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.

Pennine

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.

Yvonne

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

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.

 

 

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

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

Larry

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

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

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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 last post

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

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

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

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

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

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

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

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

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

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

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

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

Rob”

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”.

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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”.

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”….

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”