Larry the Downing St cat and “Keeping it real” for NHS Change Day

I walked down the familiar street, past the terraced houses towards a black front door. Armed police patrolled the area and onlookers gawped from their huddle behind a black iron railing. The familiar number 10 swung inward and away from me as I approached. I was greeted and ushered past Larry the cat – rescued from very different streets – and into the waiting room. I was back in Number 10 Downing Street for the second time in a week. As Chief Executive of the NHS Confederation, along with a group of others, I was here to discuss the mechanics of healthcare with policy advisors. As I walked up the stairs, past the portraits of every Prime Minister, I took in the surroundings of this world famous place.

Larry

Later, I sat thinking and promised myself two things…..

Firstly, that I will never take for granted the privilege of events like this. Larry was happy sleeping away his time but I know access to people with real power is a thing to be used well and for the benefit of everyone. In my new role this is as important as ever.

10_Downing_Street_door

Secondly, that my entry through this front door and the route into these meetings are for one purpose only. To ensure that the NHS can succeed and keep delivering care to people behind different doors, on different streets – the streets of your village, town, city or hamlet. The NHS needs to make changes at pace to keep up with societal change, demography, financial challenges and to retain trust around quality of care. How easy it would become to engage in an intellectual debate about structures, incentives, legal instruments, markets and economics and forget the purpose of the conversation – to ensure we deliver the best possible care.

Morley terrace

Two weeks from leaving my former role as Chief Executive of Leeds Community Healthcare NHS Trust, the memories of the patients I have seen, the homes I have visited is fresh. From proud dads of newborn babes to exhausted carers of dying people – birth to death, head to toe, mental and physical health of everyone, whether prisoners, the homeless, shelf stackers or millionaires. It doesn’t take much for me to recall the palpable joy or sadness, frustration or relief.

To ensure that it stays that way, I have made a pledge for NHS Change Day. My new job is a representative one that has the NHS at its heart. That requires ongoing visits to organisations across the country. But I will also repeat what I did as a front line Chief Executive and go “back to the floor” once a month with staff and patients at the front line of the NHS. I have always said if you want to understand something you should try to see for yourself.

change-day-web-banner1

Getting out of my middle class bubble and into the real lives of staff and patients to see the impact we have is the most powerful incentive for success I know….and if you have the opportunity to be trusted to go behind the closed doors of other people’s lives, take it. You will be humbled, surprised, shocked and amazed by what you find the NHS achieves every day as well as seeing where things truly need to change.

Change day is on 3 March. You can pledge here.

The last post

I left my role as CEO of Leeds Community Healthcare NHS Trust today. This was my final message to Staff. Thanks to each and every one of them.

“This will be my last piece for Community Talk as I leave the Trust tomorrow (7 February) to take up my role as Chief Executive Officer (CEO) of the NHS Confederation. In that role it will be a real privilege to represent all NHS organisations – and particularly this one – on the national stage.

I was tidying up this week and I found the bullet points I wrote for my interview for this job in January 2011. As the trust was about to be created, I said there were four things to do:

  • Establish LCH as an organisation with a sustainable future and the right culture
  • Establish LCH as a credible and equal partner
  • Shaping the context we work in during tough times – influencing others to understand how important we are
  • Delivering high quality services every day

The first three were all essential to deliver the most important of those points – the last one, the reason why we exist.

I would love to write one of those triumphant pieces that said this was all delivered and everything is great. It would be very easy to talk only about the brilliant things we have achieved. That wouldn’t be a completely true reflection, and as someone who lives our values I know it is always important to be “open and honest and do what I say I will”.

So how are we doing? We are not an FT yet – but we do have a sustainable future and support across the city. A national integration pioneer and one of the pathfinders for children’s services. Award winning services and tenders and business won – through innovations like Traded Services in Speech and Language Therapy, the Musculo-Skeletal service winning the Any Qualified Provider bid and the new West Yorks Custody Suites. We have a good reputation too.

A culture that is built on values is essential. Our values are clear and in many places guiding every decision we take.  Our work on engagement is lauded nationally and internationally – and now that we have children on interview panels for paediatricians and old ladies interviewing nurses we will never go back. We have a good culture in the trust in many services. There is still work to do if we are to be truly led by staff who feel empowered to speak out safely, innovate and change in every service. This will be a critical piece of work in the coming months as the new Operations structure beds in. We have great staff and a real commitment to quality and change that drives improvement. Innovation is rife in many parts of the organisation and needs more support in others.

We are an equal partner in the City and have helped lead much of the system change – from vulnerable people to innovation to integrated care. The Council CEO describes our relationship as one that shows others how it is done. We have been very influential on national issues and locally too –through chairing national networks to showcasing our work to national figures. This work never stops as we work in the most difficult context for the NHS.

Most importantly, we have delivered services each and every day. Often this has transformed the lives and often it has simply made things a little better for people facing unimaginable issues. We have protected the health of people for the future and helped others in their last moments. Two million contacts a year, seven days a week, 24 hours a day – always aiming to deliver the best possible care. In some services this has been a test of capacity and resilience – where demand has been too high or the weather has conspired against us. In others it has been a period of change and transformation. All services have delivered efficiencies.

What has seen us through? All of this has been possible through you – only through you. I have been impressed and grateful for the daily examples of the passion, commitment, professionalism and guts that our staff show. On my back to the floor sessions I have witnessed the little miracles of kindness, compassion and care that take place behind closed doors every day in Leeds. All evidence that what we do matters and contrary to so much that has been written about the “culture of the NHS”. I have also seen the mistakes we have made and the impact when things go wrong for staff and for patients. Sitting with families who we have failed is a humbling experience and, thankfully, an infrequent one. We will always make mistakes – things go wrong – but we must continue to learn from them and minimise the risks. I have also seen corporate, admin and support staff working to external deadlines that can be punishing – making sure tenders go in, that plans are approved or that regulators are satisfied. Each of you is an important cog and every one of us plays a role in making a difference to people and the care they receive.

So, I know my successor will be lucky to be your Chief Executive. It has been my privilege and one I will carry with me always. Thank you for your support, hard work and the difference you make every day.

Rob”