We can all learn from “The Bay Way”

I was asked by Jackie Daniel at University Morecambe Bay NHS Foundation Trust to write  a blog for the trust. Jackie is a new breed of NHS leader who has shown huge resilience and an approach to system leadership that underlines how some of our most talented people are now working in some of the toughest circumstances.

“In my role I read a lot of commentary and reports about the NHS. Just recently I read about how NHS providers are “in a ditch”, how we have “spiralling” deficits and no plan to fill a “£22bn black hole” and that we need ”a better plan”. It’s always a gloomy picture and there is always an angle if you want to take it. My angle is that we have the biggest challenges for a generation and a huge consensus about how we address them. We should stop commentating on the state of play and get on with the game. That takes leadership at all levels – of the kind being shown in University Hospitals of Morecambe Bay NHS Foundation Trust.

If we are to improve care to meet patients’ needs today, there are some simple things that we need to focus on:

  • We need to recognise that the NHS is a system not an organisation – one that is deeply reliant on social care. That system needs to work in ways where the 7 main national bodies – including Monitor, CQC, Department of Health – operate in ways that support local trust leaders like Jackie and her team to succeed. You can’t dictate what happens in Walney from Whitehall and you shouldn’t try. By working together at a local level, we can solve the problems that bedevil the NHS.
  • We need to sort out the money. The system needs us to fund social care and prevention properly. A 32% increase in delayed transfers of care due to a lack of social care shows how if you cut social care, the patients suffer, and the NHS bleeds. We also need to manage the balance of investment so mental health, community and GP services get support. Flexibility will be key and Morecambe Bay was the first trust to trigger the arrangements that increase the prices commissioners pay because of geographical isolation. Jackie and Aaron worked with local partners to prove that the national arrangements don’t fit in South Cumbria.
  • We need to recognise its our people that matter. The NHS is not made of drugs, kit, hospitals or beds. It is made of people – from porters to paediatricians, secretaries to surgeons, therapists to theatre staff and beyond. People are our greatest investment and our biggest asset . Give them some headroom and they will drive the changes needed. The work that Jackie’s team have done through Listening into Action is a great example of how we harness the power of people. What we need across every bit of the NHS is to build trust with our staff and make them feel supported in their work by an organisation that truly cares for them. This is not where we are today but it is something we can build, ward by ward, team by team, trust by trust.

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  • We need to work with communities and focus on place. We waste the assets of people every day in the NHS – the patients we see are often skilled experts in their own condition, the carers we meet coordinate care and solve problems every day. They need to be part of the team and part of the future. This is especially true as most of our patients have long term conditions and will always be with us. Looking at people, communities and place is essential – look at what you have achieved in Millom as a brilliant example of this.

Many of these themes come out in the NHS Confederation’s Commission into Urgent Care for Older People. This started as an inquiry into A&E pressures and quickly became about the cause of those pressures and not just the visible symptom of crowding in A&E. It’s a great report that highlights how we are increasingly dealing with an ageing population with growing dementia cases and co-morbidity. The system often fails older people and the result is they end up in hospital. The report also showcases some fantastic practice across the NHS and identifies the how we could change and help trusts thrive. In each, there is a sense of system, financing, staffing and community.

One of the clear messages is that hospitals have a critical role to play in leading change with these services as part of joining up care across communities. Often this debate gets into a bit of a cul-de-sac where people define hospitals as organisations that are somehow not part of communities and hint that they are part of the problem. Anyone who has been to somewhere like Furness General Hospital knows this is a redundant idea. The model ships in the entrance, the paintings and murals, the plaques from High Carley and Roose show a proud history of community. And as a Barrovian I have many memories of the place. They reflect the joy and sorrow that goes on each day within its walls – it is where my twin nieces were born, it is where my younger brother was pronounced dead after he committed suicide and it is where my Dad gets treatment regularly for his hip. The hospital is clearly part of my history and my community. To thrive it needs community based alternatives and to retain connection with the people it serves.

Luckily, we now have an opportunity to plan for a new future in healthcare. This will be set out in place based plans called sustainability and transformation plans [STPs] that cover the next 3 to 5 years. Trusts like yours with effective leaders like Jackie give me hope that the plans will be good. My job at the NHS Confederation is to help ensure that you have the right conditions in which to deliver them.”

Thanks to Jackie Daniel for asking me to write this piece – and for being a great example of what values based leadership looks like in the modern NHS.

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Just ask George

Will you indulge me for a moment or two? I want to tell you about my son George. He is 14 and without doubt one of the most popular people I know. Walking to school or in the local community is an experience punctuated by people saying “hello George”, high-fiving him or giving him a wave. It’s the same in school, with pupils and teacher alike. At a recent party we attended, where many of the teachers were mutual friends of the host, one of them whispered to me how he is “universally loved by everyone at school”.

He is one of the most hard working, committed, passionate and fearless people. His school reports are glowing – he is ahead of all his peers, often top of his class and his attitude to learning scores are off the scale. Hopes are very high for him exceeding expectations in his GCSEs and he is world class at spelling.

He has been on the school council in primary and secondary school. He was voted on by the other kids. He is currently a school representative for PE in high school. As a result he gets to sit on interview panels for the some key appointments and also talk to OFSTED about what it is like to be a pupil when they do their inspections. His insights are always important and usually wise.

Being good at school attracts rewards, which results in trips to theme parks like Flamingoland and Alton Towers. He loves dangerous rollercoasters and hair raising rides – as well as zip wires and high ropes.

As well as being a star pupil, he engages in a number of school clubs and out of school activities. He is a member of the school choir and the school performing arts group as well as Stage Door theatre school. He has performed a number of concerts and plays. As part of the school climbing team he has competed in and won events – as celebrated in awards presented by Johnny Brownlee at the school sports awards. He plays Tennis on a Sunday and sails on the local tarn in the holidays with the Sailing Club.

He dances at the Northern School of Contemporary Dance every Friday with his dance group Me2, who have wowed audiences at the West Yorkshire Playhouse, Phoenix Dance Studios, the Audrey Burton Theatre and elsewhere. His stage group performs shows at local theatres in which he sings and acts with a passion and some talent.

He is great at volunteering too. Every week he marshals at the Woodhouse Moor Parkrun, supporting the runners and helping with the arrangements. He was co-director this week and named junior volunteer of the year in 2014. When he marshals other races for local clubs he knows so many of the runners he gets a bit hoarse from cheering to spur them on.

Outside of this, his teenage boy tendencies mean he is glued to his ipad or the computer when he can be, playing games or researching films on ImDB, which he loves to watch at the cinema with his mates or buy on DVD. He is pretty cool and the dance teacher tells me how popular he is with the girls. Theatre and musicals also form part of his obsessions and he can tell you just about everything you ever wanted to know….

I am so proud of him I could burst.

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George would not be who he is today without the support of Leeds Mencap.

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They were the ones who helped us in the hospital the day after he was born, with kindness and positivity.

They were the ones who provided the space for other parents like us to share a coffee and a chat and get informal peer support.

They were the ones who helped with speech therapy, portage and transition support for inclusion at nursery, at primary school and elsewhere.

They laid the foundations for us as parents and for George to transform from being a lovely baby into the success he is today.

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On 12th July I am running the Leeds 10k for Leeds Mencap. You can sponsor me here. Please do. The difference they make is clear to see. Just ask George.

Leadership – My “No Excuses” Role Model

Adam Bojelian was a remarkable person. That was clear for everyone who attended the celebration of his life in Tadcaster yesterday. The celebration was a perfect reminder of the beauty of his poetry – cousin Lara reading The Green Fish was a personal highlight – and the tributes came from across the globe for someone who touched the hearts of many with his can do attitude. A fifteen year old boy who wrote poetry by blinking and captured the imagination of anyone he came across.

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Adam was a “No Excuses” role model. The photographer Paul Clarke read “My Creation Myth” and prefaced it with this statement – so simple and true. Adam had every reason to not do his homework, be bitter about life or let his challenges get him down. Instead he approached life with glee, never making excuses. For him “every colour was perfectly placed”. And a duff joke or two was always at hand.

Alongside people like Lara and Paul, I was privileged to be asked to be one of the 15 people to read one of Adam’s poems and say a few words. The poem was Leadership – something I commissioned for the NHS Confederation Conference in 2014. I needed something to set the tone for the whole of the leadership in the NHS and Adam responded brilliantly. He gave us something that defined good leadership and challenged our perceptions about the potential of people.

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I read the poem and new that it was right, it was wise and it was clever. A challenge to the reader to be a better leader. It was exactly what was needed and I shared it on Twitter. It was read and retweeted widely. Some time later, someone pointed out that the poem’s puzzle had been solved. It was not just a challenge to the reader but also spelled my name down its spine. I had missed this completely and it was something I won’t forget – one of those moments that catches you inside and is truly humbling and a personal challenge to me to be a good leader too.

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Subsequently the poem has had a life of its own. It was a wow at the Confederation Conference receiving spontaneous applause from around 1,000 delegates. The Leadership Academy have used it in their work. NHS Employers have used it in their Equality and Diversity work. It is shared widely. It is a gift that keeps on giving.

Maybe one day I will be as good as the leader it challenges me to be. What is clear is that Adam was a leader and a role model. And I wanted to give a gift to Adsthepoet and his family in return. So here it is – the poem I wrote for Adsthepoet to celebrate his leadership – my no excuses role model:

Leadership (For Adam Bojelian) 

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This rhyme solves a puzzle, as you will see

This rhyme confirms what a good leader should be

 

A good leader aspires to be the best

A good leader debates and challenges the rest

A good leader speaks up against poor care and injustice

A good leader teaches us to cast off our prejudice

A good leader helps us to see the funny side

A good leader engages and shares what’s inside

A good leader puns (I know it’s not quite a requirement)

A good leader is open to risk and excitement

A good leader energises all that they touch

A good leader transmits our dreams back to us

 

Now, this poetic trick has been played before

Look closely and you’ll know whose name is worn

At the heart of this poem

 

II

No surprises this time

No poetic reveal

Yet the power of art

Weaves a subtler knife through our hearts

The echoes of good leadership last forever

They beat its rhythm for a lifetime

Listen carefully to yours

What do you hear now in its pulse?

Adam, Adam, Adam, Adam

 

If you think this is sad and solemn, it’s not meant to be. Kirstie Stott ended the celebration with the poem happiness. Perfect. As was her wordle of the three words Adams’ twitter friends had provided her with. Her choice was for her boys to “be like him”.

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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.

 

Good leadership is all about giving power away

One of my friends died last week. He was a truly unique individual. The Crematorium had to rig up speakers outside for the mourners who could not fit inside the building. It seemed everyone in the town new him and had turned out to celebrate his life. They all said the same thing – he would do anyone a favour, was always positive and was constantly giving. Nothing flashy just lifts for friends, a slab of millionaire’s shortbread or tray of cakes miraculously appearing as he dropped in to say hello, food for the homeless, chat (he could talk), musical tips, DVD box sets to borrow. Mostly what he gave people was his time and attention – all day, every day that he lived.

He seemed to me to embody something I learned when I visited the South Pacific almost twenty years ago. A real lesson about giving. I was in Rarotonga in the Cook Islands. One of the islanders was describing his wedding with great pride.

“It was the best wedding ever. We gave so much away!”.

Because in some island nations being rich is about how much you give to others, not what you keep for yourself.

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This came to mind as the Top 50 NHS CEOs was published on the same day as the funeral. This was part of a series of leadership pieces put on by the HSJ and sparked some debate about the nature of leadership. You can see what I think about leadership in blogs on this site – particularly “Some Things are Just Too Heavy for Superman to Lift”,Forget theJanitor at  NASA, Andy Makes People Better” and “The Smallest Thing, the Biggest Difference”

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At the heart of what I think about my leadership is a genuine sense that to be effective, I have to give away as much authority as I can, whilst retaining the accountability I hold. As an NHS CEO, that meant remaining personally accountable for the safety of every patient and the value of every penny, whilst giving staff authority to act and creating the right system of values so that we could be successful. This is not risk free. It takes time, trust, courage, resilience, a focus on purpose and a value based approach that engages all staff. [Yet another plug for Michael West’s work here]. The results are always surprising and unexpected – people tend to go further than you imagine and the impact can be spectacular.

Alongside the the list were pieces each day from some of our best Chief Executives. Reading the HSJ pieces by people like Dame Julie Moore, you can see that giving works. “Trust your staff”.

Compare this with people who retain tight hold of any power and authority they have. Leaders who hold positional power will lose it if their position changes. If they tell people what to do, that will be the best they ever get and few will ever achieve even that.

Some people fear that giving power and authority away denudes their personal store. My experience is the opposite. Some things are infinite or able to be self replicating – Dean Royles wrote powerfully about this last week. Compassion, he argued, is like love – you can’t give away every ounce of love you hold as it is inexhaustible.I think the same is also partly true for power and authority. Your influence and impact can grow the more you give away, enhancing your power and authority.

As I write this, I am reflecting that the one word that I would use to describe my friend now was that he was “good” in its truest sense.

I will be championing a style of leadership that is also “good”. One that is based on giving and is essential in a complex system like the NHS – one of delegated leadership that unlocks the potential of NHS staff by giving them authority to act, safe in the knowledge of where the accountability ultimately lies.

 

 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Footnote: Look at #WithouttheNHS on twitter