer GP fellows in Oct 2020

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In this episode we talk to Dr Julie Duodu and Dr Lucy Carter. I can’t stress enough how incredible these two ladies are and what a pleasure it was to be (a small) part of their conversation. Julie is a GP in Leeds working at York Street practice, a large inner city practice in Leeds serving the homeless population. Lucy is a GP in the culturally diverse borough of Hackney in London.

As much as I try to make some of these episodes short and a quick listen, I can't do that for them all...This is a longer episode than usual, but I think you’ll understand why. We hope you enjoy hearing the experiences of these amazing women.

We kick off with Lucy and Julie filling us in with how they are both doing in this challenging time (3mins). We discuss the opportunity the events of recent months have given to talk more about race (6mins). We cover the challenges with talking about race (6mins) and becoming more comfortable with being uncomfortable (8mins). Julie and Lucy share a mutual feeling of being proud of their heritage but feeling a pressure to fit in (12m20s). We discuss how society’s attitudes have impacted on the journey to where they both are now as GPs (18m40s).

Lucy and Julie share their experiences of attitudes to race in the workplace (23mins 20s).We discuss being labelled as ‘the black doctor’ (27mins) and having to negotiate racism in their everyday work (29m30s). We go on to discuss the importance of good leadership in having a unified stance on anti-racism (34m 40s). We also talk about the importance of representation and diversity in leadership and how inspiring and impactful this can be early in a career and beyond (37mins)

I ask Lucy and Julie how race impacts on health inequalities amongst their patient population (39mins). We discuss COVID-19 and how race and ethnicity impacts their (40mins).

We discuss Lucy and Julie’s views on some of the solutions to dealing with race and health inequalities for our patients (46m 35s) including:

• Recognising that health inequalities exist and that race plays a huge part in this; 
• Opening up spaces in the workplace to explore biases;
• Decolonising medical curriculums, defaulting from the white standard;
• Increasing the diversity of race and ethnicity in leadership roles;
• Keeping the conversation about race going into the future (53m 10s);

As always we finish with further resources and magic genie wishes (60m).

Lucy’s resources

• Brit-ish: Race Identity and belonging by Afua Hirsch
• Robin DiAngela White Fragility: Why is is so hard for white people to talk about racism

Julie’s recourses

• Natives by Akala 
• Superior by Angela Saini 
• Colour brave rather than colour blind TEDTalk by Mellody Hobson  

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We talk about some of the many changes in primary care over the last few weeks (5min 40s). These include; phone and video consultations; losing the GP waiting room; sharing clinical decisions and talking more with colleagues. We discuss the effects of coronavirus on those people living in deprivation (10mins 10s) and Jonathon shares some experiences from his practice and his patients (11mins). Jonathan talks about the social determinants of health and the importance of prevention along with all the stuff we are seeing in the media at the moment like PPE (14mins 50s) . 

One of the things that GPs can do is advocacy and Jonathon was keen to discuss the work of Dr Rudolf Virchow 1821-1902 (19mins). Virchow is famous for saying that politics is nothing but medicine on a large scale and that our role as doctors is to show the link between social conditions and medical diseases (21mins). Jonathan explains why Virchow's message is particularly relevant at the moment. We explore the role of a GP in advocacy and coordination of a response to support those who are most in need and vulnerable. We discuss how much our job in primary care should include advocacy on behalf of our patients (26mins) and Jonathon offers some ideas for some steps clinicians can take forward to achieve this. Jonathon mentions collaboration, networks (e.g. The Deep End Network), treating long term conditions. We finish our conversation talking about the importance of caring for our patients (28m 55s), Jonathon shares his favourite book (32m 10s), and he tells us what his magic genie wish would be (34m 40s). 

Jonathon’s recommended Book

Let Us Now Praise Famous Men by James Agee (photographs by photographer Walker Evans)

Other reading

“Caring Effects” Julian Tudor-Hart and Paul Dieppe (mentioned at 30mins 50s)

Jonathon’s excellent blog

My (Rachel's) favourites

• If you want to learn more about advocacy and Rudolf Virchow
• Jonathon has written lots about trauma informed care but this one will get you started
• Coronavirus consulting and more about Jonathon’s experiences over the last few months

You can also find Jonathon on tweeting on being a GP and topics related our discussion @mellojonny

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Dr James Matheson shares his experience on what is going on at his practice in Oldham, Greater Manchester, during this worldwide pandemic. James highlights how we are uniquely well placed in primary care to identify those most in need.

James shares some of the positive stories of support during this crisis. He gives an example of how those living with homelessness have been housed almost overnight after years struggling to achieve this. We also talk about what we can learn from this crisis to support the most vulnerable in the future.

Alongside seeing patients with Covid-19, James discusses the importance of continuing day to day care especially for the most vulnerable. He shares some of the things individual GPs can do to support these vulnerable people and how we can identify and reach out to those people most in need. We discuss the risk of Covid-19 for patients living in deprivation, but also the impact of little or no financial reserve during this time. He talks about some of the vulnerable groups that are particularly likely to suffer during this crisis. He mentions those living with homelessness, Gypsy and Travellers, refugees and migrants.

To finish James tells me why he is feeling positive about the future.

Please check out a recent blog post Fairhealth in the time of Covid-19 from Dr Tom Ratcliffe

The RCGP are releasing some guidance on supporting vulnerable patients very soon. Keep an eye out on their resource hub and I will also post a link here.

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Show Notes

I was honoured to have a conversation with Sir Michael Marmot just a few weeks before The Marmot Review 10 Years On is due to be released. He told me the report has been performed in ‘the spirit of self examination’ to see if there has been any impact or if any good has come from the original report (2mins). He mentions the importance of the report amid the current context of worrying life expectancy figures (2m45s) and sheds some light on the reasons behind these worrying trends (4m40s).

Sir Michael Marmot is world renowned as a specialist in the impact of inequalities on health with internationally acclaimed research, writing and public speaking on the topic. The professor talks to us about how he perceived his role in all of this (8mins) as someone who synthesises evidence and chains of reasoning (10m40s) to formulate recommendations. Despite being an international spokesperson for such an important issue, Michael tells me that he doesn’t see himself as particularly political (12m50s) but does feel able to present information ‘in the spirit of social justice.’ We discuss if the moral case is enough to inspire or create political change (13m30s) and how to create action around health inequalities. With years of experience of sounding the claxon for this important issue, he gives his views on how we unite people around this goal and how to deal with actors in the system that might not prioritise equity (15m 30s). With government promising more spending we talk about current opportunities for spending in areas that are most in need (17.30) and gives hope that there will be clear recommendations coming out of the report for where government should direct their resources. We talk about practical action for health professionals too with six recommendation of how we as health professionals can take steps try to tackle health inequalities (19mins).

With climate change likely having the biggest impact first to those most disadvantaged and in need, Michael is aware of the current importance of climate change and environment. He shares with us how he is involved in trying to bring the environmental and social determinants of health agendas together and how actions to improve health can contribute to meet carbon neutrality (23mins).

To finish we ask for Michael's book recommendations (24m10s) and his genie wish (28m10s)

Michael's book recommendations (24m10s)

Development Is Freedom – Amarta Sen

Capital Twenty First Century- Thomas Picketty

Great Expectations by Charles Dickens (first 2 pages if nothing else)

Further reading

World Medical association report- Doctors for health

Look out for the Marmot review 10years on report due to be release on February 25th

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'My experiences of life have lead me to believe that in most public services the inverse care law applies, it shouldn’t. It’s an inefficient use of limited resourse’ - Victor Adebowale

Show Notes

Lord Victor Adebowale is a busy man so I was so pleased he managed to squeeze in a chat with me for the podcast. He talks with honesty and humour. Every time I have met him our conversations give me so much to think about.

Victor shares his experiences as Chief Executive of Turning Point. He tells me how he and his team make it their mission to try to tackle the inverse care law (2mins). He talks about the importance of a clear vision for his team and what a privilege it is to try and improve the complex lives of others (7mins). Turning Point’s role in the system is complex but made even more so by the need to run an effective business amid all the complexities of the system (9mins 10s).

Victor thinks about how we can best design services to fit the system and the population. He explains the importance of having positive rather than negative value transfer (10mins) and how Turning Point put clients at the centre of service redesign.

We discuss competition and his experience of collaborating with local services and the community (14m30s) and when this does or doesn’t work. We bring in the concepts of place based approaches and population health explaining how his team works hard to understand the needs of and build trust within a particular community to try to deliver this.

In his chief exec role he explains the importance of working out what the right question is (21m 10s) and says that is often questioning whether a process matches the intention (23mins). For Victor one of his main intentions is tackling the health inequity and the inverse care law (24mins). He says ‘What else are you going to talk about if you are involved in health care?’ For him he says this is a logical approach (25m 50s) for him and feels this would be the same for any sensible human being wanting an impact in the system. He talks about how we cope when other people in the system don’t share the same priorities and how we can build some accountability to ensure health inequity moves up the priority list(28mins 40s) . We discuss measuring success and impact in a system (29mins) and how trying to reverse the inverse care law should be taken into account when thinking about any measure we use for the system.

Victor’s recommended reading

Anything by Professor Michael Marmot e.g. The Marmot Review: Fair Society, Healthy Lives

Invisible cities by Italo Calvino

Genie question (48m10s)

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As a medical student, just over 10 years ago, Laura saw ‘health being done badly’ and having a big impact on her friends and neighbours. Laura decided with a team of colleagues to set up her own GP service which was the founding of Hope Citadel. She is now responsible for running 9 GP surgeries across greater Manchester.

I was so excited about talking to Laura as I personally find her inspirational. Her dedication to the people in her community and team is heart-warming. Whenever I see Laura I leave with a feeling of belief that change can happen. Laura starts off our conversation by telling us what is so special about Hope Citadel and how it compares to normal general practice (3m30s). She shares her experiences working in one of the most deprived areas of the country (8m15m) and how important, particularly working in areas like hers, to be fantastic generalist (10m30s).

We discuss co-planning, patient centred care and bargaining (12mins) and how important primary care is in all of this. We also hear about focused care at Hope Citadel (14m45s) and how they are using their incredible focused care workers to help with some of their more complex patients.

‘If you go to outpatients are you going to see an SHO and is that worth half a day off work on a zero hour contract?’ (13mins)

Laura is rightly proud of her team and what they have created. She shares with me her insights into how she chooses her team at Hope Citadel (18m40s) and where this all sits in the bigger picture of Manchester and beyond (20m40m). We touch on the complexity of politics and the role of doctors and health professionals in speaking out about what we see (23mins). Laura tells us how she feels her voice has developed more validity over time (24m20s).

Laura’s career so far has been anything but conventional. We discuss her courage of stepping off her medical career journey and choosing to do something to make a difference (26m40s). She says she wishes doctors were braver, but she admits that she is not sure if she knew then what she knows now whether she would have created Hope Citadel (30m30s). She describes her naivety as being really freeing and shares some of her lessons she has learnt along the way (32mins).

We discuss Laura’s faith (37mins), her family and friends (40m30s), and how these all play a part in making Laura who she is. Laura shares her insights on values, imagination and vision as part of all of this (38m20s). Despite all of this, Laura still finds time to have fun too (42mins).

Laura’s Best Book (50m45s)

Growing pains by Dr Mike Shooter

Genie question (48m10s)

Recommended reading- Harry Potter

‘If you do the right thing clinical outcomes will follow’ - Laura Neilson

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Dolly is currently doing PhD in Public health at the University of Cambridge and runs the “Big Tent of Ideas” festival, a national debating festival bringing people together for conversation and debate.

Show Notes

I learnt so much from talking to Dolly. Her graduate studies in politics have been so different to mine in medicine, yet I was fascinated in her insights in tackling health inequalities, public health, and policy….and wow does she pack a punch!

Dolly kicks off by telling us about her work, a few years ago, at the Centre for Social Justice (CSJ) (3mins). She describes her role as ‘a conductor of an orchestra of musicians,’ convening experts to inform the piece she led on obesity (5mins). Her work at the CSJ seemed pivotal, leading her to academia (masters then PhD) in public health at Cambridge. Her long-standing interest in individual liberty and the works of John Stuart Mill leads us to a discussion about what it means to make free choices about health, both at a policy level and for individuals (6m 30s).

Dolly is now working on her PhD, looking at what influences the policy making process at a local and national level (15mins and 39m20s). She tells us how important it is to think about who, what and how arguments and evidence become influential. Dolly is keen for everyone to be involved in the policy making process (17m 30s). Dolly then goes on to talk about the practicalities of using research in analysing policy: recognising our own previous experiences; our own ideas of what evidence is (28m 30s); peer review (31mins); and how we can make the policy making process more transparent (31mins).

A key theme to our whole conversation was bringing together different people’s experiences (33mins). We talk about the importance of understanding our own and other people’s motivations and values (38mins).

We finish our conversation talking about politics (43m 50s). We cover Dolly standing for parliament, and her role with the “50:50 #ask her to stand” campaign, encouraging more women to stand for parliament.

Intro about Dolly (1 min 20s)

Dolly’s top reading (58 mins)

On Liberty- John Stewart Mill

Geoffrey Rose- Sick Individuals and Sick Populations

Professor Kay-Tee Khaw- Cambridge University

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Nigel is a GP and set up the national charity Pathway, a model of integrated care providing patient centred care for the homeless. He is also a founding member of the homeless and inclusion health faculty providing education and a network of health professionals dedicated to supporting health in excluded groups across the U.K.

Show notes

We hear about what got Nigel Hewett interested in vulnerable groups, particularly the homeless (8mins). He talks about the health services he has been involved in and run over the years to try and help with this important vulnerable group. He also talks about staff attitudes to the homeless, quality of care for these patients and how important it is to educate and support professionals early in their careers around this topic (7mins). Health professionals working with these groups can feel isolated and we discuss the importance of forming alliances with other health professionals and supporting each other (24mins). He gives some top tips for working with homeless patients (9mins) including ways of managing drug seeking behaviour (10m30s). He also suggests using warm, understanding and empathetic scepticism rather than cynicism. He gives some tips on negotiating too (22m30s).

Nigel outlines some of the problems homeless patients face when admitted to hospital (12m30s). He gives some suggestions of seemingly simple but often overlooked questions to ask homeless patients when they are admitted like ‘Do you have somewhere to go to on discharge?’ He talks about how pathway teams can take a multi-agency overview to both support and advocate for these patients while in hospital and before discharge.

We discuss the fact that the health of the homeless identifies emerging trends in health and the system (27mins), politics (28m20s), legislation (31m35s), housing (32m20s), picking your battles (35mins), and something that he feels is key to all of this, child poverty (41mins).

With years of experience working with marginalised groups, particularly homeless patients, both on a one to one and national level, Nigel gives us an insight into some of his learning along the way (39m20s) and how professionals working with vulnerable groups can protect and look after themselves (46m25s). We also hear about what is new on the horizon for Nigel and his team (50m40s).

Nigel gives such a great overview of the challenge of supporting and providing health care to vulnerable groups in the UK. We hope you enjoy our conversation.

Nigel’s one book (51mins 35s)

Even the dogs by Jon McGregor

Further reading

Homeless service standards for commissioners and providers

Professor Suzanne Fitzpatrick at herriot watt- pathways into homelessness-

Pathway

Focused healthcare

Buurtzord system, Netherlands

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David has had such an interesting career, starting at The Centre for Health Economics in York, moving into The Department of Health and then on to The Kings Fund developing an ever greater interest in reducing health inequalities as he goes. He shares with us how much he values being able to get different perspectives from lots of different sectors and how The Kings Fund works hard to try to do this. He also tells us what he is up to at The Kings Fund, particularly talking about their vision for population health. He explains to us what this vision means theoretically but also what this looks like in reality and how it has been received and used locally since it was released. We also talk prevention, legislation and finance with the recent release of The Prevention Green Paper and he gives me an insight into where The Kings Fund sits in all of this. David talks honestly about how to avoid publications being poorly received and also what makes him lose sleep at night. As always on the the podcast we finish with David’s one big wish for tackling health inequalities.

I hope you enjoy this episode as much as I enjoyed speaking to David.

David’s best book

The Great Escape by Angus Deaton

Watch out for his Christmas tweet with his favourite books of the year too.

Further reading

The Kings Fund Vision for population health

The Government’s Grand ageing strategy

Lessons from the Wigan deal

Michael Marmot’s- Fair society, healthy lives

CIPFA – Action on prevention

Anchor institutions

Greg Fell’s Blog

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Chris tells us why he likens talking about health inequalities to saying grace. He gives us an overview on what has being going on nationally to tackle health inequalities. He also discusses an intervention he came up with called the population intervention triangle which looks at how services, community and civic based interventions interact around place-based approaches. We discuss in more detail an aspect of this triangle of how services and community can work better together. One example of this being primary care networks. We discussed how he almost prefers the word mitigation when talking about prevention and we talk about realistic ways of achieving population health and the barriers that stand in our way in achieving this. Chris also gives me his favourite outcome measure that he uses to look at levels of health inequality. We touch on so many topics including leadership, fragmentation, variability and making a business case for tackling health inequalities. He feels adamantly that you can hit front line objectives while making a population health impact. If you like thinking about big picture stuff this is the episode for you.

find out more about chris

Chris’s Best Book

Factfulness by Hans Rosling

Further reading

You can find the Population Intervention Triangle, Labonte’s Prevention framework and the POTS framework that Chris mentions in the PHE document that Chris produced – Reducing Health inequalities: System, Scale and Sustainability This is a good read in itself. Lots of tips and tools which can be used to look at populations too.

The recently published document that Chris mentioned on place based approaches can be found here.

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Full website page- https://www.fairhealth.org.uk/podcast-greg-1

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Full website page- https://www.fairhealth.org.uk/podcast-carey

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I find that the problems and solutions to tackling health inequalities feels challenging. I often feel like I don’t know enough or have the confidence to speak up. The magnitude and complexity of the problem makes it difficult to know where to start. Sometimes what feels like the right answer can often feel political, complicated and impossible. I’ll be speaking to experienced colleagues who are also interested in and currently working on reducing health inequalities. We’ll be speaking about the current problems and possible solutions in this area on our journey to finding fairhealth.

Rachel Steen, fairhealth

Music- CC-BY 4.0- Scott Buckley, Rainbows

Podcast editing support in early episodes - Becky Wood, Digital media production student at Sheffield Hallam University

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