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Meeting 2 of the NHS Assembly: Supporting Carers, Workforce and Environmental Impact

Meeting Two of the NHS Assembly

Friday 5th July 2019

I’ll start this blog with “Happy 71st Birthday NHS!”. What an institution our NHS is, and what it achieves, I’m living proof of the success of our NHS, despite the challenges it faces. If you want to know what the NHS is capable, look at patients like me, patients with the more complex conditions and needs, patients who live on a knife edge, patients whose every second depends on intervention and care from our NHS, and who benefit from a vast majority of services and specialisms in our lifetime. We are proof of what are NHS does and achieves. I owe my life to our NHS. Just a year ago we appeared on Victoria Derbyshire to celebrate the NHS’ 70th birthday, then rushed to Westminster Abbey to the NHS 70th birthday celebration service, I can’t believe it’s been a year since that day. Our NHS is a fine institution, a system, a service, but what we must remember, is our NHS isn’t actually the buildings or the policies, our NHS is the people who make up its workforce. We love our NHS, we own our NHS, and we should – and do – take pride in our NHS. Thank goodness for Nye Bevan’s innovative vision and persistence to see it realised, that has transformed the UK and the healthcare landscape, and improved the health of UK residents and saved countless lives. Lives including my own. Thank you, NHS, and Happy 71st Birthday. 

It was a delight to spend this day with the NHS Assembly for our second meeting, and what a great meeting it was. Today we looked at supporting carers and the caring workforce, about workforce issues including race and equality, and about reducing carbon emissions and becoming a more environmentally friendly and sustainable NHS. 

NB – This is quite a comprehensive description of the meeting today, there was so much rich content that I just couldn’t cut it down! 

Session 1:

First up we had a fantastic presentation on the Interim People Plan (click here) and making the NHS a great place to work by Prerana Issar the new Chief People Officer at NHS England & NHS Improvement. Prerena previously worked at the United Nations. The Interim People Plan is all about enabling the NHS workforce to deliver the outcomes in the NHS Long Term Plan, by making the NHS a great place to work and supporting the wellbeing of NHS staff, enabling career development, flexibility to support the workforce to reach their potential, increasing diversity (especially at senior leadership level) and being more inclusive, creating compassionate and engaging leaders and transforming the way the workforce works together and improving the ability for joined-up, multidisciplinary, collaborative working, as well as enabling the culture changes necessary for the NHS Long Term Plan to be implemented and fulfilled. The five key themes of the Interim People Plan are:

  1. Making the NHS the best place to work 

  2. Improving our leadership culture 

  3. Addressing urgent workforce shortages in nursing 

  4. Delivering 21st century care 

  5. A new operating model for workforce 

Prerena gave a very engaging and informative speech and the discussion following this was very rich. She used the words of the great and well respected philosopher – Bob the Builder (of course) – whose wise words “Can we fix it? Yes we can!” are great motivation for us resolving the issues currently facing the NHS and the workforce. Although, a member of the Assembly later changed this to “Can I do it? Yes I can!” as it recognises the fact that we all share the responsibility of implementing the changes and improvements needed, implementing the NHS Long Term Plan, achieving the outcomes set in the LTP and the Interim People Plan, and that we must take both collective and individual ownership and responsibility for making this happen. It’s also about enabling leadership and the development of leaders at every level, investing in people and investing in people as leaders, who can guide, steer and enable this work and empower, motivate and bring on board all of the workforce to make these changes and future-proof our NHS and the workforce. 

We talked a lot about blockers and enablers, and culture – importantly – came up a lot, as the culture change is the foundation of these outcomes and improvements being realised. If you cannot change the culture – vertically and horizontally – then the outcomes in the Long Term Plan and Interim People Plan will just not happen. The People Plan has to overcome the barrier of culture and to create a new culture to take this forward. We need to scale things up and scale things down at the same time, and to break down some of the hierarchical barriers that exist. 

Prof Russell Viner, President of the Royal College of Paediatrics and Child Health (RCPCH), mentioned the need for safety, people feeling safe and staff feeling safe, and about quality of care and quality of support. He also touched on the need for training, as well as for flexibility in the system and participation of the workforce and of individuals in enabling these changes and implementing the People Plan and the Long Term Plan. 

Mr Richard Stubbs said that the NHS is the most beloved institution in the UK, and he’s not wrong. Then, Mr Andy Knox talked about developing something that meets people where they’re at currently, to build upon it. It’s no good if we do this work, and where the work begins, isn’t at the point where the workforce and individuals are currently at. We need compassionate patient advocates supporting patients to navigate the complex and often disjointed system. 

Prof Anne Marie Rafferty talked about a new approach, around having safety rounds at the beginning of each shift, about helping people move forward and progress in their careers. She also talked about thinking about how we’re connected to each other, about practice engagement, and starting from where people are at now. She also talked about artificial intelligence and where this fits into the system and implementation of the LTP and IPP, supporting connectivity, monitoring and innovation. Dr Clare Gerada reflected on how it’d be beneficial for staff to have a debrief at the end of each shift. 

Miss Amy Overend then described how staff have a limitation on how much they can show they care, due to pressures, competing interests and ensuring they give fair and equitable care to all. She also talked about postgrad training for nurses and the barriers, for example Amy has a diploma rather than a degree and this limits her progression, and moving further up the career ladder, a lack of degree and a lack of masters hinders her, she is a middle level manager and yet she’s struggling to progress and move forwards. We need to look at career progression for nurses, supporting them to develop, grow and progress their careers, and how we can achieve that, meeting people where they’re at and offering opportunities and investing in staff. 

Dr Clare Gerada then reflected that we need to support, fund and enable career progression for nursing staff. 

Dr Niall Dickson then shared that if we’re going to tackle workforce and enable investment in health and care, then we absolutely must include social care and the social care workforce in our work and in improvements and innovation. It needs a system-wide approach and to target not only senior managers, but middle level managers and other staff too. 

Chris Hopson shared how focusing on leadership is really important. He talked about how we’re making our people ill by making them work harder, we need to create sustainable jobs for staff working in the NHS, and how leadership behaviour makes a difference. We also need contact between the top and the bottom of the system. 

Another member shared how we focus too much on the practical aspects of leadership and leaders, rather than values, skills and interests in addition to the practical aspects. We also need to make our workforce feel safe. We all talked about how we need to focus on staff wellbeing, to value our workforce and to ensure our staff are fit, well and supported, including psychological support if needed, in order for them to deliver the best care to patients. We need to focus on staff and patients first, you can’t put one above the other, so often we talk about putting patients first but actually, staff need to come first too, or else they cannot give the best care to their patients and will not be able to do their job fully. 

Then Dido Harding, Chair of NHS Improvement, said a few words around needing to raise the profile of people issues, and to resolve, make changes, support, innovate and improve wellbeing and support, and how it is very easy to say we’re going to do this, but it is harder to actually do it. She mentioned changing the behaviours within the NHS and how we change these behaviours, and leading change and shifting culture. 

Fatima Khan Shah then talked about how we treat staff is how they’ll treat patients, and about staff having tea and coffee (and cake/lunch/food) provided at work to support them in their role, about their dedication and hard work being rewarded, feeling valued. We need to send the right message to staff, that they are valued and cared about. Staff need to be valued, and feel valued. We also talked about the issue of BAME (black and minority ethnic) inclusion, representation and about role modelling, we need for those getting it right to role model for other trusts and organisations to support them to be more inclusive, supportive and better employers. She also talked about recognising peoples’ achievements, celebrating the dedication and hard work and achievements of staff — staff feeling valued is key. If people feel valued, they’ll naturally work harder. 

Miss Juliet Bouverie talked about the fact there are a lot of rules and a lot of bureaucracy, and how we need to simplify processes — and how this will free up time and skills for frontline staff and indeed managers. She talked about needing leaders who “get” collaboration and utilise it. We need to make this stick. Decluttering processes, for staff and for organisations contracting with the NHS. 

Other points raised included Gabrielle Mathews talking about going back to how people become part of the system and including them, about how they’re trained and the importance of training that meets the needs of future staff and sets them up to work in the system. We talked about people burning out before they’ve even entered the workforce, the training alone leading to burnout. We need to ensure students feel ready and able to work when they begin their placements, not be burnt out, demoralised and struggling as they begin employment within the NHS workforce. Dr Carolyn Wilkins mentioned moving beyond co-design into democratic design, involving people in the designing of training and services. About sharing plans and not blaming others if they don’t work. And about language and integration. Caroline Abrahams talked about it not just being how you join the workforce, but how you leave it too, making use of the rich wisdom and experience of the older workforce and not forcing them out too early. Mr Gudras Singh talked about speaking up against others, and about discrimination and how those who haven’t experienced discrimination, usually don’t want to talk about it, as it’s uncomfortable. Clenton Farquharson talks about culture change, behaviour and collaboration. Dr Graham Jackson talked about not just change vertically, but horizontally too. It needs to be across the whole system. He also mentioned how we seem to have lost the immense pride people felt/feel about working for the NHS, and we need to regain this. Rob Webster talked about needing solutions, to be solution focussed, and key enablers being HR staff.  The need for psychological support for staff was mentioned, and staff not leaving the NHS adversely affected by the job, they should leave as they started, whole, well supported and with good health and wellbeing. 

As you can see, there was a fantastic group discussion about workforce and so many rich perspectives. There’s a real consensus in the group and commitment to working together, learning from each other and developing solutions. 

Session 2:

Beyond our workforce: supporting all our people

Helen Walker (CEO, Carers UK) and Carolyn Wilkins (CEO Oldham Council and CCG)

We were told some key stats about carers in England, and these were:

  • On average, 1 in 7 people in the UK workforce are unpaid carers 
  • This rises to 1 in 5 NHS staff providing unpaid care – this equates to around 250,000 NHS staff members providing unpaid care 
  • Unpaid carers save £108 billion to the economy through the care they provide 
  • There are approximately 7 million carers in England today
  • And 600 people give up work every to in order to provide unpaid care.

Most of us will provide unpaid care at some point in our lifetimes, and it does not discriminate – it doesn’t matter who you are, no one is immune, and anyone and everyone can become an unpaid carer at any time. Some will only do it for one person, others will provide unpaid care to multiple people — and not just people within the immediate family, but the wider family and unrelated individuals too. 

Carers often feel ignored and invisible, and that no one cares or recognises them or their needs. We need to build a carer-friendly NHS, an NHS that is friendly to unpaid carers generally, and specifically to unpaid carers amongst the NHS workforce itself, it needs to become a carer-friendly employer too, and the NHS Long Term Plan and Interim People Plan seek to achieve this. The NHS Long Term Plan and Implementation Plan mention GP identification of carers, and how important this is in supporting unpaid carers. We need to support NHS staff and carers overall in their role and in looking after themselves, for example, flexible working, adjusted hours, more support and in terms of their own health, flexible appointments, home visits and remote consultations. Often, decisions are made out of necessity by carers: if the person they care for has an appointment, they have no choice but to support that — then where do they stand with their job? 600 people a day give up their job to provide unpaid care — a decision made out of necessity. We experienced this with mum, mum had to give up her job to care for me, she’d been caring full time and working full time for years, and something had to give, and we managed to make it work so she could give up work and be paid to care for me — but that decision was necessary, it wasn’t a free choice. We need to make a strong business case for supporting carers, including supporting them to remain in work; imagine how many specialist skilled and dedicated workers — none of whom are easy to replace in the current climate, let alone to find people to fill highly skilled/specialist positions — we are losing every day to unpaid care. Are we grasping the economic benefit of supporting carers to continue working? Does every employer have a carers policy? Are they doing all they can to support carers? It’s even like when unpaid carers accompany the patient to appointments; does anyone ask if the carer is okay, and do professionals identify them as unpaid carers?

Helen Hassell then mentioned about GPs registering unpaid carers, for things like flexible appointments, remote care, home visits and so on. She also brought up Personal Health Budgets and how these are seen as the answer, but how there’s issues around the delegation of healthcare tasks and often CCGs will provide funding for care, but the services to provide that care just don’t exist. She mentioned having to train her son’s PAs herself, as there are no facilities to provide the training in his needs as an adult, as many of the specialists in his needs are paediatric and now – like me – a young adult, suddenly there are no equivalent professionals and services. 

I then spoke up about our experiences, how the system is not proactive, I have very complex needs and the system relied on mum to provide my critical care-level care for years without support, and we begged and begged for respite and support, but none was given; then mum became ill with her brain tumour and suddenly it was panic stations as the CCG then had to react to an emergency situation with me needing 24 hour specialist care, no care package, 3 weeks to set it up before mum’s operation, and the insistence I would be placed in residential care in an elderly nursing home, which I fought and won, but only because I am capable. I said how, outside mum doing my nursing care tasks, it has to be intensive care nurses who can meet my needs, they cannot be delegated, and about my Personal Health Budget, and how mum was never asked if she was happy to care for me, or happy to take on all these extremely complex and high risk procedures, and happy to provide the levels of care I needed, it was just expected she would do it. I then said caring should be a choice, not an expectation. The system should not just expect people to become carers for loved ones, it should be a choice and where it is agreed they’ll support their loved one, asked how much they feel able to do, what tasks they feel able to take on, that their needs are assessed, and professionals knowing where the individual needs support in their caring role. It should never just be expected they’ll drop everything to provide the care to their loved one, at any cost or expense to themselves, their lives and their health. I mentioned mum’s never had a carer’s assessment, her needs have never been assessed or documented. Dr Chris Ham then asked me whose responsibility I thought it was, so I said that our GP knew mum was my carer, and did nothing, the community nurses knew, and did nothing, the CCG knew, and did nothing, the social worker knew, and did nothing, it is everyone’s responsibility and yet all of them knew and didn’t pick up on it or act upon mum’s status as an unpaid carer. 

My point of “Caring should be a choice, not an expectation” that received a lot of shares on Twitter and numerous individuals complimented me on that contribution. 

Rob Webster then asked if the carer’s agenda was meeting the needs of carers? Were carers being asked and involved? Fatima Khan Shah said how anyone can become a carer at any time, it doesn’t discriminate, age, gender, race, socioeconomic status, it doesn’t change your likelihood or need to become an unpaid carer. She talked about how carers are part of the system — not as assets, but as enablers. These carers often have transferable skills. She also highlighted the issue of young carers, often dealing with highly complex situations, and identifying and supporting them within health, social care and education. 

Joan Saddler mentioned how we need values based leaders, and about carers cost savings – trying to translate this into a model and working with and recognising carers and supporting them, working in partnership and enabling them, carers are an enabler to the health service. Another mentioned the metrics of the system, and about achieving and measuring outcomes. They then posed a question: “Are we a room that sits and talks or are we a room that acts and enables change?”. A key question for us all to bear in mind. 

Wellbeing strategies for carers were mentioned, as well as carers policies that outline how carers are supported, what is available and how we can achieve what we need to achieve whilst supporting the carer in their employed role and their caring role. We need to build resilience. We need to find ways to support carers so they can continue to add value to the system. We discussed needing to create a flexible workforce. We also talked about what a carer is going to look like in future, and how policies need to change, grow and evolve and be flexible, to meet the changing needs of carers in future. My point about caring being a choice and not an expectation was raised again and said to be very “powerful” by Helen Walker. We then discussed the patient themselves and their role in the carer’s life, work and support, and how complex patients often know more about managing their health than professionals do, about devolving budgets down to the individuals (Personal Health Budgets once again). Helen Hassell then continued from her earlier point saying that actually the Personal Health Budget is the end point, there’s a whole personalised process to get to the point of getting the budget that is equally as important as getting the budget itself. However she mentioned that often these budgets are set up, but the services needed to provide the care just don’t exist, or for example, training for staff employed by the individual. Often money is thrown at people to manage their care themselves, but they just don’t have the ability to spend it. 

Carolyn Wilkins then said that we mustn’t equate leadership with hierarchy – a  powerful point, that is so right. Leadership does not equal hierarchy and there are leaders at every level. Carolyn then explained their experience of the Integrated Care System and her role as CEO of Oldham Council and CCG and how they’ve managed their workforce and supporting carers, investing in and involving communities, looking at all the assets within the local area and building a whole-community view of assets, and building a thriving, resilient, inclusive community. It’s about knowing your local area, what is available, what the demographics are of your area, and tailoring things to the needs of your local community, and reducing inequalities. She said about how, often, people don’t know what ward they live in (they’ll know town or village or city, but not the council ward they live in) and many do not know who their elected members are. Jackie Daniels then spoke about the indicators, the big shifts, and the deep connection between health, wealth and wellbeing. Someone mentioned how we’ve seemed to skirt round the issue of poverty, which underlies a lot of what we’re talking about. We were challenged by one of our members: we’ve had lots of plans and commitment from the system to carers — but what can we do as an Assembly on this, and what does success look like? 

Dr Andy Knox talked about breaking down hierarchies, compassionate leadership, new leadership models developing. He talked about supporting carers being about social justice, about environmental and economic issues and how this relates to economic growth and development. He talked about equality, and about “doing stuff that really works”. It’s about economic sustainability, social justice, welfare and so on. 

Amy Overend then talked about her experiences as a neonatal nurse and how she understands her local area and local community, but knows little outside that area and finds it really hard to get information needed from neighbouring or nearby local authorities and CCGs. It’s hard for her to do her job, when she doesn’t get support from authorities and CCGs; how do they advise and support without the information they need? Often it’s not just about health itself for the families/carers, but about benefits, housing, food banks, support, care packages, advice and so on. 

Carolyn then talked about health literacy and how this impacts care and support. And how health literacy, is not linked necessarily to overall literacy. We’ve somewhat lost the public with all these new models, new jargon and new processes. Literacy is about knowing how the system works, what to access, when, where and how. 

Session 3 & 4:

Breakout Sessions, then Fishbowl Plenaries

We then had some breakout sessions and fishbowl activities, we went into separate rooms to discuss one of two issues: 

  • Health and employment — how to we create a workforce that reflects our community (especially in relation to BAME)?
  • Health and environment — how does the NHS achieve zero net carbon by 2050? 

We went and on tables discussed these issue and potential solutions, then came back together in the main room and had some fishbowl activities with debates by table leaders about the two topics, which was really interesting, the discussions were fascinating. 

Some of the points raised in health and employment are:

The implementation of the WRES – Workplace Race Equality Standard. 

The incremental steps for achieving the desired outcomes and standards set out in the Long Term Plan and Interim People Plan, such as increasing the percentage of minority groups in senior leadership positions in the NHS. We can aim for the full number by 2028, but that takes incremental steps in the mean time that we need to map out and monitor and measure ourselves against. 

This may seem like “yet another thing to do” but we need to bring people on board, sell the vision and show the worth and importance of doing this. 

Senior leadership position are typically white middle class men, of the same generation, good level of education, lots of professional development undertaken. What about all the minority groups?

Need diverse recruiters, recruiters looking for diverse individuals and people from minority groups — it’s not about lowering the standard, but investing in people and supporting them to progress up the ladder, grow and develop and be able to take on more senior leadership positions. One person mentioned how someone applied to a board and couldn’t get a place on the board as they didn’t have experience of being on a board — but someone had to ‘take a chance’ on them and give them that first opportunity and invest in them. We need to invest in people. Mentoring schemes? Senior leaders mentoring others? We need to identify potential future leaders and nurture and develop them. 

We have a large number of BAME doctors, nurses and other professionals, but this dramatically decreases the further up the system towards senior leadership you go, with very few at the top. 

The NHS Graduate Scheme doesn’t have nearly as many BAME applicants as other programmes. 

NHS headhunters should look outside the NHS and the Graduate Scheme to other related sectors, to widen the pool of people and get more inclusion and representation of minority groups, for example there may be few BAME leaders in the NHS itself but many BAME leaders in the voluntary/third sector, should we be headhunting them too?

We need to invest in and develop middle managers. 

For example, airlines have a team who identify individuals with potential to become future leaders out of their employees; why don’t we have this in the NHS? Looking at all levels of the NHS for potential future leaders? Then investing in, developing, nurturing, mentoring and supporting them to move up through the system. 

Getting the top of the system right will set an example and enable change lower down. 

Feelings of imposter syndrome can often get in the way of people applying to the Graduate Scheme or progressing up the ladder in the NHS, not feeling they’re good enough, have the right skills, the right education and training, the right level and amount of experience etc. 

Work going on needs to be top down and bottom up at the same time. 

It’s also not just about BAME, but all minority groups, including disabled people. 

Discrimination used to be overt, open, visible, now it is more hidden, subversive, covert and more spread across the system itself, rather than particular individuals. 

We talked about reaching people – if people aren’t on the bulletins, aren’t literate, aren’t in the right places, don’t know people in the NHS, then how can we reach them to recruit them into the NHS?

It’s about good leadership. If poor behaviour is not dealt with, it can become acceptable, normalised, and become ingrained in culture. 

The NHS needs to represent the communities it serves. 

We need people from diverse backgrounds with different lived experiences, we don’t want to recruit the same type of people, or mould people so everyone is the same. We need that uniqueness, that diversity, that richness of different experiences. To bring different experiences, skills, interests, values, and wisdom and expertise to the NHS. 

Must not be tokenistic. 

It isn’t rocket science, and it cannot be dumb science. 

Individuals talked about needing to be prepared to push the glass ceiling and not be limited by others’ views and expectations, and not to change yourself to fit their ideals/their view of who you should be and what senior leaders should be.

It was wonderful to have Yvonne Coghill with us today, someone I admire greatly as I do everyone on the Assembly itself, her contributions were fantastic to have today. 

Some of the points raised in health and environment are:

We need to get patients involved. 

Need to have some vision. 

Need to reduce water wastage, single use plastics, people driving to and from hospital, car parking, use of gases etc. 

Green gym – when staff go out during their break and clean up the local area, doing something good, getting physical activity in, getting outdoors, and benefiting everyone. 

Improving health and wellbeing of staff too. 

Planting trees on NHS land to absorb some of the carbon and to create more greenery, how this benefits the planet, and patients. Land is currently going to waste.

It is ALL our responsibility!

Reducing car journeys to and from hospital, use of technology for remote consultations and results, i.e Skype or Zoom consultations. Need to support patients in using these. 

Using different ways of communication without the need to travel. 

A member said about how we often focus on the appointment itself, rather than the before and after and the impact, for example travelling, parking, public transport, etc. 

Use of carrot vs use of stick – sometimes need more of one than the other. 

Next, Simon Stevens spoke about the plans for the NHS and how the NHS Assembly members can get involved, talking about consultations, roles, boards and so on. He also talked about the value of the Assembly. 

Then Chris and Clare closed the meeting. 

I know this is a very comprehensive account of the meeting today, but I didn’t feel I could cut down the content any more, it’s so rich and diverse and I didn’t want to miss things out, but I wanted to keep it as concise as possible, hence it’s not all in neat sections and paragraphs. This is all based on notes I took today. The NHS Assembly being transparent is crucial so I hope my blog helps with that transparency. 

I did some recording and video for the Assembly whilst we were there today. I got a lot of compliments on my contributions to discussions, which was lovely. It was great to see everyone and to get to talk to people. 

I had a discussion with Sarah, one of the team, about how the Assembly gets the equal playing field so right and how there is no hierarchy. The level playing field at the Assembly is fantastic and a real breath of fresh air for me. Like I said in my blog about the first meeting in April, outside the NHS England Personalised Care National Strategic Co-Production Group, I rarely ever see, feel or experience true co-production across a universally equal playing field amongst all attendees, but the NHS Assembly excels at this. Despite being a mix of individuals of different professions, roles, backgrounds, experiences, and areas of expertise, made up of doctors, nurses, allied professionals, managers, NHS senior leaders, voluntary sector chief executives and senior leaders, patient and public voice members and everything in between, of which you’d expect there to form some natural hierarchical structure, I can allay any doubts that the Assembly is a true level playing field. Everyone there is respected as leaders, as experts and all have earned their place. There’s no “them and us”. It is so refreshing to experience this. With Sarah I also discussed the skills of individuals here at the Assembly and how we cannot expect patients and carers to suddenly walk into this level of strategic work, responsibility, influence and impact. It takes time to build up the skills, confidence, knowledge, capacity and abilities in order to do this kind of work. I said how I’m now at 7+ years of experience, building knowledge and skills, learning, developing my abilities and understanding, growing in confidence, and learning on the job, investing in myself, and others investing in me, it’s taken all that time and experience to get to where I am today; I could not have done what I do now, 7 years ago. It just wouldn’t have been impossible. I wouldn’t have been able to do it or had the knowledge, skills or confidence to contribute effectively and share wisdom, learning, knowledge, stories, information and share my own and others’ experiences. We can’t expect people with no skills knowledge power or understanding to suddenly walk into strategic work and have all the knowledge skills, experience, information and contributions jut like that. We have to invest in people, and that takes time. It also involves those in power being willing to work with us, invest in us and yes, sometimes, take chances on us. It’s not like you say say “Here’s £6,000, do co-production” as it just doesn’t work like that, it takes time investing in people, building relationships and intimacies, building skills and knowledge, getting everyone up to speed, taking ‘chances’ on people by giving them their first opportunity, mentoring and nurturing and supporting them, growing their confidence and so on. You can’t just ‘do’ this all of a sudden, it’s a slow process. We’re just lucky at the Assembly that we’re all experienced in this type of work, therefore a lot of the groundwork is already laid in all members, we all talk ‘strategic’ language, we know the jargon, we know the system, policies, processes, language, frameworks, ways of working, the culture, and so on. We can work within that. We know how to effect change within the system. We know how to build relationships. We know how to build trust and confidence — of others in us, and of us in ourselves. 

This is especially true of a lot of the work I do with young people, they can’t just suddenly walk from nothing into strategic level decision making, they need time to learn, mature, build skills and knowledge, understand the system, understand the language, policies, frameworks, hierarchy, culture, barriers, enablers and so on. That takes time investment – the young people investing in themselves, and others investing in the young people. These young people often haven’t been in the workforce at all, or not for very long and don’t have the life experience, the work experience, the roles, the skills, the knowledge that older system leaders have, and so you have to build the young people up, over time, to take on roles like this. You cannot rush co-production, involvement, engagement and uptake of committees roles. They may be proficient in medical-speak through their lived experience, but strategic language, change management, culture, unless you’re “in” it, you won’t know it or understand it let alone be able to speak it. 

Another fantastic meeting of the NHS Assembly today and I am truly privileged to be part of it. It is a role with great responsibility, influence and impact, but thats why we’re all there, to hold the system to account, to influence change, and to impact on the future of the NHS and the implementation of the NHS Long Term Plan and to support related documents like the Interim People Plan. The next meeting is at the NHS Expo in Manchester, I am not sure I can make it due to the amount of driving and needing to find accommodation and stay for 3 nights at least, but we’ll see. 





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