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.
- 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.