Good News! People, Help the People & the NHS

“No one cares these days…..everyone is in it for themselves”  A refrain that seems to echo around conversations within my earshot on a regular basis. Good news! It isn’t true. Look:

Three million people volunteer in hospitals each year according to the Kings Fund study…..and even better.

  • Innovative forms of volunteering are reaching out to new communities and engaging people in service delivery in new ways. 
  • In some hospitals, volunteers are increasingly being seen as an integral part of the care team rather than an ‘add on’

The full report can be found here.

And this is just the hospital figure. In the UK – according to the Institute for Volunteering Research, 44% of people volunteered in 2012/13 and 29% of people did so at least monthly. What a resource – imagine if it were harnessed, what could we achieve?

In an era where the NHS has to change, the role of volunteers can go even further than the range of brilliant befriending schemes, luncheon clubs and digital inclusion classes we see about the City. Volunteers as members and Governors of NHS Foundation Trusts could fundamentally help to reshape the NHS and social care.

Imagine a world where trusts had a vibrant and engaged membership where:

  • staff were recruited for values by the people who they were to treat and support. Older ladies interviewing district nurses to see if they care. School children interviewing community paediatricians to test their rapport. General managers explaining their role to sceptical citizens in advance of appointment.
  • groups of volunteers were able to look at the environments in which care was provided in the trust of which they were members, unaccompanied and trained to look out for issues, as well as using their judgement of the space as people. In doing so, they would make sure that they were “Safe and Clean”.

Safe and clean

  • Service changes were driven by staff and public members in a team testing what should change and how. A real focus on purpose and outcomes drove these changes too, with social value at the heart of reform.
  • New communications material was tested by members to see if it was accessible and readable and free from health jargon and polite, with reader groups of everyone from adults with a learning disability to older people and teens.

This is the world we are building in Leeds Community Healthcare NHS Trust. All of the above is happening through our 10,000 members….and it could not be more real.  This was brought home to me at “The Event” this week – our two-day showcase of change, innovation, research and progress……at The Event, we had members showcasing their work; members asking the searching questions of the speakers; members pushing for change; members volunteering to get involved in the next big set of changes. I looked up from my position on the stage at an audience of staff and public members and felt that something had genuinely changed.

Theevent

So why do our members get involved? Their motives are many. One member described how they wanted to give something back to the NHS. Another was angry at poor care in the past and wanted things to be better. Another lady told me how:

“I really enjoyed the recruitment. I took the day off work to help you out. It made me feel valued and I don’t feel valued at work”

If you live in Yorkshire and the Humber – get involved. We would love to work with you. Details are here

This is important stuff in terms of delivery too. As an NHS Chief Executive developing sustainable services over a five-year period, I expect to take another 25% of costs out of my organisation. In doing so, I have quite a simple view. If you take 25% of costs out of something then it cannot be the same thing afterwards. This means fundamental change is required. In Leeds, we have been driving a change that has three elements:

  1. A risk based approach that is focused on prevention and support for people with long-term conditions and older people;
  2. Joined up services provided by single teams made up of health and social care staff, supported by the voluntary sector neighbourhood networks
  3. Supported self-care and self management being delivered at scale – seeing the assets that people have and building on them

This is at the heart of our Integration Pioneer as well as our future as an NHS Trust. We want to work with the assets that exist within patients, carers, families and communities to deliver a sustainable future for the NHS….and real change is beginning to happen as a result. I blogged about this here and Elsie’s Golden Key.

If you are reading this and thinking that I am delusional or overly positive about the role of volunteers in the service of the future, the challenge I would put back is that people tend to be more intelligent, resilient, creative, reasonable and often brilliant than you could imagine. If you need some proof, look at the work on the skills of public health  volunteers published by the excellent Professor Jane South at Leeds Metropolitan University – example here.

Or you could just give it a go. Because “Patient Leadership” is a big part of your future, my future and the future of the NHS. As the NHS Constitution famously starts….”The NHS Belongs to the People”….

Pledge, Share, Do, Inspire

Staff genuinely are our biggest asset. In my trust, we aim to help people do their job and improve their job. This week’s staff blog sets out how some of my nurses inspired me this week. Tracey and Memory – you are the epitome of what makes the NHS great.

This week saw the launch of the NHS Change Day campaign building up to 3 March 2014. I was fortunate to attend the afternoon of the event, where around 300 delegates spoke about the impact that Change Day had on them and their work. It was an inspiring day, encapsulating all that is good and right about the NHS. It was humbling to hear the stories from staff and patients – and there were a number of ideas we could pinch too.

ChangeDay

I was invited as I was one of the CEOs featured in a “Kick-Starter” film shown at the event. You can see the film here

Here is my pledge:

We have over 10,000 staff and public members in LCH. They are a huge asset in driving service improvement.  They help to fulfil important elements of our strategy:

–  to ensure that people in the trust have two roles – to do their job and improve their job.

–  to ensure that local people feel they have a real say in care delivery

On that basis, I want over 100 staff and public members to make improvement pledges for NHS Change Day, so that they become actively involved in improvement within LCH.

My pledge then has two parts:

I will double the number of back to the floor sessions that I undertake – to 24 a year – and use the extra sessions to spend time in the teams that have implemented the service changes suggested by staff and patients;

and

I will hold a monthly surgery with staff and public members to hear about service improvements, celebrating where it is going well and clearing blockages where required.

Our innovation and service improvement team have put in place the process and support required to make this happen.

Make your pledge here: NHS Change Day Site

If staff have two jobs in my Trust – to do their job and improve their job – then we need to celebrate both. Regular readers should know that I like to do both and do so often. It was great then to hear from Joan, one of our fantastic District Nurse Caseload Holders this week. She said this:

I wanted to let you know about an event that happened this week at work and I felt the commitment the student nurse and staff nurse showed needed recognition.

Two nurses and a student nurse were attending to a dying patient when they were shouted by the patient’s family to say there was a crash outside the house whereby a van had hit 2 stationary cars – namely the nurses’ –  then flipped on its side. They were able to make the terminal patient comfortable then go to attend the accident. They were able to make the area safe and get the patient onto a safe area and treat until paramedics arrived at which point they were able to go back into the house and continue with the care of the terminal patient whilst the emergency services continued their work outside. The patient needed further treatment and was left comfortable and then the nurses were able to speak with the police as one of the nurse’s cars needed towing away and the other was taken away safely then the staff involved returned to finish their work later that afternoon.

I feel in these very stressful times this shows great commitment to their work and feel they need some recognition. The staff nurse was Tracey and the student Memory.

I wanted to say thank you to Joan for highlighting this – which epitomises community nursing for me. You never know what will happen in the community!

I also wanted to say thank you to Tracey and Memory – you are an inspiration and demonstrate why we must support staff at all times. Leading form every seat.

Thanks

Rob”

The NHS is in our bones – but what is it for?

I have spoken at a number of events in the past week and a recurring theme has been how much, as a nation, we value the NHS.

On Tuesday I was privileged to speak at the Black Health Initiative’s Inspirational Women Conference. Speaking to a room  full of “Windrush” nurses in Leeds, it was easy to feel the passion and commitment from these older ladies when I asked them “Why did you do your job”.

Windrush Windrush2

“To make a difference!” “Because we love it!” “It’s a vocation!”.

Fifty years later, my staff say the same sorts of things and also reflect the same Values.

Qualb1  Qualb3 Qualb4 Qualb5

The statistics from Mori that show the NHS is what makes us proud to be British, defines us as a nation and we believe delivers some of the best healthcare in the world. Fabulous slideshare on this here from Dan Wellings

I also made these points to a room full of coaches from the Leadership Academy who wanted to know about my world and how they could support people like me. I outlined that we carry accountability for something incredibly precious – the National Health Service, founded on a set of principles that we hold dear today, and inform the NHS Constitution.

“The NHS was created out of the ideal that good healthcare should be available to all, regardless of wealth. When it was launched by the then minister of health, Aneurin Bevan, on July 5 1948, it was based on three core principles:

  • that it meet the needs of everyone
  • that it be free at the point of delivery
  • that it be based on clinical need, not ability to pay

These three principles have guided the development of the NHS over more than 60 years and remain at its core.” [Source DH]

At both of these events, I also spoke about “what the NHS is for”….how does it “meet the needs of everyone” in the 21st Century.

The stories I told were not about waiting lists, 4 hours in Accident & Emergency or prescription charges. They weren’t about “the tariff”, choice or competition. They weren’t about the local clinic, GP surgery or hospital. These are important considerations. But they are not our purpose. The stories were about the differences we make in the lives of people every day. How we are meeting their needs in a 21st Centruy Britain – “making a difference” that the Windrush ladies would value. They were snapshots from lives of the people we may pass in the street or never see behind their closed doors.

Last week I spent a day Back to the Floor with Liz (a Physio) and Alex (an Occupational Therapist) from the Community Neurology team. As ever it was humbling to see the impact they make every day; their professionalism; their kindness and their support and empathy. The on-going care that we provide for people affected by stroke and neurological conditions in our trust is precious. These sorts of services are not commissioned everywhere in the country and the outcomes in Leeds really matter.

During the day I spent with the team we helped a young man remain in work following a brain injury by spending time with him and his employer on his capability. We worked with an older lady who needed to negotiate the stairs so she could spend time with her friend after a stroke affected her balance and mobility. We spent time and therapy on an active patient about how he manages his pain and the disappointment of the changes in his life after a stroke. And we helped a Mum to rebuild her life so that she can look after her family following a cerebral haemorrhage. Each of these people were living with the consequences of something that affects them long after the acute phase of their NHS experience. Each was, in their own way, inspiring and a reflection of the challenges we face as an NHS. We know that older people and those with long term conditions are our service users now. Our purpose in the NHS is to meet their needs.

My time spent with the service also demonstrated the impact of the service changes we are making. For example, I heard about how teams are being merged as we restructure management to reduce costs, the need for better mobile technology, a desire for better integration of some services and staff building a business case to get services commissioned for vocational rehabilitation. These themes of efficiency, integration, technology and business development are exactly the same discussed in our Integrated Business Plan at the Board and at a strategic level in the city. Behind each lies that purpose – making a difference by meeting people’s needs.

And it is not only older people who I could talk about. There was also the short visit I paid to the residential course delivered by our Stammering Support Centre at Bewerley Park outdoor activity centre. This involved fifteen boys and girls working in teams with therapists. It combined physical challenges with speech therapy. Each day, working in teams they will do rock climbing and some work on bullying or canyoning and the emotional impact of stammering and so on.

Stutter Bewerley-2012-_54_

It is a work of genius and the changes in the children are an inspiration. I attended the final day last year to hear presentations by the children. On arrival I was greeted by two of the boys from last year, T and J, who were on the course as mentors for the other children. Listen out for them on Radio 5 Live shortly. Through our support they had grown in confidence and stature and were showing how to “lead from every seat”. It was humbling to see how the children had developed and Laura and Jo, our therapists, described how the progress being made was amplified by the approach, the peer support and the environment. It was clear to me that we are making a difference to the lives of the children that will resonate for the rest of their lives – those who saw Educating Yorkshire will know what I mean. Imagine that 15 times over……

Then I reflected on our Board meeting and how these amazing events are described in our statistics and reports when we met this week. A dry set of “contacts”, global “patient satisfaction scores” and “expenditure against budgets” replaces the little miracles from Beeston to Bewerley Park. We are trying to address this in Leeds Community Healthcare NHS Trust. Working with the local University and 3rd sector organisations, we are developing measures of capturing Social Value – the real impact of our interventions. Alongside this we have a focus on outcome measures and patient reported experience in every service. Every service is also increasingly shaped by our members. Ultimately because as the NHS Constitution says, The NHS Belongs to the people. And as Bevan would recognise from its founding principles – it exists to meet the needs of everybody. Doing so in the coming years will be increasingly about creating a new service in a new system. As we do, we must cherish what the NHS is for – and why it is in our bones.

Footnote: Look at #WithouttheNHS on twitter