What’s So Funny About, Peace, Love and Social Media?

Dean Royles asked me to write about Social Media for #NHSEngage earlier this week. I had already posted a blog about my twitter use on Digital Mental Health curator Victoria Betton’s site here. In it I suggested that Twitter was a gift to every leader and had blurred the traditional boundaries of leadership flattening hierarchies and increasing accessibility. It provided a wealth of resources that could be accessed, digested and shared. The blog seemed to go down pretty well and I had much feedback.

There is a great Elvis Costello cover of an old Nick Lowe song that you may have heard from 1978.

“As I walk through, This wicked world
Searchin’ for light in the darkness of insanity.

I ask myself, Is all hope lost?
Is there only pain and hatred, and misery?

And each time i feel like this inside,
There’s one thing i wanna know:
What’s so funny ’bout peace love & understanding?”

This came to mind when I was asked to write about social media. The song is a plea to think differently and imagine a different world, one where many people aspire to live. This seems to me to be relevant for how social media has been and should be viewed in the 21st Century for the NHS. A world of effective digital consultations; on-line peer support; sharing of expertise and knowledge…..all of these are happening somewhere now. 

An insight that I picked up at a recent Trust Development Authority session for Chairs and Chief Executives is relevant here. If you want to change someone’s behaviour, you first have to change their mind. Colin Price of McKinsey suggested this needs four things to be in place…COlinPrice

  1.  A compelling story
  2. Processes and structures that reinforce
  3. Skills required for change
  4. Role modelling

So, if we want to embrace social media, we need to look at changing mindsets to change behaviour. This model helps me frame what I think.

I also learned that the impact of role modelling is as strong as the other three put together.

There are many people who role model Social Media use and a compelling narrative is emerging through #NHSengage. Colleagues and peers have published erudite, thoughtful and impressive pieces on the use of Social Media. I found myself nodding along to everything Dr Mark Newbold said; saying “I do that” whilst reading Lisa Rodrigues’ piece; and reflecting on how far things have progressed when reading Dean’s piece on driving a permissive culture on social media.

We are much less well prepared with reinforcement mechanisms and skills. Plans are patchy. Mechanisms can restrict instead of free up practice. My own trust is wrestling with this at the moment. Trying to forge ahead, learn from others and not make too many mistakes. But it is tough. And perhaps one of the most powerful pieces on how much more is needed was that written in October 2012 about social media and health and wellbeing from Claire Jones  – this is a must read for people wanting to understand how social media can improve access and the steps that need to be taken if this is to be the case. For example:

“People with disabilities and long term conditions are already using digital and social media to support them and to help them maintain or improve their health (Malby and Mervyn, 2012). They are doing this independently and “under-the radar” of services, because services are not set up to accommodate or encourage this. The irony is that internet use is seen on care planning documentation throughout Leeds to be considered a luxury item, not an essential for planning care and accessing our community; this has to change for the planned changes to be possible.”


“We consider that building capacity within this population to use digital technology could be considered a priority area. Access to information and skills training sessions, through libraries, community groups, mobile libraries, and access to useful directories of apps and software, and information about how to access funding for computers and online access are identified as important ways to support the population of Leeds to utilise digital and social media solutions.”

My belief is that you could replace the phrases relating to people with staff and they would also hold true. Developments like professional chats – #nurchat #ottalk #ldnurchat #wenurses – arose because staff decided with support from Social Media innovators like @wenurses that a place to talk and share was helpful. Professional #tweetmeets are starting to occur. Training is springing up through everyone from Leeds and York Partnerships FT to Inkwell Arts. 

What could we do with a decent investment and focus in building systems, processes and skills for staff and patients? We have the role models and narrative. Let’s create the rest of the requirements to improve at scale and pace. In a 21st Century NHS this is essential …..and ask yourself “What’s so funny ’bout peace, love and social media”

Note – all content in this Blog came from my experience or directly from Social Media sources. No paper or phones were harmed in the making of this blog.

All should mean all

I was sitting in my office in 2007. On the wall behind me was an enormous drawing from a recent event about what a commissioning strategy should help deliver for people in Calderdale. We were working with the council on this. Phrases like “Good access to healthcare with great people”. “A home where I feel safe”. “A job that I like”. ” Support to be in a relationship with someone I love” were placed alongside pictures of houses, hearts and nurses.

My visitor commented “How great that people are engaged in your strategy and see the link to wider issues”

“Yes” I replied. ” Around 100 people with a learning disability and their carers came up with that”.

“But it’s the same as what we all want” he replied


Last week was Equality, Diversity and Human Rights Week. NHS Employers, through their Personal Fair and Diverse campaign , sponsored and promoted a whole host of events and activities. You can see some highlights here and sign up to the campaign too.


I am delighted the Leeds Community NHS Trust has been selected as an Equality and Diversity Partner. We are one of 20 organisations that have been selected based on the work we are doing. We have also become a partner of Stonewall and are working closely with local charities like the Black Health Inititiative to look at how our services should be delivered. New partnerships with organisations like Change also help……”help what?”


They help us think about how we deal with the fact that “all” does not yet mean “all” for our services and for the NHS. This is something I learned working on commissioning learning disability services and the phrase “All Means All” comes from the excellent Valuing People team.

Because we know there are issues that affect people:

I could go on with a long list of issues that may shock but not be a surprise?

In an environment where we are going to significantly change services, we need to both keep people with us…..and get them to drive the changes with us. Perhaps this gives us an opprtunity to design services with communities who find ot hard to engage with services? That is why I was so pleased at our last Board meeting to see that we have disproportionately recruited people from BME communities to our trust membership. And that our members are already enaged in the trust. They helped recruit our senior operational managers. They are conducting the Patient Led Assessments of Environments. They are checking the way in which we communicate. And they are, crucially, sitting alongside staff at Rapid Improvement Events to help reshape services. If you want to get involved, become a member here. It’s free and will make a difference to care in Leeds.


This is only part of the programme. Training, education, partnerships all matter too. We have stammerers training staff receptionists to help them understand what it’s like to stammer and how to communicate. We have the BHI working with us on cultural competence. Stonewall are training us on LGBT issues. Patients and carers teach us something new every day.

We will keep pushing – because we are not good enough at this yet.

We need to be much better at engaging our diverse communities; embracing different leadership; and making sure All Means All; every time. I hope we get there. Because we are open to things being better, being the change we want to see….and because we will pinch with pride every good idea, insight and innovation that makes a difference.

Well done to BHI and Richard Worlock for their awards as PFD Champions this year.

Conversations with my daughter about the FA Cup, leadership and life

I was fortunate enough yesterday to go to the 2013 FA Cup Final. As a life long City supporter, I was delighted when an old friend rang me earlier in the week to offer me a spare ticket. City at Wembley. The FA Cup – alive despite the attempts to undermine it by devaluing it constantly (no longer the last game of the season, an all day national event, helicopters following the team buses to the ground….just a 5.15 kick off on a premiership day). Childhood dreams.  A chance to salvage a patchy season. It didn’t quite pan out that way. The team were lacklustre. The fans subdued and constantly singing our Mancini song, given speculation he was about to be sacked. A long damp journey home.

I was washing up some dishes earlier today.

“I’m sorry City didn’t win dad” piped up my daughter, 10.

“Well, you can be the best. Everyone can expect you to win. You should win. It’s just that sometimes you don’t” I replied.

That got me to thinking about leadership. Values. Passion. Commitment. Beverley Almo Metcalfe and Professor Michael West have both done seminal work on these issues. Michael’s blogs for NHS Employers set out the evidence on how Leadership, Clear Values & Objectives and teamwork drive better patient care. Beverley’s work includes some fantastic pieces on engaged models of leadership. Good report here. It shows that “less competent” individuals in well lead mental health teams deliver better outcomes than those who are “more competent” but are lead in ways that don’t engage them.

My view then, is that sport could learn from healthcare (for a change). Martinez lead a “less competent” team who worked without fear but with passion and with a clear objective: to win the Cup. Somehow he engaged his players in ways that made them, that way.  City’s leadership was fundamentally undermined by rumours about Mancini – sufficiently to mean we didn’t win.

Now if sport is going to learn from healthcare, we need to ensure we put in place the findings from Michael’s and Beverley’s research. Because we have some of the most competent people in the world. And I’d like us always to have the best chance of a win. For staff and patients.

Well done to Wigan – you deserved it.

Civil War, Heart Failure, Sex and Big Data

The World Economic Forum report published earlier this year sets out the issues  affecting healthcare across the globe over the next few decades. At it’s heart are three assertions. To become sustainable, health systems are going to have to focus on:

  1. The use of “big data”
  2. The way places affect the health of people
  3. Seeing  patients as assets not problems

These are themes close to my heart. You can see the full report here.

Today’s blog focuses on the first issue data and using “Big Data.”

I was lucky enough to be asked to open Big Data Week in Leeds a couple of weeks ago. This was a great intiative looking at how different groups can bring data they have together to drive insights about how healthy Leeds is. A sort of Joint Needs Assessment with a twist. Details here. My talk covered the importance of transparency, the power of data to bring clarity, insight and intelligence; and big data and the future of Leeds.

The importance of transparency. In 2006 I was leading a review of the Department for International Development on behalf of the Cabinet Office. Part of the review required trips to areas of conflict. We ended up in Nepal, where a “low grade” conflict based on ethnic lines was rumbling along. At a remote school in the Himalayas, we were greeted by the headmaster and local officials. The school was part of the aid programme. Along the walls were details of the children, their cultural roots, their attendance and grades. This was transparency in action, if a bit hard on the kids not doing so well. I asked the head about the approach. He talked about the importance of transparency and accountability to the local community. It was powerful stuff.

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“The rebels came to see us one day. They asked for a contribution to the cause. Violence lay behind the threat. I pointed to the walls. I told them that their children were in school as much as anyone. They had as much resource and the same books. And that they were getting good grades too.

I asked whether instead of us giving them money, perhaps they would make a contribution to the school.”

“That was brave!” I said.

Yes. I had also called  the army so knew they were on their way. Data are strong but a contingency was essential”

Data can be presented to bring clarity and impact. Chris Bentley’s work on health and primary care undertaken in 2010 showed clear and stunning disparities in health. He looks at how access to primary care and the support for chronic disease management affects patients.


In Birmingham, for example, you can see that according to GP lists, the prevalence of heart failure was higher in the outer areas of the City. (See map on the above left)

If you look at mortality data, you can see that mortality from heart failure was highest in the inner city (Seemap on the right). The data reveal that we need to look at why patients are not accessing primary care until too late.
This then requires us to look at the insights – is it the way services are designed? The attitudes of patients? Doctors? Similar analysis appear in other parts of the country and link to the inverse care law – I am not picking on Birmingham, justusing it to illustrate a wider point!

Using multiple data sources, real insight from patients, segmentation and analysis we can begin to make a difference.

Intelligent data can bring insight. Patients can make very rational decisions. We often just don’t like them.

As a commissioner, one of my targets was to reduce teenage pregnancy. The long term trend was down and numbers were small. However, the were a few areas of hotspots. The public health team analysed a range of data. These suggested that the hotspots clustered around a couple of schools. They also found that access to pharmacy was limited around those schools, particularly on a Friday evening and Monday morning. Insight from teenage girls suggested that they needed to be able to access prophylactic and emergency contraception at those times as they knew they may end up drinking too much and taking risks. We might not like this but by looking a pharmacy access first, then attitudes to sex and relationships, we could consider how we further reduce teenage pregnancy.

Big data are the future – as set out in the World Economic Forum Report. The multiple factors of innovation, economic problems, demography and expectation need data, intelligence, insight. We certainly believe this in Leeds and are placing this at the heart of our Leeds Innovation Health Hub. More details here.

All health partners, the universities, the council, local industries and the national bodies based in Leeds have signed up to our ambition to make Leeds a global city for health informatics. We believe the conditions in Leeds make this a unique place to make this a reality. The blurb on the press release says, we have:

  • More focus on clinical leadership in the NHS will drive up quality, improve health outcomes and enhance the patient experience
  • The city is in a unique position as home to academic expertise, public and private healthcare organisations, national NHS infrastructure and wider city technological and business sectors
  • Patients will be empowered to take increasing control of their health through better access to their own data to inform their decisions
  • Healthcare investors to Leeds will be able to test concepts to ensure they are widely deliverable
  • The ecosystem will support a focus for inward investment leading to economic growth and to become a partner of choice for local, national and international businesses wishing to innovate in the health sector

And why not. Leeds has more health informaticians per square foot than many cities in the World – a function of having the national programme for IT, the NHS Information Centre, NHS England, Health Research in health institutions and the two universities, the two largest providers of primary care  IT, insurance companies….. Marry that to a city leadership that is trying to focus on communities; that has good progress on risk stratification of patients, supported self care and integration; and wants to be the Best City in the UK; and we may just get there.

So, big data are the future. Our lives are already shaped by this in how we shop, eat, travel, communicate…..industry is ahead of us in this regard. We need to catch up, overtake and use big data, place and people’s assets for a sustainable NHS.

As the Chief Executive of Leeds Community Healthcare NHS Trust, I want us to be a part of these changes. For my organisation and for the people we serve. Because the realities set out in the World Economic Forum Report will come all too soon.

Thanks to Peter Laflin for the invite and everyone at Big Data Week 2013.

The NHS belongs to the people….


We had our Board meeting this week. Every NHS Trust Board now needs to ensure it has regard to the NHS Constitution in each of the decisions it takes. For me, this is a good thing.  Let’s start this blog with the opening lines of the NHS Constitution:

“The NHS belongs to the people.

It is there to improve our health and wellbeing, supporting us to keep mentally and physically well, to get better when we are ill and, when we cannot fully recover, to stay as well as we can to the end of our lives. It works at the limits of science – bringing the highest levels of human knowledge and skill to save lives and improve health. It touches our lives at times of basic human need, when care and compassion are what matter most.

The NHS is founded on a common set of principles and values that bind together the communities and people it serves – patients and public – and the staff who work for it.”

These are not mere words. They reflect the commitment of the staff in my organisation and the enduring love of the NHS by the public. They are backed up by good research and recent experience.

Look at the latest views of us all in this slideshare presented at the Nuffield Trust in March by Dan Wellings of Mori. One of the best healthcare systems in the world [77%] that should be protected from cuts [79%] and makes us proud to be British [top answer]

If my blog is to have any theme it is this – how will we make sure that these values and the public commitment that really do bind us together, see us through the toughest times. 

More soon.