Tim Williams: As many of you know in Health Coaching and Beyond, Ollie and I alternate conversations between the two of us, chewing over hot topics, latest news, and emerging ideas, but also bring you conversations with thought leaders and people we admire in the field of health coaching. So today has been Ollie and me having a conversation about the latest document from NHS England about adult community musculoskeletal service specification. so again we've done the reading. Ollie has done a blog about it. So if you didn't want to have to read the whole document, although it's only eight pages, so I think you probably could. We'll definitely put the link in the show notes for you. But Ollie and I just think a little bit about what this might mean. practically, what we might see, what we might notice that's different if MSK MSK services look like this. so hopefully you're gonna find something useful. And hopefully encouraging for you in the work that you are doing. So I hope you enjoy it. Welcome back, Ollie. It's been a while since we've kind of met again or we've had some great podcasts recently. I've really, really enjoyed listening to those. but you've been away, so so yeah, how's your holiday been?

ollie: it's been lovely, been lovely. And it is really nice, isn't it? I mean, we were blessed. went to the Lake District and you usually expect an English summer holiday to be wet and rainy. You might get the odd little glimpse of blue sky, but we had wall to wall blue sky for a week. I mean, how lucky is that? And to be honest, there's no better place in the world to be than the Lake District when it's lovely weather. So beautiful. The only trouble, the only complaint I've got... is that our attempt at cold water swimming just wasn't cold enough, Tim. know, the lakes and the streams, they were positively warm.

Tim Williams: You've got to start somewhere, Ollie. So maybe if that's just eased you in, then you just need to keep it going through the winter. It will get cold enough, at that at those points. So yeah, just keep going. Yeah.

ollie: Well, to be honest with I was quite happy to be warm water swimming. I think that's where, that's the difference in you and me, Tim. I'm just a warm water, soft southerner and you you're a hardcore cold water dipper.

Tim Williams: Yeah. You've got it right. You've got it right. But there has been some really interesting I mean, we've obviously been holding the fort while you've been away, it's been fine. but there've been some interesting document documents published. I think last week, I think, and I think you've written about this already in a blog, haven't you? But there's the adult community musculoskeletal service specification. So yeah, so you've already kind of reflected a little bit on this. So do you want to kind of share a little bit in terms of what your take homes were from that?

ollie: Thank you. Yeah. Well, it was really exciting, wasn't it? I mean, we keep an eye out on things that have been written in our field, health coaching and beyond. And this really sort of flagged up because one of the first sort of core NHS documents that came out that specifically talked about health coaching, I would say in parity to every other aspect of kind of health and wellbeing treatment for people. So it was the community-based adult MSK service specification. And I know that some of the kind of people have been sort of championing person-centered care. People like Chloe Stewart and Amy Robson have had a real strong part behind the scenes in making sure that it really expresses those person-centered approaches. But wasn't it fantastic just to see an NHS England document that starts to have a different language in it. It's really orientated around how we work collaboratively, how we work bright. broader than just a health system. We bring in workplace support, we bring in the voluntary sector, we bring in the leisure sector. We think imaginatively about how the whole system enables good musculoskeletal health. So yeah, it was a really exciting document to me.

Tim Williams: Yeah. It was good to see those those very specific words, wasn't it? Personalized care, you know, what matters based around what matters to the person. So that what matters to you kind of conversation, and and health coaching and social prescribing link workers. And again, using all of that, you know, shared decision making, all of that specific language, which absolutely kind of floats that boat, doesn't it? kind of in that document. Yeah.

ollie: And peer support is well in there, which we've seen, haven't we? So MSK, Musculoskeletal Services, very much include the sort of aches and pains of normal day life. But a lot of it is around chronic pain, isn't it? People living with persistent aches and pains, the area of chronic pain that we've had a long term interest in. And we know that the delivery of that involves all those things. It's so much more than just the health, traditional health intervention. Great to see that document recognising that, also I think for me it's a real shift in the tone of the way the NHS wants to operate. I said in that blog, it's moving away from a doing-to type service where services get more more refined and efficient and clever at how it does things to people, takes people's blood pressure, gives them injections, prescribes them medicines, refers them to specialists, does operations. moving to recognising actually we need to be collaborating with people and designing services that enable people to look after themselves as much as it does things to people. that for me, that was a real big shift in this document.

Tim Williams: Yeah, what what is it that people can do for themselves? and again it's not it's not abandon it's not abandoning people say like it's all up to you now. It's definitely we have a role to play in that. but yeah, it was good it was good to see that all the way, I think all the way through that document, it's not about again, we talked about that just before we kind of went live. We were talking about that kind of one stop shop and the idea that, you know, yes, it might be really efficient to kind of do everything in one visit, but that doesn't necessarily mean that's effective. So Just 'cause something is convenient and and getting everything in one place. I yeah, I don't know. I think we've been lured into that a little bit, thinking, Well that's that's the answer, but this feels like it's not saying that. Would you agree?

ollie: Yeah, and I think that's the thing, isn't it? And that maybe we're reading a little bit too much into it. We're a bit excited about it, but it's not necessarily what you do. So you could do a one-stop shop. Brilliant, great idea, really efficient for the staff, really useful for the patients. But during that one-stop shop, you might take their blood pressure, you might capture some bloods, you might sort of catch their height and weight, you might sort of do an Oxford hip score. You you might do a whole lot of medicalized things. They might see a physio and a nutritionist and a, you know, a nurse practitioner or an occupational therapist maybe even, sort of like it's, you know, it could be quite doing too focused. Whereas you could have the same one-stop shop where the focus is around enablement, coaching, peer support, building people's confidence. And you would be operating that one-stop shop in a very different way. So I'm hoping that that's what this was alluding to. not so much exactly how you organise things but the mindset and the spirit behind it of what you're trying to achieve.

Tim Williams: Yeah, I think that's a really good example of that, you know, because we've been involved in training people in that what matters to you conversation. But some some organizations that really could make good use of that. I'm just thinking like the Physio Works, the Community Physio Service in Sheffield has been doing these community appointment days. They weren't the first to do it, but it but it absolutely kind of felt like this is a kind of a real move towards this. I suppose there was a l element of a one-stop shop, but exactly what you're saying. It wasn't just about just doing things efficiently. They had people, they had it was in a leisure center. So people came for their appointment, they had an appointment with physiotherapist, they kind of started with the kind of what matters to you conversation. And on site in that big hall, they had people with various stalls from the you know the voluntary sector and the community sector, and other people that might be able to support the person in. In the things that weren't necessarily directly related to their hip or their back or their shoulder, but just gave people the opportunity to access some of those other services if that fet f if that fitted with kind of what mattered to them. So I think there that seems like a really almost like a really good example. And I know Doncaster had done exactly the same thing. and I think the the feedback from patients has been overwhelmingly positive, I would say.

ollie: Yeah, yeah, that's a great example. And I think that's for me, I think that signpost, what's good for us to talk about here, because I've already a little bit on LinkedIn, I've heard people sort of say, yeah, yeah, it's okay to say these things. But actually, what does that actually mean? What's actually different in practice when you let's say, use a health coaching approach to community MSK. So you've given a really great example there of where things are set up. with a different group of people invited, there's clearly a different sort of focal point of enabling people and helping them to sort of like connect up with other organizations, groups that they might be able to join, other people that might build their confidence. And I think that for me, that is the core shift is the focus of how you organize things and how you... actually practice how you even talk to people, what way you put your priority of your questions and your kind of shared plan you might make with people. It's all around this enabling and bringing people's skills and confidence higher up the agenda rather than the kind of medical model that we want to apply to people.

Tim Williams: I I can give you a kind of a real world experience. my wife Alison has has had a recent kind of physio appointment for her shoulder. and she was she she came back from the appointment, she said, my goodness, that was such an amazing experience. I'm thinking, tell me more about it. you know, what was it that made it really, really good? And she said, you know, the person that I saw, Vanessa, I'm gonna say Vanessa at the Physio Works, what she She she just created that kind of a sense of ease. So there was no rush. There was an absolute paying enough attention to what was going on for Alison, how this how this painful shoulder, how that was affecting the rest of her life, and a really validating conversation. and then that shared decision making, like, look, here's some of the options, you know, what do you think might be the most useful for you, and then ultimately going forward and and and giving the injection in a In a really obviously professional and and very competent manner, but it wasn't necessarily that bit, it was the bit that went before that, you know, of of just giving her that kind of validation and that attention. And I don't know that it probably took much longer than some other physiotherapy appointments, but it was just the tone of it and the approach of it. and I can contrast that because I've also had a shoulder problem, and I went to see. a physiotherapist too and again it was very much a medical model kind of you know situation. There wasn't me much in the way of attention. It was very efficient. You know, I kind of know that I wanted an injection. So maybe that kind of maybe that kind of altered things slightly. I didn't demand one, but it was very much a, you know, they were kind of typing stuff into the computer and and you know not really paying me much attention at all, then I think as an afterthought thought they'd better check some of my shoulder movements. So they did do that. and then it was very efficient. So okay, well book you an injection and and you'll get an appointment soon. It was almost and out as out the door. But there was none of this how's it affecting you? You know, what is it that you wanted to achieve, all that kind of stuff. So I don't know if that's just the difference between a really good experienced physio and a less experienced one or or or something deeper, I suppose, in terms of Making that connection. I don't know. I don't know. What do you think?

ollie: Well, let's dial down to that because it's really interesting to hear your reflections on that because, so what you alluded to the fact that sometimes people criticise the fact that you can't do health coaching if you're really time pressured and you haven't got very long, but you're not entirely sure it takes more time. But what is it you think that a skilled practitioner is doing in a more coaching style approach, the sort of approach that Alison had that meant she felt really good and sort of infused about her appointment as opposed to it sounds as though you felt a bit like yours is a bit transactional and you you didn't come away with that same sort of feeling that you've been listened to and that you paid attention to in the right way. So what are the features then? What's going on?

Tim Williams: Yeah, well there's there's there's some there's some s there's a mindset, I think. There's a mindset which is, you know, like we teach it's like the person in front of you has the most important contribution to make. They have the best solutions to their own problems. So there's a mindset. So if I know that about the person in front of me, then the way I approach that consultation or that conversation is gonna be different. It's gonna be very much like what do you think? Rather than I suppose the practitioner maybe just taking the lead.

ollie: and telling them what they know.

Tim Williams: Yeah, yeah, telling them what, you know, downloading if they what I know about about this particular situation. Cause sometimes people will think, that's useful, you know, just downloading what you know about you know, impingement of the shoulder, fine. But actually the it's a more human to human connection, isn't it? Is that is it's like what really matters to you, what's really important to you. So yes, you've got this pain in your shoulder. So what difference is that making to you right now? How is that affecting your life?

ollie: Mm-hmm.

Tim Williams: And and and, you know, how would you like things to be different? You know, what what what it and what and when when your shoulder is better, what will what difference will that make? What will you be doing that you're not doing now? What's not sound like very coachy questions, but they don't take very long to ask and they they prompt the person to think for themselves rather than being told stuff. I don't know, what do you think?

ollie: Yeah, yeah. Yeah, yeah. Yeah, no, I think that's the bit that really, I think people miss, isn't it? It feels like this is sort of soft and fluffy, but that bit you said at the end there, that intentionality of practising in a way that helps people to think for themselves, I think that's the crux of the health coaching mindset, as you say, but also the skillset as well. And it's not necessarily what you tell people because... that usually shuts down people's thinking for themselves, doesn't it? It's actually the invitation for people to start to think for themselves and to continue to think for themselves even when they're not in your presence. That takes exactly the same amount of time, but it changes the dynamic, doesn't it? Remember we often talk about this dynamic, don't we, about thinking in or thinking out. where a practitioner kind of gives people information and thinks inwards, which can almost constrict their thinking, as opposed to the opposite, which is asking questions and being curious and getting people to sort of articulate what's going on. It's not even about the response to those answers, it's just that the mechanism of doing that is getting people thinking for themselves. And that different dynamic. It's a whole different dynamic, isn't it? And for me, that's the health coaching dynamic that we're after with these services. And I think that's probably the bit that's, it's just that little bit of icing on the cake that's missing. It's not that practitioners are not good. not, like say, you want them to do the injections, you want them to understand how to diagnose things about the shoulder, you want them to explain something that people want to know. But the icing on the cake is also doing that in a style that starts to get people thinking and engaged and doing things for themselves.

Tim Williams: Yeah, it's interesting you kind of said that's kind of the icing on the cake, and it feels like it is, you know, but it feels like I suppose when you say icing on the cake, it feels like, that's just almost like a a nice extra. Do you know what I mean? Whereas actually what we know is that that is absolutely at the at the core of really great care. You know, the fact that that Alison came back from that appointment and she and and she was she was full of confidence about how she could then carry on to kind of manage. And I don't know that that was just because she was given

ollie: Yeah, yeah.

Tim Williams: great advice. I think it was because Vanessa had taken the time to understand what really mattered to Alison. And Alison had been heard. She'd been seen and she'd been heard. And therefore, whatever Vanessa had said, Alison would have had full confidence in. J do you know what I mean? Because because she's been heard. Whereas I think sometimes if we don't have that, then it sometimes it doesn't matter, even if we have got great advice and great instructions or information for people.

ollie: Yeah.

Tim Williams: If they've not been heard to start with, it doesn't matter. It doesn't matter.

ollie: Yeah. Yeah, no, you're right to pick me up on that. And in fact, think hearing you say that about what's made me, it's not the icing on the cake in terms of delivery. It's almost the icing on the cake in how skilful you are as a practitioner, because, you know, as a physio, you will have learned, you'll have had three years of training around the physiology and you want your physio to understand how the shoulder moves and works. You want them to have that core understanding. You know, as doctors and... you know, everyone expects you to have that core knowledge base, but the effectiveness of how you deliver, deliver your core knowledge, I think is really dictated by your appreciation of health coaching skills. So they're not a huge amount to learn a bit like the icing on the cake is a thin veneer on top, but it makes all the difference to how people receive it. And the most crucial thing, makes all the difference to how people then go on to lead their life as a result of your contact. So your contact becomes an enabler rather than a pacifier really. I do think we are able to use our incredible skills that we've learned over many years in a way that unintentionally shuts people down and stops people thinking. Or you can do the opposite and you can use those skills in a way that enables people to sort of like take more of a lead for themselves. And it's just that little subtle shift. I'm so passionate about it because I think we can teach people how to do this really easily. It's just a thin extra on top, but it makes all the difference to the outcome of the interaction, I think.

Tim Williams: Yes. Yeah. Yeah, and actually, you know, my experience of doing some of that teaching is that when people get it, it just brings another level of satisfaction and joy to the work that they do because that's actually that is how people want to support their fellow human beings. You know, that's my experience. It's not it's not kind of seen as like, this is something extra I've got to do on top of everything else. It's as a different way of being, which actually Is is more how I'd like to practice from from this moment on. Because it's not all about me sorting everyone out. You know, just downloading everything you know about something for a lot of people just can be overwhelming. And that's not what you want people to go away from your conversation with a feeling feeling of overwhelm. You want them to go away with a feeling of confidence, like Alison did. yeah.

ollie: Yeah. Yeah, Yeah, and I think actually reflecting that's one of the things I've definitely tuned into as a clinician. Now that I know how to coach is you start to see people's energy change, don't you start to see them open up. And you know, it's a skill because you can nurture people. Sometimes people feel very overwhelmed and very. in a hole and you can't just flood them with right come on it's over to you off you go you know you need the skills to be able to nurture them at the right pace and I think that's the whole thing about tailor-into-activation isn't it but When you tune into that, start to see people's energy build, whether it's from a very low level to just being a bit more confident or that lovely moment when you see people just flourish and go, right, I know what I'm doing now. I'm away. I'm, know, that perhaps comes as people become more activated, but that becomes your source of energy as a clinician. You, you realize their energy is, you you're the person you're working with. Their energy has changed. You've transformed their thinking and their optimism and their skillset for, for self-management and self-care, which will, you know, will then assist outside the room. And I think once you've tuned into that, it starts to energise your role as a helper and as a carer. We all go into this because we want to see people thrive around us. And you start to notice how what you're doing with people is helping them to grow and thrive rather than feel overwhelmed and weighed down with more burden and more responsibility.

Tim Williams: So, I mean I've explained that, you those community appointment days, that might be one way, I suppose, in which this kind of this new MSK specification, what that might look like. But I don't know if you kinda have got any other thoughts in terms of, you know, when when let's say, let's say you have a service and they are managing to achieve all of the things in this specification that that set out like this is this is what a really good service does. What what are the kind of things do you think would be different or that people would notice?

ollie: Yeah, that's a good question. in a way, I was wanting to get onto sort of the context that it gets delivered as well, because I think what was really interesting in that document was around valuing the role that voluntary sector can play and leisure providers. I think we're seeing more more leisure providers now, aren't we? personal trainers or the staff that working in leisure centres are taking more of a role in this enabling coaching style role. So in a way I don't think it matters who's doing it necessarily, what they're doing. So to answer your question on that, I think it is around systems, know, services that are seeing people... start to think better, start to behave differently. And participation for me is always a really key word, you so that might be participation in joining in groups and joining in classes and literally going to leisure centres where they weren't before or joining groups that they didn't feel confident to join before. But it also might be participating in proactive stuff for themselves, you know, so they do start to do. more confident movements. They do start to sort of engage in activities that build their self-confidence and self-belief, you know, which might be eating differently, moving differently, managing their stress, their sleep, but it also might be just how they start to talk to you, you know, how you start to sense more self-belief and more optimism and more of a can-do sort of like, dialogue you're hearing. So I think those are the sort of things you'll notice. You start to notice people, because these things often build over time, don't they? You know, if a service starts to behave in a more coaching style way, sometimes it might feel a bit strange to start off with. Like you say, people are asking you, well, what matters most to you? What are the things you're doing already? What's working already for you? They might initially start to think, well, that's your job, isn't it? I come to you for those suggestions. I want you to be the expert. That's always how it's worked before. But so it can sometimes take a little bit of time before people sort of come back and go, well, actually, OK, yeah, you know, I'm starting to do more things. And I'm glad you're noticing what I'm doing, because that's brilliant, because now I'm starting to get confidence in this. And it gathers its own energy. So it might take a little bit of time before these things start to happen. But I think that's what you're noticing. You're noticing people being more proactive themselves, I think.

Tim Williams: Yeah, great. And in terms of it's making me think actually, reminding me we had a group supervision session in the last week week or so where where someone came and we'll get this quite a lot, don't we, on our on our programs, because you have people who have some kind of some personal trainer type experience and then they kind of layer on the health coaching skills. But in some ways they kind of still feel like they're kind of wearing two hats, you know, because some w someone will come and they know what a I think they know what a PT is. You know, they know what a nutritionist does, and often it's can be along the lines of, you know, here's an exercise plan, here's a here's a diet plan for you to kind of follow. And that's the expectation that people have. But but actually blending in, layering on those health coaching skills and mindset, the conversations are going to be totally different, aren't they?

ollie: So what does that look like? So instead of someone giving you a diet plan or an exercise plan, what will be different then, Tim?

Tim Williams: Yeah, I suppose for me it would be finding out from the person, well, one, you know, what's currently going on in life. Just tell me a bit about that. What's going on for you at the moment? And again, I think that's exactly what Alison's physio said. You know, what's going on for you at the moment? What else is going on? and again, just get an idea about the context and then and then it's like out of all of that stuff, what's really important to you at the moment? What really matters? So I think you can get to that what matters to you kind of conversation. Okay, and so what is it that is that is You know, in in what way is this current situation working for you or not working for you? Okay, so what do you want instead? What's the outcome that you might want from this? Okay, well that sounds great. And what will be good about that when you've achieved that, what will be good about it? And what might and again, if it was a coaching conversation, you've moved quite quickly maybe on f with some people to kind of okay, so what what might get in the way of that? Okay, and then when you know what's going on get might get in the way of it, then you think, well, okay, so bearing that in mind, what ideas have you got?

ollie: Yeah, yeah. Yeah. Yeah. Yeah, yeah.

Tim Williams: About how you might achieve it. I've got some thoughts, but what what might your thoughts be? So that's so you can see how kind of seamlessly, I suppose, it it goes into that kind of very much a coaching conversation. and you blend in the kind of the expertise that you have, but it's not it's not your expertise first, I suppose. That's maybe the thing. It's the it's the person's expertise first, and then you join in with yours rather than the other way around. Does that make sense?

ollie: sure. Yeah, Yeah, no, completely. It's much more asset based. It's much more building on your experiences and maybe even some of the things that working already for you. So you're not saying don't do that. Do this. You're really tailoring it towards what they've already done. Yeah. Yeah, that's helpful. And I think that's sometimes missing in these documents, isn't it? Is that what does that actually look like then? You know, when you say bringing more peer support and lived experience and health coaching and shared decision making, you know, it helps, I think, to have this conversation because it's just subtle shifts, isn't it? But so the other thing I wanted to get onto is one of my slight bug bears really is around. And this is from my own. kids experience as well actually in the way the workforce is in the leisure sector which you know has so much potential doesn't it has so much potential to be an enabling and a kind of like a sort of inspiring sort of force for good but so often it can be just slightly distorted and I was talking to a commissioner from the council just recently and they recognized that there's some of the sort of the you know regulation and the kind of like training of coaches in the leisure sector is much more orientated around performance and around sort of sporting ability and outcome from a sporting sense rather than outcome about how you're growing as a person and how you're developing your own self-confidence and your self-skill and I think the leisure sector, think, which is also wanting to come into the MSK space, is so close, but just with a little fine tweak can bring in these coaching skills, whether that's in sports coaching or whether that's in just encouragement within gyms or, you know, it is having these direct health coaching style conversations. think we can bring those skill sets into those contexts as well. And they can make such a big difference.

Tim Williams: So what would that so what would that look like, do you think, in terms of in terms of the the leisure sector kind of getting more involved in in in community S K, what would that what might that look like, I suppose?

ollie: I suppose that the one of the, I can be specific really and just think about sort of my experience sometimes of sporting, you know, sort of opportunities that are set up in ledger centres for people is they're all around achieving certain targets, know, about sort of like, you know, almost like just on a pursuit of excellence, you sort of like you're hitting your personal record, you know, sort of, and particularly for kids, I think there's that sort of like drive to performance as opposed to participation and the fun of joining in, you know, and deliberately trying to make it feel good. I've had so many experiences with my kids where they come back from a thing, it was terrible, you know, we got shouted at, you know, we were told we were not performing and to some degree they want to try and be as good as they can. they want the team to be good but mostly what they want is just to enjoy themselves and to have a laugh and to feel like it was such good fun going there they want to go back again you know and I think you know there's a vest there's a there's a win-win for everybody here because I think leisure providers they want people to come through their door they want their services to be used they want it to feel like be accessible no matter what your ability you know and Yeah, there is a top end where you want your, your, your pursuit of excellence and elite is inspiring to everybody. It's wonderful to see people gain medals and perform well. And we can all kind of like, you know, sort of, support them and cheer them on. But for the majority of general public, they're going to get, get more physically active and be looking after their musculoskeletal system by, being more proactive. You know, it's the. It's the social and the connection and the fun side of it that's so important. And I'm not criticizing all personal trainers or all team coaches. I they're a hugely dedicated bunch. They usually give up their time. They're often poorly paid. They often volunteer, you know. But again, it's just another thing, I think, where you bring in some health coaching skills. It's tiny little change and you can make them far more effective. about how you make people, how you help people to enjoy what's going on and come back and have this positive energy rather than a little bit of a sort of, I'm feeling like I'm being shouted at and I'm being put down. I don't know, have you seen that, Tim? You've had kids, haven't you, go through, you know, after school clubs and, you know, you've got kind of family members who have experience of joining in stuff. What's your thoughts on that?

Tim Williams: Yeah, I mean obviously my my kids, you know, criticize me for not pushing them hard enough, Ollie, you know, when they're kind of Yeah. Well, no, only in in jest, in jest, I suppose, you know, it's that kind of you know, that the the reason they're not at the World Cup is because I didn't kind of push them as as youngsters to kind of you know, go every every week to to kind of football training and things like that.

ollie: today. Yeah, yeah. they could have been at Wimbledon. They could have been like lifting. They could have been there alongside you, Bellingham, scoring the winning goal for the semi-final. Yeah, if only you'd pushed them more,

Tim Williams: Exactly. Exactly. So I feel utterly, utterly responsible for that. but but I but I but I absolutely agree. You know, actually if the leisure center wants to make it a really big and positive impact, it needs to be working with the people who are at those lower levels of confidence, knowledge and skills, really. You can you could of course you can work with the people who who are really highly activated already and make kind of incremental improvements, of course. But in terms of

ollie: Yeah.

Tim Williams: Making really big difference to the nation, it's working with those people who are not the elite athletes, not the people who are just chasing personal bests, but people who want to just move a little bit more and get a little bit more active. So, yeah, again, they what they don't need probably is the boot camp approach, I would suggest. You know, they need something different to that, which is more encouraging, more.

ollie: Yeah, yeah.

Tim Williams: paying attention to their kind of starting point and what else is going on for them and more kind of holistic I would suggest. I don't know, what do you think?

ollie: Yeah, no, I agree. And hearing you say that, it's about that shift, it? I think this is almost the crux of health coaching, isn't it? Or health coaching as we see it. You're shifting away from performance, whether that's health performance, sporting performance, you know, you're moving towards helping people feel good about themselves, I think. And it's the skills that enable people to feel good about themselves. And yeah, sure. If you're poisoning yourself with really, really bad diet, or you're really not moving at all, you're probably not going to feel very good about yourself, so that might come into it. But I think the skills of health coaching are the ways of helping people to feel good about themselves and build on that self-belief and self-efficacy and self-worth, if you like, really. And that we've really, I think we've really underestimated the value of building that up and how that compounds over time and leads to the end outcomes. the health outcomes that we're after anyway, you know, but that we should be more purposeful in the way we deliver the support we deliver, whether that's a leisure provider, whether that's an MSK healthcare professional, whether it's a voluntary sector health coach or link worker trying to support people. I think the core bit for me is the health coaching ethos is how do we help people feel good about themselves and build on that.

Tim Williams: Yeah. Because actually, if they don't feel good about themselves, why why would they bother with all the other stuff? Why would they bother paying attention to their diet and moving more and, you know, not poisoning themselves, you know, actually if they don't feel they're worth it? You know, so so again, I think that's maybe the bit that's missing. People maybe, you know, just focus on the bit maybe someone is even being referred with w for, which is maybe weight loss or maybe getting more active. But actually, some of the reason people are not active, some of the reason that people

ollie: Yeah,

Tim Williams: are not paying attention to their diet and their nutrition or, you know, poison themselves with all sorts of other things, is because they don't feel they're worth bothering with. So if you don't build if you don't build that, even if you did work with someone and help them make some small changes, there's a really good chance those changes just just frit away over time because the mindset of that person hasn't particularly changed.

ollie: Yeah, absolutely. That's why I love about these conversations Tim, is it gets us to the crux of why we're doing what we're doing, I think. I think, you know, sometimes a misconception that health coaching is around getting people to follow the right diet or to do the right exercise program or getting their blood pressure down, their blood sugar lower. And yes, some of those are ingredients and some of those are end outcomes that follow on. But I think what we've learned, haven't we, that health coaching is that core of building someone's sense of self-worth and agency and the role they take themselves. that then once you've enabled that, these things follow on. And it's really nice to be able to have the opportunity to just to really dive down into that. And, you know, let's circle back to the MSK document, you know, to see a document that's starting to articulate the value of this in... the NHS that we're all wanting to see thrive. And I think that's a real case for optimism for me, that we're seeing the value of purposefully doing this, purposefully building health coaching skills into our service.

Tim Williams: Yeah. And as we've observed, it's it's not it's not impossible to do it. In fact, it's relatively straightforward to do it. And it doesn't take a whole load more time. it's actually energizing for the for the practitioners who are learning these skills. so if in i in in in the NHS where people might be kind of feeling a bit burnt out, kind of constantly doing two, actually one way to kind of suppose support people to kind of keep on going is is this more doing with and being alongside people is much more rewarding. And we know that from people.

ollie: Yeah, yeah, yeah, yeah. No, it is, it? is. Well, that's what keep us keep us banging this drum, Tim, really, isn't it? Is that it's a win win all around, isn't it? know, everybody feels better if we focus on these skills. I mean, what do you think is getting in the way of it then? What what why aren't we naturally working like this? Is it because we're in this sort of firefighting, constantly chasing a crisis? You know, there are there are just It feels like there's such major in-your-face problems to solve with people that we just don't have time to take any of this health coaching style mindset or practice.

Tim Williams: Yeah. Well I'm sure there's definitely there's there's definitely an element of that. And and sometimes when we're really under pressure, what we tend to do is revert to kind of what we think we know works, which is, you know, seeing people more quickly, you know, getting people through the doors, getting the waiting list down and all that kind of stuff, seeing people in shorter periods of time, almost like paying attention to the efficiency part as like that's the only thing that matters. when actually it probably isn't that effective. I would suggest. So I think there's a there's a there's a kind of a a way we've been brought up in the system that that that prioritises efficiency over absolutely everything else. And there's an element of expectation that people bring and kind of this is what my this is what you need to do for me. and I think we we are a lot of us maybe want to Yeah, want to kind of fit with those expectations that people have of us. Yeah, sometimes. We know maybe don't want to be too challenging or challenging back. But I think there's a lot of assumptions there. I think there's a lot of assumptions which are limiting for us, which is, you know, we need to see people quickly. That's the only thing that matters. and this is this is what I this is this is what works. And I and I think we need to challenge some of those assumptions because I think they're limiting us, but I also think they're limiting the people that we we work with as well.

ollie: Yeah.

Tim Williams: What do you think?

ollie: Yeah, no, think you're right. think you're right. think hopefully this sort of document gives confidence that we've got permission to work in a bit of a different way. I think it definitely needs to be backed up by the air cover to do it, the headspace to do it. If you are going to go a bit slower and go a bit deeper with people, you need the system to back you on that. I think... I think there's enough evidence out there to show that we can have confidence that if we do take the time to sort people properly, you we don't have failure demand, we don't have what I've sometimes called passivity demand, we're not constantly feeding this beast of just doing things to people and doing things for people so they keep coming back. I think it's that point now, isn't it, where you need that air cover from the commissioners, from the leaders that slowing down like this might on the surface look like you're doing less, but you're using different skills in a different way. And I think we just need that confidence that this is the right thing to do. let's do it. And it might mean that we have to stop doing some other things for the time being that are nevertheless worthwhile, just not perhaps as valuable as building people's self-confidence and agency and self-belief.

Tim Williams: I we talk about this, don't we, on our programs, but you know, we are wired, aren't to sort and to solve and to save. That's that's kind of our wiring. If it wasn't our wiring before we got into the NHS or health and social care system, it it definitely is by the time we finished our training. And so we kind of think that that's our job. But actually, if we knew that the people in front of us had the best solutions to their own problems, we would absolutely have different conversations. And I think that's where the health coaching skills and mindset come in.

ollie: Yeah, yeah. Well, it'd be lovely, wouldn't it? I'd love to see what's emerging. mean, to have an optimistic finish. You people are organizing in neighborhoods. We're organizing different teams. We're drawing on the voluntary sector. We're drawing on the leisure sector. You know, there's a capacity and capability within those systems that we can draw on. I think we know optimistically that we can build these health coaching skill sets in... Very easily doesn't take a lot of time doesn't take a lot of effort just really takes a mindset shift I think we just need a little bit of air cover around the transition period That probably needs a little bit of funding, but it doesn't need a huge amount And I'm really hope as we transition to neighborhoods looking at working with different way There'll be a little bit of funding to do some different projects and I hope it will this sort of document will draw them to community MSK projects and give us that little bit of headspace to to redesign and reorganize it in this way. And I think there's a huge amount to gain from this, so much to gain.

Tim Williams: Yeah. I don't know we're we're coming up to time, but again, the other thing I think would be really exciting about this, and I think you've alluded to it as well, is that actually if we can see how this might work for the MSK service, and there's no reason why other other services can't use this really as a blueprint for kind of how they might work more holistically with the people that use their services. I don't know. What do you think?

ollie: completely, completely. Well, we've seen it. viscerally in chronic pain and people like Lee Vaughan and Deepak Ravindran who are championing these sort of approaches, haven't we? But we've also seen it in metabolic health, you know what the public health collaboration are doing, know, people like, you know, sort of Campbell Murdoch and David Unwin and so on, they're showing how you can enable people to work together in groups, peer support, enabling type care. You know, I've seen the new mental health centre that's set up in the community in Sheffield that I've been a part of where you again, you're drawing lived experience, you're drawing the community in. So, know, yeah, there's so much potential for this. Like you say, it is just that probably that mindset and that confidence that this is this is this is what we should prioritise now.

Tim Williams: Right, we should probably draw our conversations to a close, but it's been it's been good to talk about that, Ollie, and I know I know we're

ollie: We've rambled on, we? I hope people find that interesting. I love talking to you about this, Tim, because it really helps my, I actually think as we go along with these in these conversations, but we'd love to hear from you what it triggers in you and what thoughts you have. Please interact with us on LinkedIn and in the comments in YouTube and just, yeah, let us know what you're thinking. We're all on learning journey together, aren't we?

Tim Williams: Yeah, I agree. And I think that, you know, in the the landscape at the moment is is is also quite it's really challenging. I was gonna say quite. It's really challenging. So actually having conversations like this where we can really focus down on why it is we do this work would be is really important. And and the kind of the value of peer support as well. So again, if you're in this space and you're feeling like you're you're you're in the battle but you're by yourself, please reach out and and let's get you together with some other peers who are also in this space. Cause I think it's just having that. that conversation that in just encourages you that we're on the right we're on the right track and and what we're doing feels like the right thing to be doing.

ollie: Yeah, absolutely. And value what you do. What good, really good health coaching conversations do is you see someone grow in front of you, see their energy start to come out of themselves. And see that and value that. That's so important. I would say it's more important than checking their blood pressure or prescribing antidepressants. I mean, that is such a great thing to value achieving that. And you don't have to be a doctor to do that. You might be a peer support volunteer. Do you know what mean? If you see you have that effect on somebody, such a valuable part of system. So good on you if you're doing those sort of things.

Tim Williams: Alright, good to speak to you, Ollie. We'll let people go now. Okay. See

ollie: This has been Tim, catch you next time.