When nothing is sure, everything is possible...


"Do you people here in Scotland ever talk about your history" was the question that got the biggest response in the fascinated audience. It was a slightly nervous laughter that spontaneously entered the room. Oh yes we talk about our history, especially just now as we approach an independence referendum. But that wasn't what the lecture was about, it was about the Alaskan approach to building wellbeing in, with and through a community, the Nuka system. The story of this thirty year process was inspiring and thought provoking.
There's much for us to learn from this I'm certain.
There's so much we are doing well here in Scotland. A focus on person centredness, on co-production, on safety and quality are so important.   They feel hugely important parts of the jigsaw but just maybe not the full picture. The difference in the Alaskan experience was the community involvement and the commitment to that at every level. It's a cultural movement, a social movement, an unashamed paradigm shift in power and influence in health care. All voices are heard within the system. It's  a system that serves its community, that focuses on well-being not ill-health,it's not a fix it model it's model of shared responsibility.
What's interesting is it was born out of oppression, of a failing system but became a leading and much admired success story. It's a story of leadership at all levels, of a joined up approach that teaches everyone it's core concepts with the neat acronym of WELLNESS, with a consistent feedback loop for all.

 Core Concepts

  • Work together in relationship to learn and grow
  • Encourage understanding
  • Listen with an open mind
  • Laugh and enjoy humor throughout the day
  • Notice the dignity and value of ourselves and others
  • Engage others with compassion
  • Share our stories and our hearts
  • Strive to honor and respect ourselves and others

 It listens and learns, focuses on humour and compassion. No one  can opt out, no one is too important to sabotage it. I'm absolutely certain it won't be perfect all the time, what is? But what is clear its a full and absolute commitment to relational systems and care, to well-being , it's culturally shaped and it recognises and values the spiritual element in a care system. 
I'm sure many of us were inspired. I certainly was and know there are many who want to work in this way here but we aren't there yet. We need a more holistic approach not just in health and social care but in our communities and our culture. I read a quote by Margaret Drabble recently that said, "when nothing is sure, everything is possible". Of course when you are deep in uncertainty, whether through illness, burnout, the stress of social pressures that could sound trite. But if you are thinking about real paradigm shifts maybe they only will happen at those times.
We are recognising that small tweaks to a system is not going to be enough to deal with the challenges of health and social care and its not peculiar to them either. Education, housing, the benefits system need to reflect the values we are crying out for in our lives and work too. Politicians alone cannot achieve this, it's down to all of us, we need to step up and work with leaders at all levels to do this, the politicians role is to support the right environment for this. 
The parallels are there in the experience of illness. Sometimes it takes a serious diagnosis like cancer to review your life and relationships. To let go of relationships, jobs, behaviours that aren't serving you; the chaos giving you the clarity and courage to act. The freedom created when you are challenged at your core to know what's important, what's right shouldn't be wasted.
The question for me is are we there yet? Are we ready to acknowledge the extent of the disease in our systems? Will we be courageous enough to really change how we receive and deliver care, letting go of hierarchy and power and really embracing the potential for shared responsibility at all levels? What the Alaska experience shows that once we are everyone will gain. That's the outcome to aim for.

Reasons to be hopeful
I noticed this week lots of conversations about the lecture. Many have been thoughtful and reflective about what they heard. I heard people stimulated by and hopeful about the potential for change. We need to all step forward now to make it happen. I'm definitely up for that and it seems to me the right time has to be now.


  1. Health and social care is such a complex topic.There's lots of work that needs to be done to strive for shared responsibility on all levels. You have lots of thought provoking questions and ideas that could apply to many places in the world. Whether people are ready or not is also something to wonder about. As you say it's time to step forward.

    1. Thank you, as you say we can all learn from each other, the underlying issues are the same. Thanks for commenting, it's great to hear from you.


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