2b) I do believe “all knowledge is relational”. On a completely separate tack, I am passionate to see the hierarchy created by knowledge within the NHS broken down. The managment restructuring within the NHS had some great potential to create a more level paying field. But it has amazed me to see the CCG’s in England created with a dominance from doctors, only one nurse on the panel and no other therapists…..

Within general practice, it is rare to find practices where all the partners are not doctors, or if there are others, it is usually senior nurses or practice mangers. There are some exciting models where all members of a practice are partners (Bolton/Tower Hamlets in East London). Such models break down the hierarchies of money and knowledge as power and recognise the amazing contributions and to be made from across a team. Not only so, but data from these places indicates high staff morale, high patient satisfaction rates and good clinical results – a pretty awesome combination! This can work in hospital settings also and gives the hospital team and potentially the wider community the chance to participate in their workplace/heath service more holistically. It brings the possibility of participatory budgeting to the fore which is really exciting model for budgeting and corporate financial responsibility.

To flip power on its head and make it that which allows the mountains to be made low and the valleys to be raised up is at the very heart of kenarchy. Level playing fields – make for a better game!