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.”

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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”.

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  • 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”

#AboutMeLeeds – It’s A Matter of Trust

I am really interested in the power of information to transform care and improve safety. You may have picked this up from an earlier blog – “Civil War, Heart Failure, Sex and Big Data” – and some people may know I was a professional statistician for a while. So I was delighted to be asked to contribute a blog to #AboutMeLeeds – a week long discussion on data and privacy and innovation. Details via Victoria Betton’s excellent Digital Mental Health Site are here

All of the blogs are worth reading – and cover diverse and bumpy ground. From using data to transform care, to critical questions like “how private is private?”. Find them all here

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“It’s a matter of trust

The Secretary of State for Health, Jeremy Hunt, did a back to the floor session in our services last week. He worked alongside health and social care staff looking after older people who needed extra help to become well enough to go back home. During the staff round table discussion at the end of the session, over a cake and a sandwich, he asked what would be the biggest change that would improve care?

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The answer may surprise you. The physiotherapists, Occupational Therapists, Care Support Workers, doctors, nurses, catering staff and others did not ask for more staff or better facilities but better data. To have a single set of information that could be communicated once, added to anywhere, shared and held electronically would make clinical decision making, care preferences and communications better. The nurses and social workers who met Norman Lamb, the Care Minister, said pretty much the same thing.

What gets in the way of this?

Alongside the technological and cultural issues lies a complex issue – Information Governance. Two words that strike fear into the heart of many who wish to revolutionise healthcare.

Surely the NHS and Social Care organisations should be able to share all data with each other?

No they can’t. A sensitive issue you have shared with your GP may not be relevant or appropriate. For example, should relationship problems that are causing stress in a relationship and potential mental health problems be common knowledge?

OK, but don’t people believe that this happens already anyway?

Perhaps they do – although anyone using the service over time will quickly know this is not the case. GP clinical records are not visible to all community staff. Hospital records are not shared outside the four walls of the hospital and many community records languish on paper in people’s homes and health centres. This needs to change and it must be done safely.

For me, Information Governance is as important as Clinical Governance. Keeping the information that we hold about patients safe and using it appropriately will be at the heart of reforms – for two reasons:

Firstly, it is a matter of trust. The NHS and Social Care both deal with people at their most vulnerable and hold information for which stigma remains. Mental health conditions, sexuality, alcohol and drug abuse, HIV….issues affecting people from all social strata, despite the best efforts of brilliant campaigns like Time to Change. Trust is at the heart of the relationship between health and social care and citizens. We trust our GP more than any public figure – 94% trust rating according to MORI for example – and if we are to succeed as we radically transform and change care that trust must be retained. [We can have a go at reducing stigma alongside this too].

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Secondly, services must be integrated around the needs of people not organisations. This requires data to be shared in ways that are currently not feasible.  Real time data, that are accessible to patients and care givers, in ways that my staff were demanding from the Secretary of State. This requires the way we think about Information Governance to change – to be a gateway and not a barrier to sharing data. This will be harder than it sounds. As the NHS becomes more complex and pluralistic, the approach will need to change – and patient consent and trust may become a matter of personal politics as much as safety.

Is it possible to get this balance right?

Yes. If we can assure people that they have a say in what is shared and create simple mechanisms for giving consent. People already make informed choices about what they will share every day on social media, for example. Some of their choices may appear unwise – but they are theirs to make. This will need the right clinical leadership, the right public debate and a focus on the real prize: Safely sharing your data so we can always provide safe care… and ultimately so we can stop wasting everyone’s time asking questions you have already answered.”

Thanks to everyone at the Leeds Data Thing for their support

Cinderella’s 100 million pieces of magic

What Does the Term Cinderella Service mean?  I was musing about this recently. Here is the Longman English Dictionary On line:

“a person or thing that has been ignored or treated as less important than other people or things – Example: A Cinderella  service within the NHS.”

There are many potential Cinderellas in the NHS – each unheralded or put upon service will hear the claim routinely. Mental Health Services, rehabilitation, renal support, learning disabilities have all staked a claim.

I was going to suggest, looking at the definition, that NHS Community Services are “ignored and treated as less important than other people or things” and therefore fit the bill. It is rare for a politician or senior NHS Leader to talk about a community matron, podiatrist, dietician, family support worker, health visitor or school nurse. Most would struggle to tell you what an Occupational Therapist does – like all our staff they are just brilliant.

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And show me the policy documents that trumpet the role NHS community services will play in the future system – one tailor-made for them. Michael Scott wrote about this here. I have also written about this here. The policy documents don’t exist and the scale and role of community services is not understood. But…….

Then I thought about the 2 million contacts we conduct every year in Leeds. The difference they make and the satisfaction and support that they give to the people who really matter – the patients and families we support. I wrote previously about the “Little Miracles of Kindness and Compassion” that take place in homes across the City. Helping a child communicate for the first time. Rebuilding a life after a stroke. Keeping your feet and your sight as a diabetic. Preventing a suicide in prison. Helping teen Dads work out how they need to be in frightening new lives – where we value them not treat them as pariahs. Sourcing patients with STDs and getting them help. Or, as a grateful family told me about their Dad recently, a good death with the sun on your face in the garden. And as one older lady described to me at our Colorectal and Urological Services Open Day –

“The doctor referred me to Sister Lodge. She has helped me get my life back. She has given me hope.”

Jen

So maybe it is time to rethink the idea of cinderella services. Because if 2 million contacts are part of the Leeds Landscape, then I reckon maybe 100 million contacts take place in NHS community services like ours in England. That dwarfs activity in hospitals. And every contact will be working with people to help them with something they believe is important – their lives. Ignored and unimportant? No.

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And then we need to think about Cinderella herself. Wasn’t she the one with all the talent, resourcefulness and ingenuity?

So if being a Cinderella service means being cherished and valued by the people you serve and having the skill and talent to succeed in the toughest of climates, then I am proud to be running a Cinderella Service. One that, with my colleagues across the country, tries to pull off 100 million piece of magic each year.

Some things are just too heavy for Superman to lift

Heroic leadership has had its day. It is a notion that doesn’t work in complex systems. It can also have dangerous side effects. From major corporate failures in the US to tinpot dictatorships. Commentators and researchers such as Beverly Almo-Metcalfe have been suggesting this for some time and that a new approach to leadership is more effective in the 21st Century. One that focuses on distributed leadership, underpinned by core values such as dignity, respect and trust.

Not everyone agrees. The Health Service Journal probably reflects the chatter around the NHS as it seems to constantly question where a new Superman will come from to rescue NHS England and, by some feat of heroism, the whole of the NHS. Who will this new Superman be, they seem to ask, who will wrestle the monsters of demand, cost effectiveness, fragmentation into submission?

My advice. Stop looking  – as the Flaming Lips once wrote:

“Tell everybody waiting for Superman
That they should try to hold on best they can
He hasn’t dropped them, forgot them or anything
It’s just too heavy for Superman to lift”

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[Courtesy Barnorama.com]

Fortunately, the time could not have been better for a new type of distributed leadership in the NHS. This is one where leaders work with an adaptive style, moving beyond pace setting and directive styles, to bring in affiliative, coaching and partnering skills too. I spoke to a bunch of new Graduate Trainees this week and was able to point to two seminal reports that will shape the zeitgeist.

The first was the Berwick Report. What a great report here.

Berwick

Like the phenomenon of Notes from a Small Island – where Bill Bryson helped us realise how brilliant Britain is –  here was an external view of everything we take for granted. Among the findings in the report, three things stood out for me.

  • the distributive leadership and commitment of staff in the NHS.

“Your nation’s commitment to health care as a human right and to healing as a shared mission is second to none in the world. And all of that is possible through you; only through you..”

Don Berwick’s Letter to NHS Staff

  • the need to focus on skills for improvement and leadership at every level in the NHS. This will make us a real learning organisation.

Skills

  • that we need to measure everything better and in real time. We all know that this is an essential part of improvement science

The second was the Michael West study into NHS Cultures, here. This is worth a whole blog in itself and everyone should read the summary document. That blog will follow.  For me, the research lays the foundation upon which the new NHS system will need to be based. Here is a great quote from it:

West

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.

Professor Michael West

In my trust, we are aiming to become a world class learning organisation. We also believe in leading from every seat. We have a long way to go yet, but the green shoots are everywhere amongst the cracked earth of cost improvement and reform.

Fundamentally, when it comes to it, we need leadership from every seat in the NHS, The nurse leader staying on to support her team and make sure a patient can die at home because she has the expert knowledge of the specialist equipment in place.  The receptionist walking 5 miles through the snow to make sure the healthcentre is open on a winter’s day. The manager putting 900 staff through a programme that focuses on value based leadership because she thinks they need to know. The speech therapist marketing services to schools to ensure the kids get the right provision – then being there when a troubled child pulls a knife and can be talked down. The consultant running and arranging an international conference on stammeting and stigma. The primary care mental health teams putting patients first and working extra shift to assess patients and meet commissioner expectations. The equality manager challenging preconceptions in public meetings and being challenged back. The clinical leaders tackling poor practice through support and education – putting themselves in the firing line. The line manager throwing a party to celebrate 25 years service for a member of staff. The Chief Executive saying sorry I got it wrong. The finance manager working extraordinary hours to meet external deadlines and helping staff through tough times. The prison health team making prisoners carers not just offenders and showing this to the world…..all examples of leadership in my trust.

No superman was required. Just the leadership of committed and values driven staff, working towards a common goal.  So perhaps if you see Superman, tell him the weight is too heavy for him to lift alone. But together? Anything is possible.

Little miracles of kindness, compassion and care

Nobody buys new pyjamas because the district nurse is coming round. Community nursing, therapy and health visiting provides a privileged insight into the
lives of people needing care in their own homes. People in our services see how we really live in modern Britain.

Behind closed doors, little miracles are happening every day, lives are being changed or people are persisting with conditions that lead to lives many find beyond comprehension.

This is the world my staff inhabit. Populated by all sectors of society – we treat everyone everywhere. Stoical women living with Parkinson’s , the epitome of Yorkshire grit. Young mums with palliative babies, seeing through short lives to the full. Teenage girls not letting  cerebral palsy get in their way. Refugees, the victims of torture and trafficking. Aged singers reminiscing about life before COPD and reliving mixed race marriages in 1950s Leeds. Young dads, doting on precious bundles, eyes like saucers. The rich, the poor and everyone in between. From head to toe and birth to death.

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I try to spend at least one whole day a month back to the floor and often manage more. Every one of these sessions leaves me with an indelible memory of the people I meet. It often leaves me emotionally drained and carrying a set of concerns about them too. On the back of yesterday’s session with our fantastic Parkinson’s Nurse Specialist, Paddy Harris, I feel exactly the same.

That lead me to thinking about our staff and the weight they carry of all those lives. Every day working close to life, death, joy and many people with persistent, ongoing struggles. How do they cope? Some tell me the love of the job and the difference it makes drives their energy levels. Others say, after a challenging visit,  they readjust in the car before the next one. Regular exercise,  the support of teams, recognition from senior colleagues, a card from a grateful family. Small touches making a lasting difference…..
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Our staff need to be supported to flourish in this reality. Michael West’s work shows how much this matters. Do read his blogs.

Good leaders create a positive climate for staff so that they feel engaged and have the emotional capacity to care for others. There is enough negativity in health service organisations – fear, pain, anxiety, loss, uncertainty – that we must counterbalance it with positivity. This is both fundamental to leadership in the NHS and not widely understood. Expressions to staff of gratitude, appreciation, support and encouragement cost nothing but profoundly impact patient care”

And if the research is not enough for you, listen to Tommy talk about how “the district nurse put her arm around me and told me I was doing OK” . The power of a bit of kindness that
helped him through tough times as a carer for his mum. That nurse’s compassionate approach is something we need all our staff to be able to deliver. I have seen this from band 3 support workers and band 8 community matrons and staff  in between (as well as drivers, therapists, doctors…)  Retaining this valuable asset requires that we look after our staff.

The RCN survey into stress among nurses is a sign we need to do more. If two thirds have considered resigning, then things need to change. In my organisation, as well as back to the floor sessions, I have just finished listening events with community nurses. These have been a necessary part of how we are growing and changing services. In the news we hear about A&E being busy. This is the same for my 24-7 community nursing and therapy services. A boost of over 35 extra nurses in the next month – with support from commissioners – is essential. Nurses tell me of the strain they are under whilst new capacity comes on stream. At each session they have noted the importance of knowing that I know what they face, that the chair and other directors too. Just being there to listen helps… …and I now, more than ever, appreciate that this impacts on the resilience they need to do one of the most fulfilling and important jobs in the world.

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So next time you casually tell someone that nurses or staff in the NHS don’t care, ask yourself when you last spent time with one and what you might be doing instead that will support them to do what they do best. Let’s lead with a positive culture that promotes little miracles of kindness, compassion and care.

Forget the Janitor at NASA, Andy makes people better….

“There is a famous story about President John F. Kennedy’s first visit to NASA’s headquarters back in 1961. While touring the facility, the President’s entourage reportedly came upon a man mopping the floor in one of the hallways. The President stopped to chat with the man, shook his hand, and asked what he did at NASA. The janitor proudly addressed the young President by saying, “Sir, I’m helping to put a man on the moon!” ”

It was our monthly staff indiction this week. I open each of these sessions with new starters to the trust and discuss Vision, Values and Leadership. I ask three simple questions during my half hour slot, giving everyone in the room a minute to discuss the question with their neighbour. We get some great answers from the 30 to 40 people present. The mix of professions, roles and services – from prison pharmacists to community counsellors, rehabilitation consultants to community healthcare support workers, office receptionists to graphic designers – always makes it real. I ask:

Why do you do your job?

What Does High Quality Care mean to you

What’s the best thing that has happened to you this week?

You should try it, in your teams, at least once a month. The answers will reconnect you with purpose, energise you and remind you of the impact you have every day.

And the best thing that has happened to me this week? Was an answer to that first question. One of our HR team was my neighbour. Andy – why do you do your job?

“To make a difference to the people of Leeds. Because I am part of the recruitment team and we make sure we employ the best people, quickly. So, indirectly I make people better. And being from Leeds, that matters to me.”

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So it not only “janitors at NASA who put men on the moon”. We call it Leading from Every Seat. More on that in my next blog – because we have it. In spades.