Making good trouble: Clenton Farquharson CBE on co-production, equity and change

Key:

• J: Jo Vigor

• C: Clenton Farquharson

J:           Hello and welcome to the Kings Fund podcast where we explore the big issues and ideas in health and care.  I’m Jo Vigor your host for this episode and I’m delighted today to be joined by Clinton Ferguson, currently the Associate Director of Think Personal Act Local.  Clinton has made significant contributions to health and social care during his care, often drawing on his lived experience, using the services as a disabled person.  In 2022 Clinton was voted as the top leader of the social care top 30 awards.  In response he said, I’d start a leadership revolution if it was left to me.  Leadership is not about command and control, rather it’s about restoring a sense of being human, being kind, trusting people, being able to really listen and care and we can all do that.  Clinton, welcome to the podcast, it’s great to have you with us today.

C:           Thank you Jo, and thank you for the warm welcome.

J:           You’ve had a stellar career so far Clinton and we really appreciate the work that you’ve done for society Clinton, if I may, with your leadership journey.  So for the listeners who are with us today and aren’t familiar with your story, what is your story and how did you get to where you are now? 

C:           That’s a good question.  I’d like to start from growing up.  Growing up in Birmingham with my parents who were part of the Windrush generation from Jamaica and my early life was I would say a mosaic of cultural richness and profound challenges.  What I meant by that, our small home was always alive with vibrant sounds of reggae music and comforting aromas of my mother’s cooking, which wasn’t great for my waistline growing up.  It was a world where the strength and fortitude of my parents I believe laid the foundation of the journey that would define who I am now.  Picture this young boy in a secondary school, silently battling undiagnosed dyslexia but labelled challenging behaviour, that was me.  My educational journey marked an invisible disability, underscored what I believe the critical need for understanding and support in our schools.  My parents having faced their own battles adapting to life in the UK, instilled in me and my brothers and sisters, an unwavering commitment to (inaudible 00:02:47) and justice.  They taught me to push through adversity, no matter the odds and all those whys, insights and wisdom my parents gave me, culminated to a pivotal moment for me at 27 when I was working in a nightclub in Birmingham, I faced a life altering moment.  I intervened to protect a young woman from being raped.  That act of courage, I was stabbed 26 times and that night for me changed everything.  I transitioned from living with an invisible disability to navigating life as a wheelchair user.  That physical and mental scars, including post-traumatic stress disorder, became a symbol of both limitations and new found strengths and a constant reminder of the fortitude which now defines me.  My journey has been one of fortitude, turning pain to power and challenges into opportunities.  Today I would say my story is a testament of hope, determination and the belief that even in our darkest moments we can find the strength to rise and lead with purpose.  Reflecting on 1981, the lessons learnt when we had riots around where we were growing up in Handsworth and in Birmingham, are still quite relevant today and the concept of making good, trouble, continues to inspire and challenge those striving for justice.  It reminds me and others, that the path to equality is never easy.  But it’s through brave challenging that we sow the seeds of progression and hope for a more just world.  As we look to the future I believe it reminds me of a quote by the former civil rights leader, John Lewis, make good, trouble.  He paved the way for I believe meaningful and enduring change.  So I believe change often arrives unexpectedly as when you’re born, and leaves you just as bewildered, yet it shakes us in ways we never anticipated.  That’s a bit about the background of why and where I am today.    

J:           The ability and bravery to be able to tell that story from the invisible disability to the visible disability I think is really moving.  So with that in mind, earlier on I read a quote from you where you talk of a need for a leadership revolution.  I can see in your point about making good, trouble, that you’re leaning into that.  So what type of leader are you?  If you were to take all of those behaviours and characteristics that you’ve talked about how does that translate into the type of leader you are?

C:           I just believe in holding on to hope and I think as leaders hope’s the biggest thing which should bind us.  What I mean, not hope just to be optimistic, I believe in hope in my darkest of times where I had my post-traumatic stress disorder manifested itself into some serious mental health where I wouldn’t even get up out of bed.  I didn’t see a light at the end of the tunnel.  If it wasn’t for good people who were in my life.  You know, my wife now, my mum and dad, my brothers, sisters and especially my friends, who helped me build that I could see the light, even in the darkest of moments.  I think hope, determination and realising there is ups and downs and without that deep determination, has helped me to try and make that impact but not just for myself or my family, but the wider us, you know, the larger us, thinking about it’s not just about me it’s about caring about other people.  That was why I started my journey.  For me it started the day I decided to confront the stark realities of a lack of wheelchair access or trying to go to my local shops and realising I didn’t just feel excluded, I felt I had to do something.  It was easy at first to pour out my pain and scream and shout at the shop owners about it and I thought no, I can’t be the only person going through this, let’s try and create a collective action on those of us that are marginalised and sometimes left behind.  So that was the moment for me that made me think about my call to action for a better word on my learning.  So I defined my experiences that I should use them in a positive way to ignite what my mum would say.  There’s a Jamaican saying and it’s made me laugh now when I think about it, she said one hand can’t clap.  You can’t do everything on your own, you need like a village to help support you.  At first I used to think she’d lost her marbles, but the more now that my mum has left us, she passed away last December, I’ve been writing down more and more of her sayings and sharing them with my daughter and explaining what they mean to me now.  Because at the time I just thought she’s off again, she’s off again, so.  But that helped I believe shape the passion to create real change.  Yeah, lasting change.  Those experiences has propelled me to advocate for those voices that are often overlooked.  So that’s where I would say has driven me.  A perfect phrase I often say, if you’re not at the table you’re on the menu.  That resonated deeply with me during the time.  It served as a powerful reminder of the importance of ensuring that every voice, especially those that are most marginalised … and it’s not only being heard but valued in decision making processes and it for me becomes clear to me that we cannot create policies that uplift everyone unless it includes the perspective of those who draw … especially on care and support and often we’re not in the room. 

J:           Absolutely.  I do have a question about how we draw on people’s lived experiences and how important that is to policymaking.  Can I just circle back, Clinton, your passion and your message around hope is so powerful.  How do you continue to look after yourself?  I can see that you put all of yourself into your work and into how you do your work, so how do you continue to top yourself up?  So as a leader, what would you say to others about looking after yourself?

C:           Looking after yourself is one of the most important things.  One of the things that I try and do is refuel and re-energise.  So I surround myself with people who help pick me up and I help pick them up.  My biggest passion is, I go on cruises.  I go on cruises with my wife and family because it’s really accessible.  But also I love being on the sea and I use that for reflection.  It enables me to think of the possibilities or the art of the possibility and hope.  It makes me feel closer with nature.  But that hope is what drives me I believe and also that change is possible.  Because you have to create different mindsets and sometimes we end up having a fixed mindset.  The biggest thing on Blur is, how do you try and occupy a growth mindset, especially with people who have the real opposite perspectives than you.  I think that’s the best point to learn from, trying to understand their perspective, because they believe that with all their hearts.

J:           Absolutely.

C:           That’s the one thing that my mum … I used to think she was a (inaudible 00:12:09), especially with some of the stories she told us, nobody would rent a house to my mum and dad, the signs of no blacks, no dogs, no Irish.  I said, how did that make you feel?  She said I had to keep alive the message that was told to her, that she was coming to Britain to help build a better future.  I said how did you keep that belief that you were here to help build a better future when you were faced with people who were hostile.  She said son, you will face that in everything that you do in life.  But what you’ve got to hold onto, some people are not ready yet to hear your message.  What she said was, yet.  I find that profound, that some people are just plain not ready yet to hear what you’ve got to say.  It doesn’t mean you just forget them, how do you try and accommodate them moving to where you are and also you moving to where they are to try and see what is that emotional baggage that they’re carrying that makes them think that way.

J:           I mean, what a story.  Your mum is such a wise lady isn’t she.  What an influence on you. 

C:           My mum is my hero.  When she passed I cried like … I’m getting emotional now.

J:           Yeah I’m not surprised.

C:           She’s my rock and I found it hard when she passed.  I lost my way because every time I needed that reassurance and that lift my mum was there, even though she had Parkinson’s, she had her own care and support needs but she was always bright and lifted me.  That’s why I struggle with the term, resilience, it’s not resilience, it’s fortitude.  If we think about what those words are and what they mean, fortitude was the rock that my mum was and my parents were built on and they passed that on to us in our DNA, if that makes sense.  Don’t get me wrong, I don’t (inaudible 00:14:28) hold on to hope, I realise some of the current realities that we live in, but you have to keep believing there will be a better tomorrow.

J:           That makes perfect sense.  Clinton, we have a saying in the team here, we talk about grounded hope.  So it’s not hope in a world where we’re looking for unicorns, it’s hope in a world where it’s grounded and we can keep each other going and we can recognise the complexities of the world we all live and work in.  But at the same time we can support each other through that.  I mean you’ve talked a lot about community.  I love the fact that your mum absolutely sounds like your local hero to you and she sounds like such a wise lady and her lived experience will have informed so much of who you are and some of the things that you think and do in your work now.  If we move on to your work now, you’re currently an Associate Director of Think Local Act Personal.  How would you sum TLAP up in a couple of bullet points, is that possible?

C:           TLAP stands for Think Local Act Personal and we’re about looking at bringing alive personalisation.  When people talk about personalisation in a policy sense it’s basically about a life not a service and using the super power which I call co-production, with people who draw on care and support, including carers and it’s that perspective that’s often missing when we’re talking about decision making when people are creating policies on my behalf without me and others being in that room to shape and design and deliver that service if possible.  So in short it’s about making sure no-one’s left behind.  That’s basically what we’re trying to achieve. 

J:           We’ll return to the podcast in a moment.  Over the past 20 years there has been a growing emphasis within health and care on ensuring that the voices of people who draw on care and support are heard.  So how can this be done?  Get your ticket to our virtual conference in December to learn how health and care leaders can turn listening into action and enact meaningful change.  You can find a link in the show notes.  Welcome back.  That’s brilliant Clinton.  Using that term, no-one’s left behind, for people who are in policymaking who may be listening in today, or leaders, both formally or informally, within the health and care system, what does coproduction when done well, what does that look and feel like for people?

C:           For me, when coproduction is done well you feel that your opinion, your thoughts, your perspectives have been included.  But you also understand why certain things aren’t able to be done, because you’re fully included in the conversation, so you help understand what are the expectations, the boundaries, what’s insight, what we’re going to discuss, what’s out of sight of what we’re going to discuss and why.  Because often we don’t really understand the why and the why is really important and often missed because we go straight into the policy and how to deliver the policy, but not understanding the context of how lived experience lived and living experience can play out in this. 

J:           Clinton that’s really helpful and really interesting because the question that then comes to mind for me is often as you said, people in leadership positions or who are undertaking policymaking are really thinking through how do we undertake policy that speaks to the majority.  So if you’re used to working in that way what would be your recommendation to people are their first steps to work in a different way where you are looking at the systems thinking?  What would be your advice? 

C:           The first advice for me is, once you’ve got people in the room, how do you help people see the bigger picture?  What I mean by that, how do you go about informing them about equity, what we mean about equity and the equity of experience.  Because some people in life, experience a far worse outcome because equity hasn’t been reflected in policy areas.  Like a classic policy area was, if we think about people who get free medication prescription, there was an issue for cystic fibrosis patients who didn’t get their drugs free.  That anomaly and inequity in the system was only really sorted out last year, I think last year January.  That was constantly an issue.  That’s where sometimes we don’t understand what fairness and equitable means and looks like and it helps sometimes marginalise a section of the population that are left out.  So it’s about understanding that and giving people a richer picture.

J:           Clinton, does the concept of equity … and you’ve talked about this earlier on in our conversation … but does that concept of equity, is that a grounding principle for the work that you do in coproduction? 

C:           I believe so, it has to be because people need to understand the nuance and the difference between quality, diversity and inclusion.  I use the analogy of, shoes, to describe equality.  Shoes is like everyone has the opportunity to have a pair of shoes, that’s the same opportunity.  Equity would mean to me, that each person has shoes that fit them, especially like my size 13s, if you only offered me a size eight, I’m really going to struggle.  So we have to personalise those shoes to fit my needs.  Then the diversity for me in that analogy is, that we have different styles, you have that choice and control of the styles that we have, that meet your unique perspective of the world.  Then inclusion would be, having all of that and also being able to get access to that.  That’s what that analogy is for me, it’s understanding equality is about giving everyone the same opportunity, equity is that the shoes fit me, diversity basically is about having the different colours and styles that suits me and inclusion is, all of the above, but also how I have access to that as well. 

J:           That’s brilliant Clinton, and I love the analogy and really bringing that to life.  I think what you’ve done there is brought me onto some of my final area of questions which is about the future.  In July we saw a new Government come into power for the first time in 14 years, if there was one thing you’d like to see the new Government do in this space, what would it be?

C:           With the new Government I’d want them to look to the future with the opportunity to re-imagine our health and social care system and this for me is about that gives us a chance to advocate for policies that prioritise inclusivity, but also equity that I talked about earlier.  But also about defining what we meany by welling individuals and communities.  For me, together we can build a system not only that meets the needs of today, but also I believe paves the way for a brighter, more inclusive tomorrow by picking up all of the elements that I’ve talked about earlier.

J:           That comes into your point about hope as well isn’t it in terms of re-imagining the health and care system and advocating for those changes.  I think that then brings me on to some of the reality that is now coming to the fore.  So there are some encouraging changes from Labour so far, but there are also areas for concern including Labour’s decision to cancel the cap on social care costs.  Do you think there’s a role and opportunity for the opposition parties to hold Labour to account?

C:           Absolutely I do.  It’s not just to hold them to account but be part of the solution.  What tires me about politics, it’s really easy to try and score political points off each other.  What I would really hope for is, politics where everyone sees the goal is about making people’s lives better.  If that’s the collective goal, what is your role as a politician enhancing and uplifting individuals and communities.  Especially if we’re coming together to look at health and social care.  Because we often see health just through the lens of hospital discharge and health and social care is much more than that.  That’s why I think framing it as care and support and using … the Government’s talked about the national care service, I think that might be a really useful way of discussing what that social contract might be between citizens, central Government, local Government, providers and the systems that we’ve built up.  I’m part of the group called Time to Act, with other senior leaders.  That’s looking at how do we re-imagine using social care futures and vision of care and support, but it’s about that better tomorrow that I keep talking about.  It’s about coming up with solutions for making personalised care and support, how we really embed the choice and control, how do we re-imagine moving from not just hospital discharge, what might care closer to home look like.  How would we look at early intervention and prevention, especially if that’s rooted in the carer.  Especially promoting wellbeing.  How doe we start making that grounded so people fully understand what wellbeing is. 

J:           I think that’s great Clinton because what comes to mind to me is that in that re-imagining work, there needs to be a national conversation of engagement work with citizens and staff who work in the health and care system about what could be different.  You’ve flagged there the need to move much more into that prevention agenda, care closer to home, so I do think that it sounds like there’s an opportunity for having some broader conversations with the public and staff about the future of the health and care system.  Clinton, I’m going to move us on to my final question today which is that your writing and your work offers a huge amount of hope on so many levels, so if our listeners were to take one thing away from the podcast today, what would it be?  What would you hope it would be?

C:           That’s a really … for me, what I would hope people would take from this, it’s stay true to your values, build strong networks and always remember the power of your voice in this discussion and be persistent.  Also, use your fortitude … are essential in your unique perspective.  But embrace it and use it to drive change that you want to see in the world.  Most people often talk about what they stand against, what happens if we turn that on its head and you articulate and tell a story of what we stand for. 

J:           Thank you.  Again, I think you’ve touched on some really complex topics today around equity and inclusion and we’ve just had the riots recently in the UK and I think it’s really important to keep reminding people that these issues are live but we can all work together to do something about that as well, alongside changes in the system.  So I’m going to close the podcast conversation today Clinton.  It’s been a fantastic opportunity to work with you and thank you so much for joining me today.  Is there anything that you would like just to say in this last few moments?

C:           I think in this time and moment we’re in … and I think the biggest thing we should hold onto and it was the former American President, Obama, said change will not come if we wait for some other person or some other time.  We are the ones we’ve been waiting for and that for me, that’s the change that we seek and let’s seize on this moment.  It’s so important with what’s going on in the world, the riots, our health and social care system and it’s about all of us and I mentioned it before, the wider and the larger us, to help reform.  Whether you can stand or sit in my case, together for a future that works for everyone.

J:           Thank you so much for joining me today Clinton, I’ve really enjoyed speaking with you.

C:           Thank you Jo.

J:           The show notes for this episode and all our episodes can be found at www.kingsfund.org.uk/kfpodcast and you can get in touch with us via X, our account is @ the Kings Fund.  The producer for this episode was Natalie Cleverley and it has been edited by Bespoken Media.  Don’t forget to subscribe, share, rate and review this episode wherever you get your podcasts and of course, thank you for listening, we hope you can join us next time.