The bitter public battle now being fought over the future of the NHS looks set to continue. Its future shape uncertain, and the mounting resistance that is so visceral is based upon fear, uncertainty and crucially a genuine lack of trust in those that claim to be guiding us to the best possible future the NHS.

The Lancet in January 2011 agreed that the current system stifles innovation and that although vast sums have been invested in the NHS we have not seen the benefit delivered as valuable frontline services. So we need transformation.

But the question is how do we get to that best possible future? How do we create a more sustainable NHS? Here are a couple of thoughts.

Participatory healthcare for chronic disease

Patients Know Best is a platform, that enables patients and clinicians to engage in individual and collective diagnostic practice, that allows for patient sovereignty and patient empowerment (where patient data sits at the very epicenter) and for clinicians to provide more accurate and dynamic healthcare assessment and advice. Patients can interact in full confidence with the clinical team online, uploading information about their medical history, patients can also read and interact with other clinical information inputs. This means patients are empowered, they are engaged in the process. Appointments can be made online within 24 hours – everyone has full access to all relevant data, which has proven significant benefits for everyone involved. Clinicians now have the right information with the right time to consult, reflect and properly advise. They can discuss with their patients and decide together next best steps.

In this process everyone learns with deep knowledge translating into meaningful action. The insight is that patients know a great deal, they are curators of their personal histories, and all to a lesser or greater degree possess uncommon combinations of common conditions in unique personal circumstances. Clinicians can them combine that unique knowledge with their own knowledge blending together unique and relevant programmes for chronic disease care.

Founder of Patients Know Best Mohammad Al-Ubaydli says it is not only significantly cheaper but a greater degree of comprehensive accuracy is achieved in one to two orders of magnitude.

Participatory leadership in healthcare

Nova Scotia was facing significant challenges in how it was going to evolve its healthcare system. In 2006 the Government asked Nova Scotia’s public health practitioners, to ‘articulate and be guided by a collective vision for the public health system.’ This is a complex challenge, and how does one go about articulating a collective vision?

Large-scale organisational change of the healthcare system that is happening in Nova Scotia, is being enabled through a process described as ‘Participatory Leadership’, whereby it is the participation of the people that are the true actors (nurses, clinicians, patients, etc.) within that healthcare system that are being hosted (guided) into co-designing, and co-creating how they are going to find the answers to their difficult and challenging issues.

In December 2008, a group of practitioners and partners in public health from across the province took on this challenge. They initiated a search to find a process that would bring people together to seek new solutions for the common good. They also knew the process would have to take into account the complexity of public health. And they also felt that any attempt to address the current challenges of public health demands the collective intelligence of all stakeholders. They sought a process that would launch Nova Scotia into a new beginning, an approach that would foster leadership and innovation.

The real insight was that the answer to such a complex problem lay in the minds of the many, that the way forward was held collectively in all the stakeholders that worked in the current system – not in the PowerPoint charts of highly paid specialist management consultants.

The benefits of participatory learning and leadership in healthcare

Patients Know Best and Nova Scotia are stories that are real world – they are serious and they represent two simple ways in which a best possible future for our healthcare service could be delivered, that can cost effectively meet the needs of many millions of people.

They are cost effective because ‘we’, become part of the process, we have co-created it. We begin to build a shared narrative around the people’s NHS. This is entirely different to the ideology and language of markets and privatization.

They are also demonstrative of the agile organization. Agility is related to what Otto Scharmer describes as an evolved geometry that devolves power from hierarchies to evolving networks of relationships, these are organizational models in which people, patients, physicians, clinicians, support services connect with each other in more meaningful ways in which they are all part of the process. So we move from the language of economies of scale to human centered ecologies of scale.

Explicitly, the thing that joins the dots is that Patients Know Best and Nova Scotia are both designed around the needs of humanity. Participatory learning and leadership are both constructed from the understanding that seeking change for the common good calls for involvement, collective intelligence and co-creation to discover and illuminate new solutions and wise actions.

John Berger wrote, ‘what we see is shaped by what we know’, and what we make is shaped by the language we have available to describe a new reality. If that language is lacking or deficient then so will be the outcome. And that is why Andrew Lansley’s Bill is in such disarray, as his framework for reformation is not based upon the language and literacy of social innovation, participatory cultures and leadership, it is based upon a language that has ultimately done so much damage to us.

What is missing is a literacy that defines a new form of leadership relevant to today’s world: the capacity to collectively shape and create our best possible future, and to release us from the cul-de-sac of our ‘industrial free markets are best’ view.

This is extracted from the book No Straight Lines: making sense of our non-linear world

Open Access book available via (this link)

Paperback and Kindle versions via (this link)

Marcin Jakubowski tells us how. In many ways this story is very much part of the story of No Straight Lines that I have been researching, evolving and developing over the last 7 years. You can find out more about No Straight Lines here and pre-register for the free browser book, or indeed lets us know if there are other formats of the project you are interested in.

Marcin’s story is at a very human level, but it also asks big questions about ‘WHAT NEXT’ looks like, economically and, organisationally. His story is about questing for a more sustainable and enduring world, something that Gabriel Branby also talked about.

Marcin asks the What If? question, but he is one of a growing band of people, and these questions are pushing harder and currently deeper into the consciousness of our everyday lives. and I think Marcin is a trailblazer but he is also connecting up to and creating an entirely new eco-system, a ‘human operating system‘ that wants to get stuff done in very different ways.

As Tony Judt argued in Ill Fares the Land, why is it that we struggle to imagine a different world to the one we currently have, when that world could be built upon a philosophy of a more humane sense of the world we live in?

No Straight Lines, argues that we have reached the nadir of the adaptive range of our industrialised world. Now faced with an unsustainable trilemma of social, organisational and economic complexity, we have entered an era in which the rules we have previously organised our lives around no longer apply. Leaving us with both a design problem and a design challenge which we must urgently solve. By describing an entirely new way for true social, economic and organisational innovation to happen, No Straight Lines presents a revolutionary logic and an inspiring plea for a more human-centric world.

That quote has always resonated with me. As it leads to the question, what makes work worthwhile? And how do we define work? This thought cropped this morning reading an article that Per Håkansson had flipped over to me. It was Douglas Rushkoff musing on the mantra of jobs, jobs, jobs Are Jobs Obsolete? – yes he agrees we all want to be doing useful things – but the jobs our current politicians describe he feels are built on a dying age, an industrial age. Perhaps he suggests we could envision a far better way of filling our time…

This sort of work isn’t so much employment as it is creative activity. Unlike Industrial Age employment, digital production can be done from the home, independently, and even in a peer-to-peer fashion without going through big corporations. We can make games for each other, write books, solve problems, educate and inspire one another — all through bits instead of stuff. And we can pay one another using the same money we use to buy real stuff.

Its a great big idea and some I guess are already doing that. The big issue is also that jobs have come to define us as people. “What do you do?” is the line of interrogation that goes when first meeting someone perhaps for the first time. Brain surgeon or bank robber? Work and identity become hugely important.

In a post entitled Modern Life is Rubbish I refer to the work of Richard Sennett,

In, The Corrosion of Character: The personal consequences of work in the new capitalism. Richard Sennett describes how the sense of hopelessness, and isolation, deconstructs our character in the workplace, with ultimate tragic consequences. For Sennett, “character” is defined as the capacity to construct and keep commitments – not just in marriage, but also in friendships, communities, and workplaces – and the ability to provide continuous, coherent narratives of personal experience. In Sennett’s view, the “unfettered capitalism” that describes our recent history in labour markets, work schedules, institutions, and technology – renders “character” impossible. Contemporary capitalism demolishes the social and cultural foundations of “character,” and upholds instead the punishing ideal of incessant change.

Rushkoff concludes, “for the time being, as we contend with what appears to be a global economic slowdown by destroying food and demolishing homes, we might want to stop thinking about jobs as the main aspect of our lives that we want to save. They may be a means, but they are not the ends”.

The nature of work and identity appear in the forthcoming book No Straight Lines: making sense of our non-linear world

Because what Ross has done in that time is travel the length and breadth of the United States, photographing and documenting the life of juveniles in “Juuvie”. Juvenile prison. This work builds upon his last project called The Architecture of Authority.

I think its an important piece of work, its a very political piece of work, and it is a very powerful piece of work. Ross annotates one of his photographs, a picture of a boy with a massive head scar that covers the entire side of his head, The scar is from a traumatic brain injury. Many of the youth in the system have been the victims of violence, on the streets and at home, resulting in TBI and PTSD. Scars like this, while not common, are not infrequent.

What's the worse thing you can do to a human being? Solitary

Harpers Magazine have run a story on Ross’s epic journey which you can read (here) and (here).

Ross himself writes on his website,

Juvenile In Justice documents the placement and treatment of American juveniles housed by law in facilities that treat, confine, punish, assist and, occasionally, harm them. My medium is a conscience.

For the past five years, I have interviewed and photographed both pre-adjudicated and committed youth in the juvenile justice system. To date, I have interviewed and photographed over 1,000 juveniles and administrators at 300+ facilities in 30 states in the U.S. I have made sure to keep the children’s identities unknown, by either photographing them from behind or obscuring their faces.

I have photographed group homes, police departments, youth correctional facilities, juvenile courtrooms, high schools, shelters, Montessori classrooms, CPS interview rooms, and maximum security lock-down and non-lock-down shelters, to name a few. Earl Dunlap, the Director of Cooke County Detention Center, welcomed me to his facility with the words: “Welcome to the gates of hell.”

In the past I have photographed for major magazines, newspapers and institutions. At this phase in my career I am turning my lens towards the juvenile justice system and using what I have learned in 40+ years of photography to create a database of compelling images to instigate policy reform. My products are unbiased photographic and textual evidence of a system that houses more than 100,000 kids every day.

In the US all prisons are privatised – when you run a ‘for profit’ organisation, you need to input raw material to extract value – cash. In this instance the raw materials are juveniles from whose incarceration cash is extracted via the tax payer. So here’s a simple game plan one invests in prisons, and then lobbies to ensure the law accommodates easier sentencing and longer jail terms – because the more raw material one inputs the more value is extracted. Some Senators are in jail today for doing precisely that.

Ross tells me another story of a young boy, who has mental health problems, and is under 14. He shot his father with a gun. Why? Because his father had systematically raped his son since he could remember, then he started on the boys younger sister – so to protect her he shot his father dead. The boy is in Juuvie. As Ross would say, ‘Go figure’.

In a New York Times article from 2010

Gladys Carrión, New York’s reform-minded commissioner of the Office of Children and Family Services, has been calling on the state to close many of its remote, prison-style juvenile facilities and shift resources and children to therapeutic programs located in their communities. Her efforts have met fierce and predictably self-interested resistance from the unions representing workers in juvenile prisons and their allies in Albany. A recent series of damning reports have underscored the flaws in New York’s juvenile justice system and the urgent need to shut down these facilities.

Not surprisingly, these institutions do a terrible job of rehabilitation. According to a study of children released from custody between 1991 and 1995, 89 percent of the boys and 81 percent of the girls were eventually rearrested. New York’s facilities are so disastrous and inhumane that state officials recently asked the courts to refrain from sending children to them, except in cases in which they presented a clear danger to the public.

We don’t think about the system of prison, or at least very few of us do.  But in talking to Ross, and watching him work you can see the unfairness, greed, and a great inhumanity oozing out of every pore of this system. And this work profoundly resonates with me, and with the work I have been doing with No Straight Lines. This for me is an indicator of the fact that we live at the edge of the adaptive range of our industrial society, where we are deconstructing humanity almost to the point of deconstruction.

We must ask ourselves the question, what role does any organisation play in our society? Is it there to serve humanity and society, or is it there to create power? To generate huge revenues for a few at the cost of the many? And we then have to go on and ask and why do we stand for it? Will our conscience stand for it? Is this really the American Dream or is it time to reinvent it?

Juvenile In Justice will be on view at the Nevada Museum of Art in Fall of 2012 and Feldman Gallery in 2013.

In fact the question is: Is online piracy and ubiquitous free content killing our culture? I believe we must always be open to divergent and different perspectives of the world. We must be prepared to see the world from anothers’ perspective. I do think this is at times a good question to ask.

Morozov writes: Levine’s call to arms – “it’s time to ask, seriously, whether the culture business as we know it can survive the digital age”

But then one has to ask the question for example is Fox News culture? meaningful culture, worthwhile culture. Rupert Mordoch famously said he would make Sky News in the UK more like Fox if he had his way. Just have a read about the delightful Roger Ailes that runs Fox. The mainstream media that presents information as truth that plays a key and important role in shaping the debate about our world, has been found wanting. Is this system worth preserving?

But I persisted with the review – some good points raised. However,

In a chapter subtitled “How the internet could kill Mad Men”, Levine frets about the future of cable television, seemingly unaware of the fact that, back in the 1960s, American broadcast networks did their best to wipe out the nascent cable industry, which survived only thanks to a ruling by the US supreme court. Had the judges followed Levine’s conservative logic, a more fitting subtitle would be “How the networks aborted the parents of Mad Men”.

And how many times have incumbents fought bitterly and viciously to stop others. The telegraph versus the telephone for example. Morozov goes on…

Are new technologies really that much of a threat to the culture industry? Google TV – one of the projects Levine lists among the greatest threats to cable television – seems dead on arrival; at the moment, product returns outnumber sales. According to a recent survey by BookStats, in 2011 the publishing industry earned nearly 6% more revenue than in 2008, while selling 4% more books – in part, thanks to ebooks. The global march of streaming services such as Netflix and Spotify has made piracy less appealing.

None of this excites Levine, who complains that the internet has not encouraged innovation. “Like TV, the internet is only as good as what’s on,” he writes. Statements like this underscore the danger of setting internet policy based on the interests of the content industry alone. For those in this group, the internet is merely TV on steroids – its impact on the Arab spring, economic and human development and the future of learning be damned.

I arrived at the conclusion that Levine is representative of a certain form of market fundamentalism – and this fundamentalism is dangerous. Born out of not understanding, not wanting to understand. An arrogance about what is “culture” and who has the right to create it. He sees markets not as cultural but purely economic, he sees people only as consumers. Culture in his view, and people that he represents, see “culture” as a means to extract money from people. Simple. As the economist John Kay wrote,

“Capitalists are capitalism’s worst enemy, and particularly the market fundamentalist tendency which has been in the ascendant for the last 20 years”

For me, and Morozov saves it for last, is that in “Levines opinion James Murdoch was a saviour of Journalism.” The same James Murdoch who may have perjured himself, who along with his father owned a newspaper that in its quest for monetary gain, hacked into the voice mails of dead children, to get “the edge” on their rivals in the tabloid newspaper wars. If that is what Levine thinks is culture, then God help us all.

But the real frenzy isn’t the exposure of the scandal – it’s the scale of corruption, collusion and cover-up between News International, politicians and police that the scandal has revealed. As the cast of hacking victims, blaggers and blackmailers has lengthened, and the details of the incestuous payments and job-swapping between News International, government and Scotland Yard become more complex, it’s easy to lose sight of the bigger picture that is now emerging.

If it were not for the uncovering of this cesspit, the Cameron government would be preparing to nod through the outright takeover of BSkyB by News International, taking its dominance of Britain’s media and political world into Silvio Berlusconi territory. But what has been exposed now goes well beyond the hacking of murder victims and dead soldiers’ families – or even the media itself. The scandal has lifted the lid on how power is really exercised in 21st-century Britain – in which the unreformed City and its bankers play a central part.

What concerns Milne is the moral lassitude that seems to pervade all parts of the systems that are supposed to be edifices of British Life. Read: Barclays Bank The Real Indoor Pirates, or The Problem with Murdoch’s Media.

Is it time to truly Reboot Britain, which is different to playing lip service to it? A far too many people and organisations have done and are doing.  A people will only be free when they can control their own communications. And that fact has been drawn into sharp focus.