The sound of no hands clapping

I met with the Secretary of State for Health and Social Care, Sajid Javid, last week. Well, when I say I met with him, it was actually a Zoom meeting. And there were 141 other people on the call. The meeting was facilitated by those great folk at NHS Providers, and was for Chairs and CEOs of NHS Trusts across England. As it turned out, Sajid Javid’s appearance was a bit of a rushed event. The Cabinet meeting he had been in just before he was due to join us overran apparently. But nevertheless, there he was ready to tell us all how the NHS was faring and what was on his ‘must do’ list. He started with an almost shy quip – ‘Yes here I am, and it all started with a camera in the ceiling’* which was slightly amusing. Everything went downhill from there. The meeting was loosely predicated on Chatham House rules, so I can’t spill all the beans, but he wasn’t great for sure. He noted that there was no more money for the NHS, and that he was serious when he said at the NHS Confederation Conference the week before that the NHS was like Blockbusters and needed to be more like Netflix.

I thought this was a peculiar analogy. Blockbusters went out of business in 2014 and according to last week’s Wall Street Journal, Netflix currently has debts of just under £15 billion. He assured the audience that there weren’t higher than normal numbers of people attending emergency departments, it was just that we couldn’t move medically fit people out of hospital that was causing problems. If it is possible for a collective Zoom meeting audience to gasp en masse, then this was that moment. It is true that there are high numbers of people in hospital beds who don’t need to be there. In the main its because there is insufficient social and domiciliary care for them to be safely discharged. It is also true that emergency departments continue to see record high numbers of people attending each and every day. This has been the case for most acute hospitals since earlier this year. Anyway 15 minutes after these pearls of wisdom had been handed down, the Secretary of State was gone, and like many others I’m sure, I was left wondering why he bothered to turn up at all There was no applause.

Now I missed that particular NHS Confederation Conference this year. I think I was busy supporting colleagues who were busy looking after patients in our allegedly ‘not so busy’ emergency departments. It was a shame as there actually were a number of really good speakers with something interesting and challenging to say. One of these was Hilary Cottam. 

If you haven’t come across her work before you can find her website here. It is worth visiting. Hilary is, without doubt, an internationally recognised author, innovator and change maker. Read her biography and you will see just what a difference she has made to so many people in so many different places across the world. She is simply phenomenal.

Her paper at the conference was called Radical Health (although she originally wanted to call it ‘Marooned on a toenail’). It is a wonderful account that brings together some of her life’s work in finding different ways to help those many folk who need the help of others. You can find the full paper here. My computer asked me for verification before opening up the link, but you can safely skip that. Partly the paper draws upon her ideas from her book, Radical Help, published in 2018. Hilary provocatively argues that the British welfare state is beyond reform. She suggests that there are new ways of thinking about how to help both young and old in their time of need, and how we might better care for those who live with a physical or mental health problem. At the heart of this approach is the notion of human connection.    

Her paper provides case study insights into how this can be achieved. I have to admit to being in awe of the programme she started many years ago called Wellogram. It’s an approach that builds on listening to others, building relationships, forging connections, boosting confidence and a sense of self that is worthy and valued. In a phrase that I love, Hilary describes the approach as ‘weaving people together – at the right moment – to support continued good habits and to combat the social isolation that underpins so many problems’.

Hilary provides us with three reasons why we cannot continue to just tinker with the NHS. (1) the nature of the problem has changed – our health care system still foregrounds cure, and is a service provided through the use of vertical systems of command and control. Even during the pandemic, such an approach didn’t always produce the desired outcomes. (2) Care – as the current Secretary of State noted, providing care-based services is still a major problem for our society. The Health and Social Care tax is likely to be spent on trying to provide more of what we currently have, and which has been failing people since the 1960’s. (3) Poverty – the pandemic clearly revealed that poor health is rooted in poverty and inequality. The new Health and Care Act explicitly has addressing inequalities as a new statutory duty for NHS service providers. All three reasons resonate with me as I’m sure they will with many readers of this blog.

What to do about this situation – well please read Hilary’s paper. The answers she suggests I believe can only be taken forward through effective place-based services. We need to harness the expertise found in communities, in localities, in schools, with faith leaders, voluntary services and of course in the work of our public health colleagues. Hilary’s paper lifted my spirits. This is the 14th year of writing this blog. I have not missed a single Sunday throughout that time. Recently I have been thinking I should stop. I wondered if my words and thoughts made any difference at all. Reading Hilary’s work made me reflect – I concluded that if my blog makes just one person pause and think and then act differently, it will have been worth it. So, loyal reader, in the words of Arnold, ‘I’ll be back’.  

* I also read last week the terrifying news that the disgraced former Secretary of State for Health and Social Care is poised to re-enter the Prime Minister’s Cabinet.

Teamwork* in the NHS – it’s not all about nurses and doctors

Last week, we had the second installation of wireless switches in our home. These switches, which can be placed anywhere, are fascinating. I have no idea how they work. The first installation was to restore some outside lighting, and to do so without having to dig channels or drill holes in the plaster work. The second was something similar, but inside the house this time.

Backtrack for a moment. J and I on one of our weekend walks, discovered an old barn shop selling furniture, paintings, and general bric-a-brac. Hidden amongst all this stuff was a mirror, which we both thought might look great in our hallway. So, after a bit of haggling we bought it. It was only then that we realised we were a couple of miles away from where we had parked the car.

Eventually, we were able to bring the mirror home and very excitedly put it up against the wall where we imagined it would look good. And it did, except it hung right over the hall light switch. Hence getting the electrician in to fit another wireless switch. He was able to blank off the existing switch, and again without any disturbance to the walls, provide us with a wireless switch a bit further down the hall. Although I’m happy to have a go at all kinds of DIY jobs, something like this is completely beyond my skill set and knowledge. It’s why we had to employ an electrician, someone who does know what they are doing and is qualified to do so.

Of course, there are many other such skilled and vital professionals in the world. Last week, the NHS for the first time ever, recognised the contribution such folk make to healthcare services every day of the year. Last Wednesday was the first National Healthcare Estates and Facilities Day. It was a day for us all to reflect on the work done by these professionals and the value their contribution make to the experiences of our patients and our staff. Across the NHS in England, there are over 100,000 folk who work in Estates and Facilities (E&F). They make up some 8% of the NHS workforce. This group are made up of many different trades and professions, including porters, carpenters, switchboard operators, builders, caterers, engineers, gardeners, drivers, painters, laundry workers, security personnel, plumbers, medical equipment repairers and yes, electricians. In fact, there are over 300 distinct roles within the NHS E&F workforce.

The pandemic which shone a light on so many different aspects of our healthcare system, and the inequalities that are to be found in our communities, also brought into clear view the work our E&F colleagues do across the NHS. Like many of our clinical colleagues, E&F colleagues rose to the challenge of the pandemic often going above and beyond their normal duties to ensure our clinical environments were safe, clean and able to meet the unprecedented demands the NHS faced. I know in my own Trust, this was a more difficult task due to the age and state of many of our buildings, something that many other hospitals will also have encountered. 

The work of our E&F colleagues goes on 24 hours a day, 7 days a week and lots of it is hidden from view. It’s a bit like housework. You don’t notice it until someone stops doing it. Often such work is taken for granted. I wonder who, in your home, makes sure there is always toilet paper in your loo?

Due to the nature of their work, E&F colleagues can often work on their own and most are not office or ward based. Many don’t have access to a work provided computer. During the pandemic, where so much wellbeing advice and care was on-line, some E&F colleagues struggled to access these services. It is an example of an unintended digital divide that occurs in many well-meaning and caring organisations. Effective communication is always important. During the pandemic it was even more so. Not having access to computer at work means some colleagues will find themselves quite isolated; so facilitating a sense of community and belonging can also be difficult. Difficult but not impossible. 

I like to go out and meet colleagues whenever I can. I go wherever they are working and whatever they are doing. One of my first visits when I joined the Trust was to our catering services. I was totally blown away by the scale of what they did each day. It was simply phenomenal. There was a tangible sense of purpose. All shared a sense of pride in the work as part of a very effective team.  Together they all made a contribution towards providing healthy, nourishing meals, snacks, and drinks for our patients, and so helping to look after their wellbeing. For me, the catering team are a great example of how it’s possible to create a culture that is driven by purpose, and that enables people through the work they do, to truly achieve real job satisfaction.

It was wonderful last Wednesday to be able to acknowledge the work and contribution each of our E&F colleagues make. Last Wednesday, all our E&F senior managers returned to the ‘shop floor’ for the day. Judging by the photos and messages on social media, I think everyone enjoyed themselves and had great fun too! Of course, the day wasn’t just about celebrating the work of our E&F colleagues. The day is also aimed at raising the awareness of these careers in the NHS. So often the NHS is only thought about in term of doctors, nurses, physiotherapists, midwives and so on. The National Healthcare Estates and Facilities Day was a chance to showcase some of these other non-clinical roles and career opportunities. As new technologies continue to be developed, these opportunities make for an even more exciting future. I still don’t understand how wireless switches work, but I’m glad I know someone does. It helps keep the lights on!

* I started thinking about teamwork after listening to the brilliant Life Scientific Radio 4 programme last week which featured the amazing Adam Hart - if you have a spare 30 mins, maybe make a cuppa and listen - totally enthralling 

The Future of NHS Leadership, it’s a Gas, Gas, Gas!

Well last Thursday was a mixed day of fortune for some. There was the strange story of the two men who fell into a vat of chocolate in a Mars bar factory in the US, but thankfully they were safely rescued before the chocolate set. Not such good news for Aiden Aslin, Shaun Pinner and Saaudun Brahime who on day 106 of the war in Ukraine were all sentenced to death by a Russian ‘kangaroo court’ for being so called mercenaries. Likewise, poor Justin Bieber gets a diagnosis of Ramsay Hunt syndrome which has left his face partially paralysed. Perhaps not unsurprisingly, Conservative Junior Minster, Heather Wheeler seemed unable to tell the difference between Birmingham, Blackpool or somewhere godawful she had once visited. This was on the day the Prime Minister was visiting Blackpool (thankfully I was out of town on Thursday), which of course is one of the 24 areas chosen for significant ‘levelling up’ funding. It was also the day that it cost J £92 to fill her little car up with petrol.

But last Thursday, J and I were also able to go and see the Rolling Stones at the start of their UK tour. 60 years on from when they first started, and they made Anfield stadium rock! I have seen them perform on a number of occasions and have never been disappointed. Last Thursday’s concert was no different, they were simply fantastic. It may be the last time, I don’t know, (although I am searching for tickets to the Hyde Park concerts later in the month and early July).

Last week also saw the publication of the much anticipated independent review of health and adult social care leadership. It has been described as the biggest shake-up in health and social care leadership in a generation. Time will tell. There is certainly nothing in the report that people would want to argue against. Indeed the 7 recommendations have been accepted without alteration by the Secretary of State for Health and Social Care. Time will also tell whether the necessary funding and resources required to take the recommendations forward will be forthcoming. As the report’s authors note, anyone can have great ideas but, if they don’t lead to action, they are for nought.

Health Service leadership has long been one of my passions. Way back in 1995, I joined Manchester Metropolitan University as a Senior Lecturer. I had just left the NHS and had written and developed a distance learning degree programme called Practitioner Leadership. It proved to be very popular, partly I suspect because it was a programme that required only two days attendance at the university for group work, although this wasn’t mandatory. I think also, partly because it was totally accessible to anyone working in health or social care. Students could also undertake the course at their own pace. I was the Programme Manager and got to know all the students as they worked their way through their studies. Many of whom were mature students who might never have contemplated undertaking a traditional degree. Some of the students I never met until they graduated which sparked an interest in how students experienced such long distance relationships in academia.

In 1999, my co-programme facilitator, Sheila Stark, and I published a paper based on some focus groups and interviews with our students. What emerged from this research was the importance of students experiencing a sense of ‘connectedness’ with the module tutors. The students described such connectedness as a feeling of belonging. Where the students didn’t feel connected and had no sense of belonging, then their experience was poor and impacted upon their overall academic achievement.

It was an outcome that acted as a catalyst in shaping my thinking as to whether it’s actually possible to teach people leadership. With my co-writer and researcher, Professor Sue McAndrew, I then went on to develop this line of thinking eventually coming to believe that leadership is better ‘caught than taught’. Of course, it’s entirely possible to expose folk to theories and concepts of leadership, whether these be traits, styles, behaviours or beliefs, all of which are worthy points for reflection and contemplation. Having this knowledge however will never make you an effective leader. The reality is, and here I may be at odds with the report’s authors, even if you don’t know any of these theories or concepts, you can still be a successful and effective leader.

For many years I described myself as having a transcendental leadership style on my CV. This was based on my conviction that a leader’s role is to serve others. My experience has shown me this is best way of ensuring the contribution from others is creative, authentic and productive. I have been very fortunate throughout my career to have many mentors, coaches, and people who helped me through my journey of becoming. I call these folk my rabbis. They have pointed me in different directions, helped me work through choices and decisions, and shown me opportunities where I didn’t see any. I’m thankful to each and everyone of them, and have long made it my mission to try and do the same to those folk I meet along the way as they seek to develop their careers.

I’m privileged to work in an organisation that values its people. I can point to some great teams and inspirational leadership aplenty. We find ways to demonstrate the lived experiences of putting our values into action, and becoming a well-led Trust is a shared ambition across all levels of our organisation. So, I for one, won’t be shooting the messenger when it comes to taking the report’s recommendations forward. The future of NHS leadership? – it’s a gas, gas, gas.

It is the little things that sometimes really are the big things in life – kindness matters

Well it was a late night for us. Last night, due to our own incompetence, we missed the start of the #PlatinumJubileeConcert so had to watch it on catch up TV. It was, however, simply brilliant. Whoever thought about inviting Paddington Bear to be part of the concert was inspired. However, stepping back from the weekends celebrations for a moment, last Tuesday was World No Smoking Day. As regular readers of this blog will know, I have long campaigned for the eradication of cigarette smoking. It was going to be the focus for this week’s blog. But events have overtaken me and it’s the kindness of others last week that I want to write about first – if there is room in this blog, I will come back to the stop smoking issue later.

The first random act of kindness was on last Thursday. J and I had gone to what is called the Comedy Carpet here in Blackpool. It’s just under the famous Blackpool Tower. We, like many thousands of others, were there to see our heritage trams. We often see them on their own trundling along the prom, but this was a rather special Jubilee celebration bringing them all together at the same time. I don’t think the organisers had reckoned on so many people attending. There was much jostling and pushing to get the best view. It was chaos, the officials struggling to keep folk off the tram tracks.

As we stood and waited a young man arrived with a big video camera, professional tripod and equipment. He and his companion struggled to find a clear view of the track, and began to lose their patience with those around them. Into this chaos another man arrives. His face is familiar. I turn to J and say, ‘I think that’s Roger Johnson from the BBC North West Tonight programme’. He hears me, looks up and smiles. After assessing his cameraman’s situation Roger decides to move to somewhere a little more prominent. He helps collect the equipment and as he passes us, he pauses, says hello and asks if we are okay and enjoying the afternoon. It felt like a genuine and warm moment. He didn’t need to stop at all. The pause was a little thing, but it is the little acts of kindness that make the big difference. We didn’t see him again until later that evening as he broadcast his show live from The Comedy Carpet.

The second act of kindness was the following day. We had a walk planned. To get to the walk route, we needed to take a tram and then a ferry to get from Fleetwood to Knott End across the Wyre estuary. As we are on an economy drive J had purchased a day ticket the day before and we were mindful that we needed to catch the return tram before the ticket ran out. We got on the tram with 5 minutes to spare on the ticket. However, the tram wasn’t scheduled to leave for another 6 minutes. Some slight anxiety as the deadline loomed. The conductor came to the rescue and accepted the ticket with just seconds left on the timing – apparently it was J’s smile that clinched it. It was another little act of kindness. He had no need to do what he did.    

The last act of kindness followed a very sad event. Last Wednesday, one of our Ragdoll cats went missing. She’s called Delilah, (seen here to the left of the picture) and was my favourite of the four cats we share our home with. She was a happy afterthought, when we went to buy her sister, Willow, I decided we couldn’t leave Delilah behind, so purchased her too. They have both given us much pleasure and as far as cats can, they provided unconditional love and regard. Delilah has sat beside me all through the pandemic Teams and Zoom meetings. She’s rarely missed one.

By Friday, when we still hadn’t seen any sign of Delilah, J mounted a social media campaign asking for any sightings, neighbours to check their sheds and so on. Sadly, Delilah had been knocked down by a car but had managed to get herself on to a neighbour’s drive before she passed away. Our neighbours didn’t know who the cat belonged to and as she wasn’t chipped (another story) they couldn’t find out. The family called the Council who came and took Delilah away. They then posted a message on social media asking if anyone was missing a cat, describing Delilah to an absolute T. When J contacted them, the family were in London celebrating the Queen’s Platinum Jubilee, but still took time out to tell us what had happened and what they had done in caring for Delilah even when she had died. Their kindness made our loss slightly easier to bear. It was a little thing, but it made a big difference to us.

On a weekend that up that point had been so full of joy and happiness Delilah’s untimely death filled us with sadness*. Writing this on Day 102 of the war in Ukraine, made me realise what so many folk caught up in the war must be feeling. Delilah was a cat who was much loved, but she was a cat. Many Ukrainians will have lost so much more during the conflict. They remain in my thoughts and prayers.

I also gave some thought last week, to others whom I’m sorry to say previously, I had not given a great deal of thought to at all. It was to the people who live in the 59 countries that make up Africa. The continent was in the news last week as Africa has become the new marketplace for tobacco. Globally, smoking has been in decline, but mainly in those countries worldwide that raised taxes on cigarettes, limited cigarette marketing, banned smoking in public places, and instigated hard hitting anti-smoking health campaigns. In such countries there has been an unequivocal reduction in the percentage of the population who continue to smoke or start smoking. In many of the countries in Africa, the reverse is true.

What was once played out in the US and Europe by multinational tobacco companies, is now being seen in Africa. They are selling cigarettes cheaply, and to young people too and using the power of marketing to make smoking glamorous and cool. I don’t know what the answer is, but we need to find a way to help African countries tackle this problem. If we don’t, the hard won health gains across Africa are likely to literally go up in smoke. We should remember that their problems are our problems too. I’m sure we can all do something, and enough little things can bring about big changes.

 

* Billy our parrot, who mimics everything we say, and all the noises we make (pouring wine, answering the phone and so on) has, ever since we had the cats, called out Delilah, Willow, Clemmie whenever we open the patio doors to call them in for their food – he hasn’t yet realised Delilah has gone and at present he is still calling them all in.