A Christmas Call – a blog with John Walsh

One of my colleagues from Leeds, John Walsh, does joint blogs with people from across the system. I was privileged that he agreed to write one with me. Here it is. Happy Christmas.

“ Blessed is the season which engages the whole world in a conspiracy of love.” – Hamilton Wright Mabie  

Last Christmas a worker at a NHS health centre for the homeless rushed through the streets of the city centre loaded down with carrier bags. In the bags were Christmas gifts and tins of chocolates. She had hoped her colleague would accompany her but the colleague was drawn away to clinical duties due the demands on the service.

The destination was the local refugee drop-in. The idea was for the refugee children to each receive a small present – a colouring book and pens – and gifts of chocolates for everyone there. The money was raised, the gifts bought, donated and duly wrapped. The clock was running fast so the worker decided the best bet was to walk across town.

The city centre bustled with people and shoppers. Halfway through the journey the handle on one of the bags burst. Our friend sighed, grabbed the bag by its body and ventured on. She was stressed – she had so much work on back at the centre and was behind with things too. She arrived at the drop in centre – flustered and out of breath. She was happy to put the bags down.

The refugee drop-in was full – adults and children filled the centre and sat around tables. People who had endured unimaginable experiences a short time before in the war torn areas of Syria were here and were safe. She started to distribute the chocolates on the tables and gave the presents to the children. The children opened the gifts and got down to the colouring and drawing. Colleagues from the local authority arrived with presents too.

As our friend stood there she started to fill with emotion and well up with tears. Something was unfolding before her – something very simple yet incredibly significant. It was an experience that touched her heart. She stayed a short while and then returned to the busy, never ending world of NHS healthcare.

On her way back she reflected on what she had seen. For a short time at the drop in centre, she had stopped her rush-a-day work life and been given a clear message. There were three parts to this.

The first was she recognised in that little church hall what really matters. It’s people who matter. Seeing the joy in the faces of those children was what both Christmas and work was all about. Seeing people with nothing, happy to receive and to find joy in simple gifts. Caring for others and bringing joy to those near and far from us was the most important thing. It is what we do to others that teaches us most about ourselves and what our services should do.

The second reflection was that we are all in this together. The local authority, third sector, shops that gave free chocolates, good hearted individuals who helped and the faith community who hosted the sessions. It said that we work best when we work and learn together. Each bringing their own contribution to make something greater than the individual parts.

In that room she saw how cities and services must be in the future – moving from silos to solidarity. Solidarity comes from the French for ‘interdependent, complete, entire’. Solidarity here was a unity for change and care in the heart of a city.

The last reflection that struck our colleague was that we all have a part to play and that a public service ethos is a powerful connector. She had seen it in the busy colleagues who couldn’t attend but who spent time meticulously wrapping the presents; the local Co-Op manager that donated chocolates; the fact that the city was working to support the most marginalised.

This wasn’t just a Christmas tale but an everyday one – people in the NHS and with a public service ethos everywhere – united in a shared purpose to do good and make a difference, whatever your circumstances, wherever you are from. This was an event perpetually happening in so many places.

Public services sometimes get things very wrong. At other times they shine like diamonds.” 

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Public service is a deeply held belief and drives people to create the best they can. This is one of the main reasons why we think so many go the extra mile and work outside of hours to try to help. This wish to publicly serve is something to value, cherish and celebrate. It is about making a contribution to build a better world. A world without social workers, therapists, nurses, doctors, support workers, porters, drivers, chaperones, hostel workers, advocates and everyone who chooses to serve people as a public good would be a lesser place. Public service is a commitment to social wellbeing, development and cohesion.

At this time of the year we hear and see the great Christmas tales. Books like ‘A Christmas Carol’, films like ‘Its a Wonderful Life’ and the story of the health worker at the refugee centre remind us what really matters.

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When it comes down to it, it’s all about people – like you, like us and everyone else who makes a difference to those we care about.

The writers would like to wish everyone a great Christmas and happy 2017. We hope it will be a time of great joy for you and yours.

We dedicate this blog to all those – families, patients, carers, staff and volunteers and people out there who every day show us what true humanity and care is all about – thank you – you inspire us to keep on hoping and going. 

 

John Walsh and Rob Webster

Photos used from public sources #AdsParty @NHSEmployers, Closer magazine from @nhsbarnsleyccg featuring @allofusinmind health integration team, York St Practice @lchnhstrust, and drop-in centre @pafras_leeds

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

b4Welcome to The View

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

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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.

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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.

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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,

 

Rob

Chief executive

 

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

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.

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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.

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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.

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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.

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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.

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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.

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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.

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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!

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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.

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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.

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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.

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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

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.

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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.

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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.

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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.

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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 safety of every patient, the value of every penny

When I graduated in 1990, I went to work for the Department of Health as a professional statistician. One of my friends asked me:

 “What do you actually do all day? Do they give you some ‘rock-hard sums’ to do in the morning and you get to leave when you have finished them?”

I politely told him that it was a bit different than that (in the usual robust and Anglo-Saxon way that young men do). The job did entail doing a lot of “rock-hard sums” as I was arguing about multi-dimensional scaling and logarithmic regression models with the British Dental Association’s advisor. He was the president of the Royal Statistical Society and very kindly tolerated dealing with a young upstart 22-year-old me. I am sure he could have demolished me quickly in any debate – yet we agreed on a lot and he was supportive. Looking back, this was an early lesson for me in power and how to use it.

I was reminded of that this week. I have been asked about the day-to-day role of a Trust Chief Executive by Alex, a graduate trainee who was shadowing me, and a front-line colleague at the curry club. “So what do you actually do each day?”.

Here is what the rules say the role of the Chief Executive is in my Trust [adapted from national guidance and agreed by our Board]

As Chief Executive I will…
  • Be accountable to the chair and  to the board of directors directly.
  • All members of the management structure report either directly or indirectly, to the Chief Executive.
  • Run the trust’s business.
  • Be responsible for proposing  and developing the trust’s strategy and overall objectives.
  • Implement the decisions of the board of directors and its committees.
  • Provide information and support  to the board of directors and council of governors and ensure that board of directors’ decisions are implemented.
  • Facilitate and support effective joint working between the board of directors and council of governors.
  • Provide input to the board of  directors’ agenda from themselves and other members of the executive team.
  • Ensure the chair is aware of the important issues facing the trust and propose agendas which reflect these.
  • Ensure that the executive team provides reports to the board of directors which contain accurate, timely and clear information.
  • Ensure that they and the  executive team comply with the board of directors’ approved governance procedures.
  • Ensure that the chair is  alerted to forthcoming complex, contentious or sensitive issues affecting the trust.
  • Provide input on appropriate  changes to the schedule of matters reserved to the board of directors and committee terms of reference.
  • Support the chair in their tasks of facilitating effective contributions and sustaining constructive  relations between executive and non-executive members of the board of directors, elected and appointed members of the council of  governors and between the board of directors and the council of        governors.
  • Provide information and advice on succession planning to the chair, the nominations and remuneration  committee, and other members of the board of directors, particularly in        respect of executive directors.
  • If so appointed by the board of  directors, serve on any committee.
  • Lead the communication  programme with members and stakeholders.
  • Contribute to induction programmes for new directors and ensure that appropriate management time is made available for the process.
  • Ensure that the development needs of the executive directors and other senior management reporting  to him/her are identified and met.
  • Ensure the provision of appropriate development, training and information.
  • Ensure that performance reviews  are carried out at least once a year for each of the executive directors. Provide input to the wider board of directors and council of governors evaluation process.
  • Promote and conduct the affairs  of the trust with the highest standards of integrity, probity and corporate governance.
  • Ensure the provision of effective information and communication systems.
  • Lead the delivery of good and effective partnerships, agreeing with the Chair the appropriate lead on key stakeholders.

This is a big list – and each of them covers a broad scope. For example – “Run the Trust’s business”, “lead the delivery of good and effective partnerships” and “promote and conduct the affairs of the trust with the highest standards of integrity, probity and corporate governance” each have depth and breadth.

In practice you can get a good sense of what this means through looking at the CEO Diary Blogs of people like Jonathan Fagge of NHS Norwich Clinical Commissioning Group and Dr Mark Newbold of Heart of England NHS Foundation Trust.

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Difficult choices, public accountability and a focus on leadership, strategy and delivery are highlighted in every one of these. It is clear that, whether you run a commissioning or a provider organisation, these are system and organisation roles….and both Mark and Jonathan present examples of excellent leadership in both. So this is helpful at explaining about what a CEO does in the NHS. And as a former statistician, I would say it is all “necessary but not sufficient”. I would add two really important additions for emphasis.

When describing my role, I say that I am here to:

1. Be accountable – for two things only. The safety of every patient we care for and the value of every penny we spend. By “Value” I mean impact, quality, effectiveness and value for money. As the Chief Executive I carry this accountability 24 hours a day, seven days a week. It is like a coat that I never take off and one I wear gladly when the culture and systems are right and one that can feel incredibly heavy if they are not.

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2. Create the culture where others can succeed. This is one where people feel able to take responsibility and use the authority that they have been given to act. I have written about this elsewhere (“Some things are just too heavy for Superman to lift”) and will not repeat myself here.

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So what does a Chief Executive do all day? Everything required in the list of bullets above and, more importantly, balances keeping the accountability while ceding authority to others. It is never easy – I often get it wrong – but it is an essential part of everything we do, each and every day.

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Seeing the wood for the trees

Sometimes you look at something so often, the obvious becomes “hidden in plain sight” and we cannot see the wood for the trees.

The Internet  is a wonderful thing. I was perusing twitter recently when I came across this brilliant little clip of Richard Feynman via Brainpicker.

In it, Feynman explains how we all think trees grow out of the ground and then goes  on to explain how they are really made out of the air (the carbon that makes the wood comes from Carbon Dioxide in the atmosphere). He then goes on to explain how fire from burning wood is “stored sun” – the energy from the sun as it finally finds a way of escaping. It is magical and once I understood it, obvious. (I did have to rely a bit on my A Level Chemistry)

Richard Feynman was an amazing individual on many levels. A Nobel prize winning physicist, safecracker, calligrapher, musician, author , joker, polymath. [Read “Surely you are joking Mr Feynman” to learn more]. His biggest gift was teaching and a love of equipping people with the tools to make them think.

This little film made me think very hard about the NHS and how we talk about it, debate it and consider its power.

The usual debate goes that the NHS grows out of a national system of commissioning and provision, with regulation of the market and regulation of the quality of care that is provided.  Funds flow from the Treasury and care comes out of the other end. The NHS is delivered in homes, hospitals, GP surgeries, pharmacies, dentists, schools and health centres paid for by the money that nourishes it and makes it grow. That is clear for all to see……isn’t it?

But just as trees don’t grow out of the ground then the NHS is made not from the system or the buildings or the money it costs. It is made of the people who work in it and from the values we share. Over 1 million people, most of whom work incredibly hard and deliver great care as Professor Michael West concluded in the biggest ever rersearch study into the culture of the NHS:

“Many NHS staff – from the blunt end to the sharp end – demonstrate every single day the values of safety, civility, and compassion, providing the highest quality of care to patients even in challenging circumstances. Their excellent work must be celebrated. More than that, their values must be continually reinforced through the commitment and actions of leaders”

So obvious yet never the first frame of reference in the debate. And you don’t need a degree in chemistry, or a polymath
genius to explain how to see our wood from our trees. It is our staff, us that make the NHS….and the care that comes out is the “stored values” escaping as compassion,kindness, empathy, dignity and respect. Or, as we know to our cost when things go wrong, not.

Over to my team…..

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Happy New Year! See you all in 2014.

It’s time to turn to the experts

I was asked earlier this year to contribute to an exhibition on the history of learning disabilities in Leeds. This involved being interviewed about the support that had been provided for me by Leeds Mencap – a brilliant local charity. When George was born he had all sorts of health issues associated with his Down Syndrome. We found the portage provided by Leeds Mencap and the Hawthorn Nursery to be fantastic. They provided opportunities to build George’s strengths and assets, and our relationship with him. Using Makaton to communicate, stickers to aid reading, matching pictures…it all came back. Then I found myself talking about what it was like to just sit with the parents of other children with a learning disability while the children were in the nursery. To be with people like yourself and talk about things candidly – from benefits to social  attitudes, our hopes and our fears, to the often comical reality we faced every day.  Suddenly, I welled up and couldn’t speak.  The power of that peer support had got us through some tough times and meant a lot, even a decade later.

Mencap

I was reminded of that this week. I have written often about the power of seeing people as assets not problems. This must be at the heart of the future of the NHS. We are now in an environment where strategy and delivery must be centred around the needs of people and their lives, not our institutions. This will focus on older people, those with long term conditions and children – because that is where care is now provided and the money is spent. We need to enter a period where commissioners and providers work together to understand that for many the idea that they will be discharged from care is not a reality.

In this world, I believe it is only right that we begin to ask what people can do for themselves and each other – when properly supported to do so.

This was very powerfully brought home to me this week and I continue to be humbled by the staff and volunteers in the trust and their care, commitment and compassion. The fantastic team who co-ordinate our programme invited me to meet about 20 of our Expert Patient Programme tutors. These are a group of people living with mental and physical health challenges, including chronic pain. I arrived as they sat around a table and spoke about the impact that being a tutor had on their lives in the last year.

“I hadn’t been out of the house for 8 years. Now I am supporting others to stay well”.

“I have got my life back on track and for the first time in years know how to have fun”.

“My mum said she was glad to see the real me again”.

“This time last year I stepped in front of a car because I wanted to die. Now I know how precious things are and that I can help others too”.

EPP

Just writing this makes my hairs stand on end. Being in the room, I was provided some of the most powerful testimonies on the impact of our services I have heard in one concentrated session. All underlining the power of people and professionals working together. A confident and feisty bunch transformed from when they started was what they told me. Thanks to each of them.

I later received an e-mail from one of the group setting out how their experiences were not the norm across the system and how it is still for some people a struggle to be heard.

“Since starting with my condition, I have had problems with the care, support, and treatment that I have received from my Consultants, GPs and other health care professionals…… Communication at the moment is a key thing ….. Patients are made to feel that they don’t know what they are talking about, and doctors know best; even though the patient is the person living with their condition on a daily basis and they know their condition.”

As a result, we are looking at how the group come and work with us on service developments and how we ensure that supported self care is the norm. This is a strong feature of our services in some areas but elsewhere in the system we need to do better.

We are also working with commissioners on the implementation of all of the work done with the National Endowment for Science, Technology and the Arts on People Powered Health. Leeds was one of 6 area working to look at a range of supported self care models that, according to the final reports:

As a result, there is a reduction in the cost of delivering healthcare of approximately 7 per cent of the commissioning budget – through decreasing A&E attendances, reducing hospital admissions, reduced length of stay and decreased patient attendances. Putting this into practice would save the NHS £4.4 billion across England.”

the_business_case_for_people_powered_health

Read the great reports on the business case and practical tips here

Of course, not everyone can self care. Vulnerable people sometimes need more. We often hear about the terrible experiences that people have. Here is another perspective, again from this week.

Our clinical lead for adult services, spoke at the Quality Committee about the district nurse she was out with visiting a frail elderly man at 11.00 in the evening and spending time with him to ensure he was safeguarded. The nurse provided his bed time visit and was there to see to his needs and make sure he got to bed safely. She had concerns he was not eating or drinking and was in conversation with social care. The nurse weighed him each night to track his weight. As he rose to get to the scales, he stepped forward and hugged her tightly.

She then patiently waited while he had a drink and a snack, ignoring the pressure she must have from the visits to palliative patients yet to come, chatting about how he was and his fears for his health. She then tucked him up in bed, wrapping him up with great care and tenderness to make sure he was warm and safe.

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We should say thanks to all the twilight and night staff in community nursing – I know this is a regular and consistent picture where staff show great compassion and care. I hope the additional winter team we have put on in Leeds helps ensure we have the capacity to ensure this is always the case. We are also over-recruiting to district nursing in a bid to build resilience of this under-appreciated and sometimes overlooked vital service. These experts in managing risk, health and social issues are – with their therapy colleagues – another vital piece of the future of the NHS.

We know the world will be different in the future and that the culture in the NHS will “need to change”. That change needs to be specific. It needs to be much more about how we treasure the compassion of front line staff given the time to care while opening ourselves up to harnessing the assets of patients, carers and families. It works and the results can make your hair stand on end.

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”….