This is your organisation, we support you, we need you

b4Welcome to The View

Hello, my name is Rob, I’m your chief executive.


Values based leadership is essential in public service and the NHS – and I have made it a feature of my ambition for our Trust. I always say that you need to be clear on your values so that in tough times you do the right thing or that you have a guide when there is no ”right answer” to a wicked issue. One of our values is being respectful, honest, open, and transparent. At the heart of this is integrity, including a commitment to equality, diversity and inclusion. We try and reflect the communities we serve in all their diverse glory.

The news is full of stories and debate that may make people who are “foreign” or “different” or not “White British” feel unwelcome. A positive story about boosting medical training has turned into a suggestion “overseas” doctors are not valued. The emerging policy that all companies will be required to list “foreign workers” has been widely criticised. I would like to offer a balancing view.

The NHS was built on “overseas” staff and continues to run because of them. When I met a group of 100  “Windrush” nurses in Leeds in 2013 they were so proud of the NHS they had built following their journey from the Caribbean. Many of them in their 70s and 80s, they were still excited and passionate about their careers, their roles and their nursing contribution.


Our own organisation is made up of a mixture of people from different and diverse backgrounds, each contributing to the successful delivery of services within SWYPFT. Our ambition is to ensure that we harness all of their potential and the strength that diversity brings. If you are feeling scared, stigmatised or disappointed by the wider debate, please know that this is your organisation, we will support you and that we need you. Every day, from porter to professor, OT to trainee you are making a difference and enabling people to fulfil their potential and live well in their communities.

Of course we don’t always get this right. There were challenging discussions at the launch of our own Black Asian Minority Ethnic (BAME) network last week and there is more to do. We have positive staff survey results in 2016 to build on. We don’t yet reflect the diversity of our population across the organisation and must act if we are to deliver services that better meet the need of populations.


Values based leaders accept feedback and challenge and I benefitted from free, expert advice on this agenda when I took part in the “Board” simulation event for the ‘Ready Now’ national leadership programme. The programme takes BAME leaders from across the country and gets them to work on specific challenges. Three groups of leaders were asked to consider SWYPFT’s approach to equality and inclusion, based on our real Board papers and feedback recommendations to the “Board”, made up of 8 real chairs, chief execs and execs. It was a fantastic insight into what was good about SWYPFT’s approach and what was not. Myself, Alan Davis and Tim Breedon left feeling the participants got a lot from the session, and that we got even more out of it. Fresh eyes, real insights.

Perhaps the most courageous statement was from a young woman who said success for her would be

“seeing someone who looks like me sitting at that end of the Board table”.

She was right, and I am sure the Leadership Academy Programme, our involvement in Gatenby Sanderson’s work on NED development for BAME communities and a refreshed inclusion strategy will help. We will certainly be better equipped and informed following the session this week and I would like to thank the participants for their passion and honesty.

Perhaps, she was a good example of “leading from every seat” in an organisation, something I talk about regularly here in the Trust. It’s something I see every day. I see it in the movers and shakers and the unsung heroes putting together the BAME network. I see it in the people challenging stigma and fear, with professionalism, care and a clear link to our values. One of my jobs is to amplify it, point it out and celebrate it.

So, thanks to our team of peer-to-peer vaccinators leading the way on flu uptake. Thanks to the porters at CNDH for raising issues about waste and recycling that was discussed at our executive management team this week. Thanks to the people and teams who were entered for our Excellence awards and congratulations to our finalists. Thanks to the team who put together the SWYPFT cycle club -according to Sarah Hennessy, our librarian, the first cycle this Saturday is an ‘easy’ 22 miles that will be fuelled by mid-way cake.

And thanks to all of you for who you are, how you are and what you do. The world outside is debating difference and there is a risk we exacerbate differences. I’d rather we celebrated our diversity, saw it as the asset it clearly is and used it to deliver for the people we serve.


Have a great weekend,



Chief executive


This post was sent to all staff on 8th October 2016. I send a mail weekly called The View.

There is always hope, help and life

“Most of us don’t want to change….but what happens when an event occurs that is so catastrophic that you just change? Change from the known person to an unknown person. So that when you look at yourself in the mirror….do you recognise the person you were but the person inside the skin is a different person?”

Nick Cave

I spoke at the 5th suicide bereavement conference last week. It was one of those events that is somehow uplifting, despite the subject matter and the collective experience of an audience shaped by catastrophe and a common desire to make suicide a rarity, and support for those bereaved a universal offer.

It was an event filled with hope and populated by quietly heroic figures. Bereaved families building hope from catastrophic events that had changed them forever – like Hector’s House for example.

At the event, Author Carla Fine spoke about how death and suicide are not the same thing. Unless you get over the suicide you can’t mourn the death. She also spoke movingly about life before and after suicide and how, following the death of a loved one, you are changed forever. In the aftermath of the suicide of her husband, Carla spoke about the things she had  learned in almost 30 years of study and travel. She spoke beautifully about 5 things that you should do if you are bereaved by suicide.They boiled down to a few simple observations that resonated with me:

  1. Protect your health – look after yourself
  2. Seek out survivors – being with people who understand is important
  3. Be with people – don’t lock yourself away when you have friends and family who will understand and be there for you
  4. Get help – you have been part of a catastrophic event
  5. Accept you have changed forever – life will always now be defined by the time before and the time afterwards


One of the things that Carla also said was:

“I’ve travelled the globe and there isn’t a  place where suicide doesn’t carry stigma”

My talk also included ruminations on my old friend stigma. It was bookended by my blogs about saying yes to life despite everything, and 5 minutes to slay a dragon. Tears flowed, some of them were mine.

In between was a description of how suicide prevention is a priority in West Yorkshire. I’m proud that this is a major part of work in the region and that we will be taking a “zero suicides” approach, based on a trawl of good practice.  The presentation was loaded with data from the Confidential Inquiry Into Homicides and Suicides and research from Time to Change, as well as work done by the West Yorkshire team. I will post this when it is available. In the meantime, its worth noting that:

  • Only 28% of suicides are in touch with mental health services
  • An estimated 90% of people who die by suicide have some form of mental health problem
  • Mental health issues amplify the chances of suicide significantly

It doesn’t take a genius to see that we have to ensure that mainstream services are more aware of mental health issues. It is also clear that the stigma of mental health prevents people from being open and from getting the help they need – as seen in the report Stigma Shout from Time to Change. The example below is replicated on many ways when you speak to carers too.

 stigmaIn this environment, lives are lost.Stigma. Fear. They will get us in the end if we are not careful. I covered this in my session. Stigma means that people with mental health issues don’t work or disclose their illness. Stigma stops us talking about the issues we face. We have got to end the stigma.

Time to change are pushing progress on tackling stigma with some success. As I write, they have secured another £20m to deliver their work. This is a source of some joy for me. They feature in my story heavily. My pledge in 2013 to talk more about how mental health issues had affected me and my family led to significant changes in my behaviour and my life. They let me see that, as Nick Cave put it, something so catastrophic had happened that I was changed.I speak regularly in public. I have done so four times in the last week alone. I have, I think, become very good at it and rarely get nervous. But the journey from my brother’s suicide to talking about it openly and personally to 300 people in  a packed hall has been the longest and hardest I have faced.


I must have looked as wrung out afterwards as I felt. Sharon McDonnell, gave me a big hug and told me to look after myself.

It was worth it. By opening up and talking about it, I hope that more people will find #TimetoTalk and #TimetoChange. I want to make this a feature of our West Yorkshire plan. Operating at scale will be important and scale can be delivered when many people choose to change at the same time. Perhaps then we can tackle the stigma of mental health and the stigma of suicide. The alternative is that something catastrophic happens that means we are changed – with the continued death of many people and the suffering of their families and loved ones.

It doesn’t have to be this way. If we talk,  there is always hope, there is help and there is life. Give talking a try. You might just save a life.

If you have been affected by this article – get help here at the CalmZone, the Samaritans, and Survivors of Bereavement by Suicide (SOBs)

We can all learn from “The Bay Way”

I was asked by Jackie Daniel at University Morecambe Bay NHS Foundation Trust to write  a blog for the trust. Jackie is a new breed of NHS leader who has shown huge resilience and an approach to system leadership that underlines how some of our most talented people are now working in some of the toughest circumstances.

“In my role I read a lot of commentary and reports about the NHS. Just recently I read about how NHS providers are “in a ditch”, how we have “spiralling” deficits and no plan to fill a “£22bn black hole” and that we need ”a better plan”. It’s always a gloomy picture and there is always an angle if you want to take it. My angle is that we have the biggest challenges for a generation and a huge consensus about how we address them. We should stop commentating on the state of play and get on with the game. That takes leadership at all levels – of the kind being shown in University Hospitals of Morecambe Bay NHS Foundation Trust.

If we are to improve care to meet patients’ needs today, there are some simple things that we need to focus on:

  • We need to recognise that the NHS is a system not an organisation – one that is deeply reliant on social care. That system needs to work in ways where the 7 main national bodies – including Monitor, CQC, Department of Health – operate in ways that support local trust leaders like Jackie and her team to succeed. You can’t dictate what happens in Walney from Whitehall and you shouldn’t try. By working together at a local level, we can solve the problems that bedevil the NHS.
  • We need to sort out the money. The system needs us to fund social care and prevention properly. A 32% increase in delayed transfers of care due to a lack of social care shows how if you cut social care, the patients suffer, and the NHS bleeds. We also need to manage the balance of investment so mental health, community and GP services get support. Flexibility will be key and Morecambe Bay was the first trust to trigger the arrangements that increase the prices commissioners pay because of geographical isolation. Jackie and Aaron worked with local partners to prove that the national arrangements don’t fit in South Cumbria.
  • We need to recognise its our people that matter. The NHS is not made of drugs, kit, hospitals or beds. It is made of people – from porters to paediatricians, secretaries to surgeons, therapists to theatre staff and beyond. People are our greatest investment and our biggest asset . Give them some headroom and they will drive the changes needed. The work that Jackie’s team have done through Listening into Action is a great example of how we harness the power of people. What we need across every bit of the NHS is to build trust with our staff and make them feel supported in their work by an organisation that truly cares for them. This is not where we are today but it is something we can build, ward by ward, team by team, trust by trust.

Medical records

  • We need to work with communities and focus on place. We waste the assets of people every day in the NHS – the patients we see are often skilled experts in their own condition, the carers we meet coordinate care and solve problems every day. They need to be part of the team and part of the future. This is especially true as most of our patients have long term conditions and will always be with us. Looking at people, communities and place is essential – look at what you have achieved in Millom as a brilliant example of this.

Many of these themes come out in the NHS Confederation’s Commission into Urgent Care for Older People. This started as an inquiry into A&E pressures and quickly became about the cause of those pressures and not just the visible symptom of crowding in A&E. It’s a great report that highlights how we are increasingly dealing with an ageing population with growing dementia cases and co-morbidity. The system often fails older people and the result is they end up in hospital. The report also showcases some fantastic practice across the NHS and identifies the how we could change and help trusts thrive. In each, there is a sense of system, financing, staffing and community.

One of the clear messages is that hospitals have a critical role to play in leading change with these services as part of joining up care across communities. Often this debate gets into a bit of a cul-de-sac where people define hospitals as organisations that are somehow not part of communities and hint that they are part of the problem. Anyone who has been to somewhere like Furness General Hospital knows this is a redundant idea. The model ships in the entrance, the paintings and murals, the plaques from High Carley and Roose show a proud history of community. And as a Barrovian I have many memories of the place. They reflect the joy and sorrow that goes on each day within its walls – it is where my twin nieces were born, it is where my younger brother was pronounced dead after he committed suicide and it is where my Dad gets treatment regularly for his hip. The hospital is clearly part of my history and my community. To thrive it needs community based alternatives and to retain connection with the people it serves.

Luckily, we now have an opportunity to plan for a new future in healthcare. This will be set out in place based plans called sustainability and transformation plans [STPs] that cover the next 3 to 5 years. Trusts like yours with effective leaders like Jackie give me hope that the plans will be good. My job at the NHS Confederation is to help ensure that you have the right conditions in which to deliver them.”

Thanks to Jackie Daniel for asking me to write this piece – and for being a great example of what values based leadership looks like in the modern NHS.


Just ask George

Will you indulge me for a moment or two? I want to tell you about my son George. He is 14 and without doubt one of the most popular people I know. Walking to school or in the local community is an experience punctuated by people saying “hello George”, high-fiving him or giving him a wave. It’s the same in school, with pupils and teacher alike. At a recent party we attended, where many of the teachers were mutual friends of the host, one of them whispered to me how he is “universally loved by everyone at school”.

He is one of the most hard working, committed, passionate and fearless people. His school reports are glowing – he is ahead of all his peers, often top of his class and his attitude to learning scores are off the scale. Hopes are very high for him exceeding expectations in his GCSEs and he is world class at spelling.

He has been on the school council in primary and secondary school. He was voted on by the other kids. He is currently a school representative for PE in high school. As a result he gets to sit on interview panels for the some key appointments and also talk to OFSTED about what it is like to be a pupil when they do their inspections. His insights are always important and usually wise.

Being good at school attracts rewards, which results in trips to theme parks like Flamingoland and Alton Towers. He loves dangerous rollercoasters and hair raising rides – as well as zip wires and high ropes.

As well as being a star pupil, he engages in a number of school clubs and out of school activities. He is a member of the school choir and the school performing arts group as well as Stage Door theatre school. He has performed a number of concerts and plays. As part of the school climbing team he has competed in and won events – as celebrated in awards presented by Johnny Brownlee at the school sports awards. He plays Tennis on a Sunday and sails on the local tarn in the holidays with the Sailing Club.

He dances at the Northern School of Contemporary Dance every Friday with his dance group Me2, who have wowed audiences at the West Yorkshire Playhouse, Phoenix Dance Studios, the Audrey Burton Theatre and elsewhere. His stage group performs shows at local theatres in which he sings and acts with a passion and some talent.

He is great at volunteering too. Every week he marshals at the Woodhouse Moor Parkrun, supporting the runners and helping with the arrangements. He was co-director this week and named junior volunteer of the year in 2014. When he marshals other races for local clubs he knows so many of the runners he gets a bit hoarse from cheering to spur them on.

Outside of this, his teenage boy tendencies mean he is glued to his ipad or the computer when he can be, playing games or researching films on ImDB, which he loves to watch at the cinema with his mates or buy on DVD. He is pretty cool and the dance teacher tells me how popular he is with the girls. Theatre and musicals also form part of his obsessions and he can tell you just about everything you ever wanted to know….

I am so proud of him I could burst.


George would not be who he is today without the support of Leeds Mencap.


They were the ones who helped us in the hospital the day after he was born, with kindness and positivity.

They were the ones who provided the space for other parents like us to share a coffee and a chat and get informal peer support.

They were the ones who helped with speech therapy, portage and transition support for inclusion at nursery, at primary school and elsewhere.

They laid the foundations for us as parents and for George to transform from being a lovely baby into the success he is today.

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G Award

On 12th July I am running the Leeds 10k for Leeds Mencap. You can sponsor me here. Please do. The difference they make is clear to see. Just ask George.

Leadership – My “No Excuses” Role Model

Adam Bojelian was a remarkable person. That was clear for everyone who attended the celebration of his life in Tadcaster yesterday. The celebration was a perfect reminder of the beauty of his poetry – cousin Lara reading The Green Fish was a personal highlight – and the tributes came from across the globe for someone who touched the hearts of many with his can do attitude. A fifteen year old boy who wrote poetry by blinking and captured the imagination of anyone he came across.


Adam was a “No Excuses” role model. The photographer Paul Clarke read “My Creation Myth” and prefaced it with this statement – so simple and true. Adam had every reason to not do his homework, be bitter about life or let his challenges get him down. Instead he approached life with glee, never making excuses. For him “every colour was perfectly placed”. And a duff joke or two was always at hand.

Alongside people like Lara and Paul, I was privileged to be asked to be one of the 15 people to read one of Adam’s poems and say a few words. The poem was Leadership – something I commissioned for the NHS Confederation Conference in 2014. I needed something to set the tone for the whole of the leadership in the NHS and Adam responded brilliantly. He gave us something that defined good leadership and challenged our perceptions about the potential of people.


I read the poem and new that it was right, it was wise and it was clever. A challenge to the reader to be a better leader. It was exactly what was needed and I shared it on Twitter. It was read and retweeted widely. Some time later, someone pointed out that the poem’s puzzle had been solved. It was not just a challenge to the reader but also spelled my name down its spine. I had missed this completely and it was something I won’t forget – one of those moments that catches you inside and is truly humbling and a personal challenge to me to be a good leader too.


Subsequently the poem has had a life of its own. It was a wow at the Confederation Conference receiving spontaneous applause from around 1,000 delegates. The Leadership Academy have used it in their work. NHS Employers have used it in their Equality and Diversity work. It is shared widely. It is a gift that keeps on giving.

Maybe one day I will be as good as the leader it challenges me to be. What is clear is that Adam was a leader and a role model. And I wanted to give a gift to Adsthepoet and his family in return. So here it is – the poem I wrote for Adsthepoet to celebrate his leadership – my no excuses role model:

Leadership (For Adam Bojelian) 


This rhyme solves a puzzle, as you will see

This rhyme confirms what a good leader should be


A good leader aspires to be the best

A good leader debates and challenges the rest

A good leader speaks up against poor care and injustice

A good leader teaches us to cast off our prejudice

A good leader helps us to see the funny side

A good leader engages and shares what’s inside

A good leader puns (I know it’s not quite a requirement)

A good leader is open to risk and excitement

A good leader energises all that they touch

A good leader transmits our dreams back to us


Now, this poetic trick has been played before

Look closely and you’ll know whose name is worn

At the heart of this poem



No surprises this time

No poetic reveal

Yet the power of art

Weaves a subtler knife through our hearts

The echoes of good leadership last forever

They beat its rhythm for a lifetime

Listen carefully to yours

What do you hear now in its pulse?

Adam, Adam, Adam, Adam


If you think this is sad and solemn, it’s not meant to be. Kirstie Stott ended the celebration with the poem happiness. Perfect. As was her wordle of the three words Adams’ twitter friends had provided her with. Her choice was for her boys to “be like him”.



5 Minutes to slay a dragon

It took me 10 years to write about the suicide of my brother  – the piece I wrote in 2013 is here and is called Saying Yes to Life Despite Everything. Writing the piece was cathartic for me and the response has been humbling. The blog has been re-blogged, read and shared widely. Friends, colleagues and strangers have shared their stories about suicide publicly in response to it. Comfort has been found in shared experience and perhaps a little hope.

I wrote the piece as part of my pledge to the Time to Change campaign. Approached at the NHS Values summit in 2012, I said I would talk more about how mental health issues had affected my family. It is a pledge I have stuck to personally and professionally since.


Except…..I have never felt able to tell my kids how their uncle died. The stigma, shame and the stain of suicide felt like something I couldn’t put on their tender shoulders. If the subject came up, vague talk of “an accident” sufficed. The tragedy of Phil’s death remained hidden.

In medieval times cartographers denoted dangerous or unexplored territories by putting sea serpents and other mythological creatures on uncharted areas of maps. Over the years, the omission of how Phil died has gnawed away at me and the prospective conversation with my children has appeared on the map of my life with the phrase “Here be dragons” firmly painted over it.  The low heft of dread has dragged through the years and the conversation has reached epic proportions in my mind.


I don’t believe in dragons or mythology or fate. I do understand fear. Fear of the unknown and fear of consequences. The irrational white noise that prepares your fight or flight responses and subjugates logic. And just as I have learned suicide is often a consequence of a loss of hope and of feeling helpless, I now know stigma is driven by fear. To end stigma we need to face our fears.

The “Take 5” minutes to talk about mental health campaign is a small positive step in ending the discrimination and stigma around mental health. It provides the permission and support to enter unchartered territory. It will be written off by the cyber-cynics as a fad, a #hashtag badge for the worthy or a promotional campaign. It will also save lives and continue a conversation that we must have if we are to map the world we live in for the 21st Century.

Take 5

I had signed up to support the campaign on twitter a couple of days ago. I added a twibbon – something i have never done before – and promised myself I would have a chat. I didn’t plan it but left it to emerge.

“How did uncle Phil die” asked my son George today. “Was it cancer? A heart attack?”. We were sitting in a wake and I said I would talk to him about it later. I resolved to use my 5 minutes wisely. Over dinner the subject of Clarke Carlisle came up. Lauren, 12, had heard the story on the radio. We talked about what happens when people become depressed. We talked about losing hope. We talked about mental health. We talked about Phil.

George, 14, looked me in the eye, reached over, squeezed my hand and smiled at me. Questions and answers flowed. The dread sank to the bottom of the ocean. The fear evaporated. The dragon slipped away.

I want to thank Time To Change. It works one person at a time and one conversation at a time. Today it gave me the tools I needed to slay a dragon. It only took 5 minutes. The impact will last a lifetime.


It’s a Wonderful Life

Every year at Christmas, the beautiful, 100 year old Hyde Park Picture House shows Frank Capra’s It’s a Wonderful Life. It’s a Christmas staple that many of us will watch on TV too. The film stars James Stewart  as George Bailey , a man who sacrifices his own needs in order to help others and whose imminent suicide on Christmas Eve  brings about the intervention of his Guardian Angel, Clarence. Clarence shows George all the lives he has touched and how different life in his community of Bedford Falls would be had he never been born. Its life affirming conclusion where the townspeople rally around George to keep him from prison is so powerful it should be available on prescription.

wonderful life

It would be easy for people in the NHS to feel like George in 2014. In bleaker moments, we can point to a bleak environment. There has been a constant stream of negative press – it is now open season on what the Commonwealth Fund decided was the best healthcare system in the world. So much so, that the real issues can get crowded out. Recent press activity now includes saying the opposite of what is true – this week’s example 4 out of 5 new nurses are from overseas [wrong! Facts here…]. Industrial dispute puts people who work in the NHS against the people who pay for it. We are facing the biggest activity surge and the biggest pressure on services in my career, with staff working tirelessly to deliver great care being kicked about like a political football. On some days, my social media feed often looks less like a conversation and more like a mob, with attacks on “NHS managers”, unpleasant trolling, doctored pictures that show me as Hitler and people behaving in pretty despicable ways to each other. Most NHS leaders and the people who work in the service are pretty resilient. But there have been moments when many of us will have wondered what it was all for….

Fortunately, the NHS’ Guardian Angel came to the NHS Confederation/NHS Employers last week to remind us how the NHS touches all of our lives. The occasion was #AdsParty . It was one of those days – the special days that touch us deeply and we never forget.

Adam Bojelian is a 14 year old poet, Brit Award winner and long term patient at Leeds teaching Hospitals Trust. He communicates his wisdom and wit through blinking. The party was a tweetmeet and celebration of Adam, inspired by Kirtie Stott and Vanessa Garrity from New Healthcare Voices and put together by the fantastic team at NHS Employers of Danni, Sam, Johnno and Andrew. The idea was simple, get Adam and his family together with all of the people he inspires through social media, throw in a bit of food and celebrate Christmas. The execution of the idea showed me why we must never take for granted that the NHS is made of people – give them the headroom and they will always exceed what you expect.


In dark moments, I will always be able to conjure up the scene, with my own version of the guardian angel Clarence whispering in my ear about….

A set of elves doling out mulled apple juice as they greet us, the Horizons team setting the tone and supported by Ronnie the Rhino – reminding us of the great work the Leeds Rugby Foundation does in healthcare and how communities matter, place matters.


The ward and nursing team supporting Adam talking about how tough things are and also how much they love what they do. They have a renewed sense of connection between them and the Trust Board under Julian Hartley’s leadership. I was reminded of Dean Royles’ work and the piece on HSJ about the Trust’s focus on the personal, fuelled by technology.


New leaders emerging in the shape of New HC Voices, with Kirstie and Vanessa’s amazing group augmented by award winners and front-line heroes Sarah Searz, Joan Laplanas, Thomas Shahanan, John Walsh – “real people” doing “real” jobs epitomising a value based approach and wanting to change the world.


Kate Granger, taking time out from being a new consultant to come and meet Adam. She has already changed the world through #Hellomynameis, demonstrating the power of an idea and a personal story that connect us all.

Films like these and these from Twitter pals who could not be there demonstrating the impact that Adam has had on them, from Chief Executives to graduate trainees, international improvement icons to nurses to OTs – and everyone in between.  Our very own Paul Deemer, was inspired to verse and NHS Employers’ staff duly obliged with their rendition of “Would You Adam and Eve It”

While the virtual log fire flickered, Kay Mellor the actress, director and author recited Christmas Gibbons and we all laughed at the reality that it isn’t the reindeer but the gibbons that do the deliveries at Christmas.

The Quarry House Choir from the Department of Health, NHS England and DWP singing “Walking in the Air”, one of Adam’s favourites. The assembled crowd look on, connected in the moment.


And above all, the inspiration for the whole thing – Adam and his parents, Paul and Zoe and their family and friends. The team starts here in the service. The patient who always has assets to share. The parents who have expertise. The families who support each and every day.


So next time things get bleak and things get tough, I will remind myself that we have a good set of strategies in the NHS with 5 Year Forward View and its ilk. We have a commitment to more resources. And above all, we have the people who can always exceed your expectations. Forget the HSJ100, Debrett’s and Who’s Who. The NHS is made of people – just like me and you and Adam.

It’s a wonderful life. Happy Christmas!



It’s not all Cardigans and Charity Shops Y’Know!

I was in Oldham recently. I was really taken by the experiences of the system in Oldham and Ashton when I visited Pennine Care and Michael McCourt’s team. Their Living Well Academy and work on Carers and coproduction around long term conditions is right in line with the future needs of the NHS – building capacity by aligning the efforts of the “team” that is already in place. With over 6 million people designated as “carers” and almost a million carers aged 65 plus, this has huge potential.


Oldham’s experiences of recent commissioning decisions is also indicative of the future. They were successful in bidding for new models of care for all of their community services in a partnership with all of the local GPs, the local authority and the local AgeUK team. True collaboration, aiming to bring integrated services through working together – not structural reform.

Both of these developments are good, but I wanted to share a story from the excellent CEO of Oldham Age UK Yvonne Lee.


Yvonne told me of their impressive array of services – from equipment and adaptations to befriending and direct patient care. She then told how 3 prospective partners had come to visit her. After 20 minutes they explained that they needed to go and put more change in the car parking meter. They had only paid for half an hour and two of them disappeared to sort this out. Their colleague leaned over and said

“They got you wrong love. They thought they wouldn’t be here long and were coming to see an old woman in a cardigan in a charity shop”.

Our understanding of the role of the not for profit sector in the NHS is improving – if not quite there yet . We need to exploit the potential fully. Because the sector is clearly part of the integrated team that sits around the families that we work with, the ones who will never be discharged from our care.

That has been my experience in my life as a carer – and it probably is in many of yours too. When George was born with Down Syndrome and we had a thousand questions about the future.


The wise consultant at the hospital said – “just wait, Marjorie from Leeds Mencap is coming in to see you tomorrow. She will help answer anything you want to know.” They were right. A partnership was born that saw us supported in George’s physical, emotional, educational and social needs across his whole lifetime. From using Makaton as his first language skill, through portage, peer support, speech therapy, school inclusion and right through to dancing at the West Yorkshire Playhouse and beyond. Alongside many others – Bradford Down Sydrome Support Service, SNAPs, Down Syndrome Association, Me2, Down Syndrome Education International -they have played a critical part in making him who he is today.

They have done so with great kindness, skill and in line with an array of rules and regulations; a changing policy context and the toughest financial challenge for a generation. If this sounds familiar to NHS organisations, then it is. And what an opprtunity to embrace the contribution of carers and this sector in dealing with a shared endeavour and the biggest challenge for a generation.


All means all – now prove it!

“All”. It is such a small word. Three characters, only two different letters. Yet it carries an immense power and sits at the heart of the first of the Bevan principles from 1948.

ConstitutionThe NHS “meets the needs of everyone”. This has subsequently been updated as one of the seven principles of the NHS Constitution. The first principle there is “The NHS Provides a Comprehensive Service Available to All”. In fact, the NHS constitution has a subtitle.

I was asked to attend the NHS Leadership Academy’s recent Top Leaders programme semester on Equality and Diversity in the NHS to talk about my experiences as a Chief Executive in the NHS. As a former commissioning CEO and a provider trust CEO I wanted to give a perspective on a topic that is very dear to me. Because any serious look at the experiences of people and the profile of staff at senior levels shows that in many places we are making progress, but we are not succeeding in dealing with issues that can still shock as well as surprise.

My presentation is available here. I won’t use this blog to repeat the issues that I set out or the key points in the slides. As ever with me, a blend of values based leadership, visible system leadership, engagement, partnership, structure and systematic approaches to tackle issues hopefully comes through.


I will focus on two quick things.

Firstly, this agenda is fundamental to every organisation and person involved in healthcare. I could make the ethical case. Or talk about the effectiveness case. Both are etched in my soul and my brain respectively. Others on the day did this brilliantly (Michael West and Roger Kline for example). Oddly for me, I will stick to the rules that frame us. There are only four common fixed points for every NHS organisation – regulator, commissioner, provider, department – they are:

  • The NHS Constitution, Values and Principles
  • The Quality Frameworks
  • The Equality Duty
  • The Finances

If this isn’t an agenda of Equality and Diversity, then what is? I could couch this as:

“Deliver a comprehensive service available to all; that achieves the quality standards expected; in ways that reflect equality and diversity in your services and workforce; hence securing best value for the finances available.”

We are not there yet and have a long way to go. Avoidable deaths for people with a learning disability? BME staff experiences of development and career progression? Access to early diagnosis and treatment of CVD for people in deprived areas? All negative indicators of a need to better design services with people to overcome barriers to care. Let’s ban the idea that people are “hard to reach” while we are at it. We have just not designed services in ways they can access.

Secondly, the need for visible leadership. You will see I have a picture of the very senior NHS Leadership team in my presentation. This has changed recently, Mike Farrar has been replaced by me. David Nicholson by Simon Stevens. The question I pose is “What’s wrong with this picture”. The answer is obvious isn’t it? What I said instead was that there was a lot right because the motives and explicit intentions of the white, male, senior leaders were to focus on this agenda.

“Yes, but how would I know?” Came a question from a participant.

I have thought a lot about the answer to this question since.

We will all only really know when visible leadership of this agenda begins to make a genuine difference. When Roger Kline’s “snowy white peaks” begin to melt and when shocking figures relating to inequalities become a genuine surprise.

There is reason for hope. There are great examples of fantastic work across the NHS. Ally this to a resurgence in commissioning for inequalities and quality; and a provider regime that is accountable to its public through membership that is representative; then we may get there. With future leaders that are more diverse being championed by the very people who they will replace, we have a great chance to ensure that all really does mean all in a 21st Century NHS.

Reblogged from a post for TheNHS leadership Academy – Thanks

Good leadership is all about giving power away

One of my friends died last week. He was a truly unique individual. The Crematorium had to rig up speakers outside for the mourners who could not fit inside the building. It seemed everyone in the town new him and had turned out to celebrate his life. They all said the same thing – he would do anyone a favour, was always positive and was constantly giving. Nothing flashy just lifts for friends, a slab of millionaire’s shortbread or tray of cakes miraculously appearing as he dropped in to say hello, food for the homeless, chat (he could talk), musical tips, DVD box sets to borrow. Mostly what he gave people was his time and attention – all day, every day that he lived.

He seemed to me to embody something I learned when I visited the South Pacific almost twenty years ago. A real lesson about giving. I was in Rarotonga in the Cook Islands. One of the islanders was describing his wedding with great pride.

“It was the best wedding ever. We gave so much away!”.

Because in some island nations being rich is about how much you give to others, not what you keep for yourself.


This came to mind as the Top 50 NHS CEOs was published on the same day as the funeral. This was part of a series of leadership pieces put on by the HSJ and sparked some debate about the nature of leadership. You can see what I think about leadership in blogs on this site – particularly “Some Things are Just Too Heavy for Superman to Lift”,Forget theJanitor at  NASA, Andy Makes People Better” and “The Smallest Thing, the Biggest Difference”


At the heart of what I think about my leadership is a genuine sense that to be effective, I have to give away as much authority as I can, whilst retaining the accountability I hold. As an NHS CEO, that meant remaining personally accountable for the safety of every patient and the value of every penny, whilst giving staff authority to act and creating the right system of values so that we could be successful. This is not risk free. It takes time, trust, courage, resilience, a focus on purpose and a value based approach that engages all staff. [Yet another plug for Michael West’s work here]. The results are always surprising and unexpected – people tend to go further than you imagine and the impact can be spectacular.

Alongside the the list were pieces each day from some of our best Chief Executives. Reading the HSJ pieces by people like Dame Julie Moore, you can see that giving works. “Trust your staff”.

Compare this with people who retain tight hold of any power and authority they have. Leaders who hold positional power will lose it if their position changes. If they tell people what to do, that will be the best they ever get and few will ever achieve even that.

Some people fear that giving power and authority away denudes their personal store. My experience is the opposite. Some things are infinite or able to be self replicating – Dean Royles wrote powerfully about this last week. Compassion, he argued, is like love – you can’t give away every ounce of love you hold as it is inexhaustible.I think the same is also partly true for power and authority. Your influence and impact can grow the more you give away, enhancing your power and authority.

As I write this, I am reflecting that the one word that I would use to describe my friend now was that he was “good” in its truest sense.

I will be championing a style of leadership that is also “good”. One that is based on giving and is essential in a complex system like the NHS – one of delegated leadership that unlocks the potential of NHS staff by giving them authority to act, safe in the knowledge of where the accountability ultimately lies.