1. Body and Mind – connecting them in medicine and in health Steve Holmes Associate Postgraduate Dean 21 st January 2015

4. Luke Filde’s The Doctor (1891)

5. Who was the last person you saw? How happy were you with the care you provided – and they got? – factors involved Sketch and Drawing by Pablo Picasso (Weeping Woman, 1937.60 cm x 49 cm)

7. Don Berwick Professor of Paediatrics (Havard) Considered 2 nd most influential person on health care in US in the 21 st century Consistently in top 50 most influential in NHS Co- founder / Chief executive: Institute for Healthcare Improvement Advocate of Quality Improvement Science Berwick DM. A transatlantic review of the NHS at 60. BMJ. 2008 July 17, 2008;337(jul17_1):a838

8. Ten top tips for the NHS (2008) 1. Put the patient at the absolute centre of your system of care – Active presence of patients, families, communities – In design, management, assessment and improvement – Open health records 2. Stop restructuring – Each change made sense but the parade doesn’t – It drains energy and resources from the workforce – Workforce learns not to take risks, holds its breath – Stability will allow faster change Berwick DM. A transatlantic review of the NHS at 60. BMJ. 2008 July 17, 2008;337(jul17_1):a838

9. 3. Strengthen local healthcare systems – Health Economy (Community) should be core – Should support leadership, management, local interprofessional co-ordination and goals – Service not units, integration is key 4. Reinvest in general practice and primary care – “These, not hospital care, are the soul of a proper, community orientated, health preserving care system. General practice, not the hospital, is the jewel in the crown of the NHS. It has always been. Save it. Build it.” Berwick DM. A transatlantic review of the NHS at 60. BMJ. 2008 July 17, 2008;337(jul17_1):a838

10. 5. Don’t put your faith in market forces – Popular idea but little evidence anywhere – In the US competition has become toxic – Major reason for the duplicative, supply-driven, fragmented system – Favours expanding choice, more transparency, better leadership 6. Avoid supply-driven care like the plague – Pursuit of institutional self interest has been the engine of low value for the US healthcare system Berwick DM. A transatlantic review of the NHS at 60. BMJ. 2008 July 17, 2008;337(jul17_1):a838

11. 7. Develop an integrated approach to assessment, assurance and quality improvement – major recommendation of Leatherman and Sutherland’s report – Many governmental and quasi governmental organizations concerned with assessing, assuring and improving performance (but not working together) 8. Heal the divide between the professions, the manager and the government – Since the 1980s a rift has developed; forget who started – get it sorted Berwick DM. A transatlantic review of the NHS at 60. BMJ. 2008 July 17, 2008;337(jul17_1):a838

12. 9. Train your health care workforce for the future, not the past – For example: leadership, teamwork, patient safety, continual improvement, measurement and patient centred care 10. Aim for health – Could have been called the “National Health Care Service” but called National Health Service – maybe they meant it. – Black Report, Wanless and Marmot – showed good health care alone does not produce great health Berwick DM. A transatlantic review of the NHS at 60. BMJ. 2008 July 17, 2008;337(jul17_1):a838

14. J Holmes

18. Physical Health

19. Mental Health

20. Resilience the ability of a substance or object to spring back into shape; elasticity. the capacity to recover quickly from difficulties; toughness

21. Mindfulness means paying attention in a particular way: on purpose, in the present moment, and non- judgementally. This increases awareness, clarity and acceptance of our present-moment reality.

22. How do we train them for the future? Assessment? Interventions? Evaluation planning now? Role models for the future?