Unseen, unsung

Last week I watched the last ever episode of Game of Thrones. Apologies to those of you who have never watched a single episode (this blog may not make a lot of sense!) and to those of you who do, I will try not to do any spoiler alerts.

I got into this television juggernaut only about six months ago, and after an intense binge of two to three episodes a night, I caught up with the many millions in loving this epic drama.

Whilst there has been a lot of noise on social media about whether the finale lived up to expectations, there was one scene that struck a bit of a chord with me.

Tyrion Lannister, as the newly appointed King’s 'hand' has gathered his Council around him to assess the devastation of the wars. He is handed the A Song of Ice and Fire book which the clerics have written to tell the story of everything that has happened.

Tyrion asks with trepidation how badly he is depicted in the book, only to be told he doesn't feature at all! As viewers of the show will know, Tyrion has been absolutely pivotal in every series, one of the characters with the greatest integrity, and in some sense, one of the most influential people in the story. So it's surprising that he isn't mentioned.

Rather unfairly, the kings and queens, knights and nobles are the people talked about and portrayed with immense power, but so often it is the unseen and unsung heroes - not recognised in the stories - that make the biggest difference.

And that’s true in our everyday lives. There are lots of people doing great things who remain quietly in the shadows. We need to find ways of acknowledging the impact and importance of these unsung heroes, and find ways to show our appreciation.

Because it is these quiet heroes, which we have all across our organisation, that keep moving us forward. They’re not high profile, but each and every day they work hard, shape things and make a difference. They aren’t seeking the limelight, as all they try to do is the right thing.

We're very modest as an organisation, but I would love to applaud and celebrate these quiet heroes more.

So, it's great to see a recent wave of teams and individuals getting more public recognition for their work, such as our estates team who won a prestigious national award last week and Chris Reynolds in our Informatics service who has just been listed in the 'top 100' chief information officers in the UK.

We’re also hearing about many other local heroes, via visits to clinical teams and uplifting social media stories. Judith Crosby, our service development director recently tweeted about her great visit to the Tatton unit in Tameside, where she gained greater insight into the rehabilitation journey that patients are on. Judith described a “lovely calm feel and positive atmosphere” and name-checked Michelle Davies for rightly being so proud of her team.

Nicky Littler, our workforce director, also tweeted about her visit to Prospect Place in Rochdale. She thanked Gemma Mlambo, our rehab services manager and Pip for “sharing his poem” - let’s keep ‘sharing the love’ via social media.

And while we’re on social media, I’m also going to name-check and thank some staff members for bravely sharing their personal stories during Mental Health Awareness Week which ran this year under the theme of ‘body image’-: Katie Benson, Sam Hartley, Shusha Smith, Sam Mooney and Ciaran Wilkinson. You impacted and inspired so many people.

Well done also to social media queen Inez Ingham, whose powerful photo post on our HMR children’s respiratory specialists Facebook page encouraging people to use their inhaler has gone viral reaching 4.5 million people.

There are so many others that I could name, but that would make this blog ridiculously long, so let’s all keep giving our quiet stars the attention and appreciation they deserve.

We want to do more to recognise and thank people through sharing your stories, recognising your achievements and celebrating your successes. We’ll be launching our staff awards in June, with new categories.  Please look out for these and put people forward. The awards are open to both individuals and teams and you can nominate yourselves and others.

I know that many of our community service colleagues will be leaving us shortly, but we really want your nominations. These awards are an important opportunity for us to acknowledge and celebrate your tremendous successes and contribution.

Best wishes,
Claire

The value of bullet-proof hair and hairspray

Many of us did hilarious and cringe-worthy things with our hair in the 80s.

And I'm no exception.

Yes, this is me, with the bullet-proof hair in this photo. When I fished it out to use in my introduction to the vision and values workshop this week, my daughter joked that it demonstrated I valued hairspray above everything!

I used this photo to kick off the workshop as a way of sharing what has shaped some of my personal values.

Some of you will know, I dropped out of university after finding out I was pregnant which was a total shock as my husband was recovering from cancer and had been told he couldn't have children.  So, when I look at this family picture, it reflects the strong values of hopefulness and optimism I hold; that life can bring you wonderful things even when you least expect them.

It also reflects my value of determination (or as my husband occasionally refers to it - stubbornness!), because I did manage to return to university as a mature student and completed my degree. It was tough, but if you work hard enough for something you want, it is possible, even if it takes a bit longer than you thought.  And given that I am still married to my hubby, I could throw in loyalty as another value close to my heart.

There's also resourcefulness, as it’s clear from the photo I cut my children's fringes to save money (which they have never forgiven me for). And finally, surely sharing this photo of our amazingly bad hair cuts demonstrates openness and bravery!

You'll each have your own values shaped by your experiences and lives. But we spend a lot of time in work, so it's important we have values for our organisation; and that those values resonate with all of us. Our values should inspire and guide us.  Values determine our behaviour, which determines our culture, which determines our outcomes. It's why they are so important to get right.

So, that was what this first workshop focused on, as we wanted to test the work we've done to develop new values, as well as look at the behaviours that we'd like to see in order to bring these to life.

We're giving some thought as to what to do with our existing CARES values. Its recognised that these work well as guiding principles for clinical teams. But we want our new values to be more distinctive and really able to guide all of our interactions; not only with the people we serve, but with each other and with our other partners.

We'll be sharing our new values of course, once we have assimilated everything from the workshop this week and another that is taking place next week. We're also doing some testing of the values with service users and carers, as it’s critical they have an opportunity to shape them as well.

There was great energy, ideas and input in the first workshop this week. We had people attending whose experience, in terms of NHS service, ranged from 40 years to four months, which was great as a richness of different views is so valuable.

It's mental health awareness week and so it was appropriate that we also spent some time at the workshop talking about our future strategy, as we shift our focus more to mental health and learning disabilities in the future.

Thank you to everyone who took the time to come and for sharing your views. I look forward to another engaging session next week.

For those of you who haven’t been able to come, don’t worry; we will find a way of sharing the work, and I will give an update on the development of our strategy in a future blog.

Best wishes,
Claire

Looking out for each other and SAS Who Dares Wins

One of my most recent service visits has been truly profound, and not in a way any of us could have imagined.

A couple of weeks ago, I spent time visiting several mental health services in Oldham, which included our Cedars Assessment Ward for dementia patients at Oldham Hospital.

As I witnessed the skill, commitment and compassion on Cedars Ward and in all the mental health services in Oldham, I thought about how incredibly close a team must become working side-by-side day after day; sharing care, ideas and experiences.

I was so impressed and impacted by the team spirit and camaraderie I saw in the services there, and so just a few days later, I was heart-broken to hear that Saima Riaz, a nurse on Cedars ward for 10 years, tragically died over the Easter bank holiday weekend.

We were all so shocked and upset with the news, and devastated for Saima's family, friends and colleagues. Our hearts and thoughts are with everyone that has been impacted by this and I hope you are getting all the support you need.

The Cedars Ward staff have described Saima as "a great nurse who was full of life, knew how to make people laugh and lifted people's spirits". They are putting a book of memories, tributes and photos together for her family, and if you would like to contribute the details will be on our intranet and in Connected, our weekly email update.

It puts everything into perspective, but I do want to touch on some other things in this blog.

We're approaching a significant couple of months as we prepare for the transfer of our community staff in Bury, Oldham and Rochdale to the Northern Care Alliance on 1 July. This will be the single biggest TUPE, with staff in Trafford, dental, child health information and Rochdale children community services then transferring to providers at later dates.

Alongside this, we're finalising work on our new values and progressing our strategic plan, with more workshops and events this month to ensure everyone can contribute. Please keep coming to these events and feeding in your views; we can’t do this without you.

The timescales for everything are tight, the milestones are momentous, the challenges are complex and the details are complicated. So, basically no mean feat and I know there’s an immense amount of work going on and pockets of real pressure. I am so grateful for everyone’s hard work and keeping going despite the uncertainty and sheer volume of work. 

Again, I hope you are all getting the information and support you need, looking out for each other and looking after yourselves.

I said in a previous blog that I was planning to drop in and see our corporate teams, just to see how you are doing. I know we all work in the same building, but I'm very aware we rarely get to see each other (maybe we need to knock down some walls!?). I have arranged to drop in on a couple of corporate team meetings and although I haven’t yet managed to do a walk around, I am still intending to do this as soon as possible.

I just want to end this blog with name-checking some important campaigns and awareness weeks…

A powerful and poignant Shining a Light on Suicide campaign has launched this week in Greater Manchester, which we have been involved in. It aims to take the subject out of the dark by getting people to talk openly about suicide. It’s the biggest killer of men under 49 in our region.

I don’t know whether any of you have been watching Celebrity SAS (where a bunch of TV personalities and former athletes are being put through the brutal entry assessment for the SAS as part of the Stand-up to Cancer charity), but I’ve been fascinated watching this from the comfort of my settee. It’s clear just what physical and mental stress this sort of assessment puts people under, but also the long-standing emotional issues that surface within people’s lives.

In a recent episode, former footballer Wayne Bridge broke down talking about the things that had impacted on his confidence and how hard finding purpose has been for him after his footballing career ended. What struck me the most, was the heart-warming scene with a couple of his fellow male competitors hugging and comforting him as he cried; and just how compassionate and supportive they were in their response.

I have a son who has experienced challenges with his mental health and so know just how hard it can be for men to open up and share their feelings. So, I am so pleased to see that we’re running two mental health awareness sessions especially for male staff on 16 May at Horton House in Oldham, as part of Mental Health Awareness Week.

We’ve also got Equality, Diversity and Human Rights Week coming up and International Nurse’s Day on 12 May. Look out for information about all of these and help us raise awareness and celebrate via social media. I will no doubt say more about both of these in a future blog.

Finally, I hope you all enjoy the bank holiday weekend (despite a lot less sunshine predicted for this one). Thank you to those who are looking after patients over this time, and I hope you also get some time to relax.

Best wishes,
Claire

The importance of a human touch

The last couple of weeks have had some sad moments, as my elderly neighbour lost his wife after a short but unexpected illness.

He is in his late eighties and loves painting in his spare time, so we have been saving episodes of Portrait Artist of the Year for him to watch with us over a bite to eat. We know he’s desperately missing his wife, so it’s our small way of providing some friendship and support.

We all know that older people are especially vulnerable to social isolation and it can have a serious effect on health. Loneliness doesn’t just feel sad; it is bad for you too.

If like me you have elderly parents, then I’m sure you worry about them too. Mine now live in Hampshire, far away from other family members, and totally rely on each other, so I do worry about what will happen if one of them is left on their own.

I visited my parents for Mother’s Day, and my mum had just been for an appointment at a dementia assessment clinic as her memory has gradually been getting worse. At this stage, they don't appear too worried and although her short term memory is a bit dodgy, they didn't think there was much wrong with her cognitive functioning. However, the same day they reached that conclusion, she sent a birthday card to my son, signed upside down and with a cheque with my brother’s name on it (they are both Chris but with different surnames!). We all saw the funny side of it, because worrying about it won’t help anyone at this point.

My mum has a very down to earth approach to growing old. She’s originally from Blackburn and has a lot of northern pragmatism, so from her perspective she's happy she has had her 'three score and ten' and isn't at all worried about 'popping her clogs' as she says!

Many people are living a lot longer than 70 these days though. The NHS is a victim of its own success in a way, as this Silver Age achievement risks a ‘demographic timebomb’ with an older and sicker population. But, how a society treats its most vulnerable – whether its children, the disabled or the elderly – is always the measure of its humanity.

And I saw heart-warming humanity in abundance when I visited The Meadows in Stockport last week, which provides a wide range of mental health and specialist care services for older people, including inpatients, a dementia day care service and community outreach services. It was good to see it from a personal perspective as well, and I was so impressed with the fantastic leadership and team work.

I had a tour of the unit and met with service managers and staff from different parts of The Meadows, including  Davenport, Saffron and Rosewood wards, as well as a range of community services including the community mental health, discharge planning, home intervention, liaison service and short-term support teams.

They are a brilliant example of true integration delivering the best possible care and support for people.   The teams are co-located, with genuine collaboration across different services. This hasn’t happened overnight, but has been built up over a long time with passion and commitment. It was clear the staff in the unit go the extra mile for their patients, day in and day out, because they care so much. It was a humbling and inspiring thing to see.

It’s always interesting to hear about people’s concerns first-hand, and The Meadows teams are worried about a couple of big issues, including potential changes to the way the local authority organises their social services, and what our aspiration to tackle mixed sex accommodation might mean for their patients and staff.

They appear to have a great model of integration and collaboration, and it made me think about Walter Leutz’s ‘five truths about integration’.  His five truths, from studying the process in the US and UK, are you can’t integrate all of the services for all of the people; your integration is my fragmentation; integration costs before it pays; you can't integrate a square peg into a round hole; and the one who integrates calls the tune.

We have to be careful that we don't bring about fragmentation of a successful model at The Meadows, just so we can fix a problem elsewhere.

Over the next few weeks I am going to be prioritising visits to corporate service teams. I know some of you will be thinking, ‘but that’s where she’s based, so surely she sees them all the time’. But it’s amazing how you can work at Trust HQ and only see the same small number of faces.

These visits will just be informal drop-ins, but I’m very aware that people have been working really hard recently, with lots of competing demands, coupled with anxiety about how TUPE associated with the transfer of community services will impact teams.

I am very grateful to all staff that have been affected by the transfer of community services for your professionalism over the last few months. So, I wanted to finish by thanking everyone, whatever service you work in across our Trust, for your continued efforts. It makes a real difference and the results are evident.

We’ve seen it with our finances for example, and although we still have an underlying deficit, thanks to everyone's efforts, we have finished 2018/19 in a better place than expected.

And it’s not just money where your efforts are paying off. We’ve hit some tough annual targets for 2018/19 as well, such as delayed transfers of care, mental health access targets and information governance training.

So, a huge thank you for your commitment and hard work. It is very much appreciated.

Best wishes,

Claire

Prioritising our people and going with the flow

Everybody has a story to tell.

Human stories are the most powerful form of communication and the way to touch the heart. They capture the essence of the human spirit and can inform, help, amaze and inspire us.

That's why we start every board meeting with a patient story.
 
Over recent months we've heard some very powerful ones. From a teenager on our Horizon unit in Bury who said that whilst it was difficult to be away from family, the ward staff “made me feel safe", to another young woman on a Tameside ward, who through the continuity and stability of her relationship with staff, was able to gradually improve her mental health. Both were uplifting stories of recovery and both individuals now want to become mental health nurses, which is brilliant for them and our services.

We've also heard from the mother of an autistic child who praised the quality of our care, but spoke passionately about the toll of a long wait for the initial assessment. And a man with a harrowing back story, who reduced many of the board to tears last month, as he explained how feeling trusted on Tatton ward in Tameside made him feel liberated and valued for the first time.

At this week’s board meeting, a young man who has used our learning disability services talked about getting a job as a steward at Man United. He's now living independently and has completed qualifications along the way.

These stories are unique in their own way, but they are all so powerful in their impact. We are moved and inspired in equal measure, and are now looking at different ways to share the board patient stories with you.

As well as weaving the patient voice across all our work, for example, through the Triangle of Care where carers, patients and professionals work together; and engagement programmes such as our mixed sex accommodation, we need to ensure the staff voice is also heard.

Listening to our patients and staff is the most important thing we need to get right. I remind myself every morning that nothing I say this day will teach me anything. If I am going to learn, I must do it by listening.

Our work is all about people, and the stories we heard from staff at our recent Just Culture conference helped bring to life the importance of this new initiative.

I know Clare Parker's recent blog talked about the Just Culture approach, so I won't cover the same ground, except to say that it's great to see the Health Service Journal recognise the importance of what we are trying to do in an article this week. You can read the story here.

None of us like making mistakes. We all do our jobs to make things better, so it can be hugely stressful and upsetting when we get things wrong, especially if an investigation has to take place. Which is why creating a Just Culture, where people feel safe to speak up, but most importantly, feel listened to when they do, is so important.

It’s actually stress awareness month in April, where health care professionals and health promotion experts across the country join forces to increase public awareness about both the causes and cures for our modern stress epidemic. It’s the top reason for staff sickness here, so it’s a big issue.

I know everyone has their own way to try and manage stress. For me, spending time with family and climbing helps. I’ve just come back from a week’s holiday climbing, which I appreciate would be super stressful for some! But it’s the only thing I’ve found that keeps me ‘in the moment’ when I’m doing it. I just breath, focus and concentrate solely on putting my hands and feet in safe, solid places!

Whatever your de-stress activity is, remember that there’s on-going support out there. We’ve got a stress clinic on 3 April where you can speak to a psychological wellbeing practitioner, and all the information will be in the Connected weekly update on Monday.

Stress is often related to how out-of-control we feel, and so I’ve learnt over the years to try and accept more easily that I have to let some things go. That’s not to say that I don’t care, but I know I need to keep things in perspective. If you change the way you look at things, sometimes the things you look at change.

I often think of the Aesop fable about the tree and the reed. The tree boasts to the reed about being firmly planted in the ground, and then ends up as a log after a vicious storm whilst the reed survives, having bent to the force of the wind until it passes over. The moral of the story is that it is sometimes better to be flexible, and go with the flow, than stay rigid and try and face the full force front on.

Finally, to those of you who have ever faced the full forcefulness of a child’s temper tantrum - Happy Mothering Sunday this weekend!

Best wishes,
Claire

Guest blog on our new Just Culture approach

Clare Parker
Executive director of
nursing, healthcare professionals
and quality governance

Your best teacher is your last mistake.

That was my opening message for our Just Culture conference last week. I also talked about Tom Hanks and an error I made which has stayed with me. But more of that later.

Almost 200 staff packed the room to hear about our new Just Culture initiative, which is ultimately all about improving patient care. We also had the honour of welcoming Dr Bill Kirkup CBE as our guest speaker.

Bill was Chairman of the Morecambe Bay Investigation and has previously led investigations into the Oxford paediatric cardiac surgery unit and Jimmy Savile’s involvement with Broadmoor Hospital, as well as being a member of the Hillsborough Independent Panel. He spoke about his experiences and eradicating a blame culture in a honest, moving and inspiring speech.

Although a Just Culture approach is already being used in the airline and nuclear industries for example, it’s new to the NHS and I’m proud that we’re one of the first Trusts in the country to adopt it.

It’s basically based on an approach where staff aren’t blamed for honest errors. Instead we feel supported and encouraged to come forward and share our experiences to allow lessons to be learned. It aims to get to the heart of what, not who, was responsible for the error. 

Healthcare is risky; it always has been and always will be. When humans interact with humans its always complex, and in addition to that, we have limited resources and often have to make speedy decisions in a fast paced environment.

So mistakes are a fact of life, but they are an opportunity to learn.

No-one likes owning up to mistakes, and it’s even harder when people are harmed.   How we respond and learn from when things don’t go as we would have liked is fundamental to good patient care.

When an incident or near miss happens, it’s incredibly rare that it was intentional, malicious or someone not learning from mistakes. So supporting people positively is the only way we can make progress.

Often when we investigate, we miss the human factor. If you’ve seen Tom Hanks in the brilliant film Sully, which is about the pilot Chesley Sullenberger who dramatically landed his plane on the Hudson River in New York, saving all 155 passengers, you’ll know what I’m talking about.

If you’ve not seen this film, I highly recommend it. Not only is it a thrilling film, but within it is a powerful message about human factors.

Everything is unprecedented until it happens for the first time.

I pride myself in engaging and involving people, but I will always remember in a previous job when I met with a family to talk about our response to their complaint about one of our nurses.  Three days later I received an email from the nurse who was upset that I had never met with her or told her what I was going to say to the family. She felt her reputation, built over many years through consistently good care, had been ruined because of this complaint.

Her email floored me. She was absolutely right and I arranged to meet her and apologised. I used it as piece of reflective practice for my revalidation, and told the nurse I was doing this. 

I certainly learned from this and it has influenced my practice ever since.

There’s no easy or quick fix to eradicate a blame culture, but a positive and open workplace culture, with trust and respect among colleagues can help. This will form part of the wider piece of work around our culture and values.

We’ve got over 5500 staff and we care for thousands of patients every month, so we also need to always remember to put any incidents in context. Amazing work is taking place every day which is changing people’s lives.

We mustn’t carry our mistakes around with us, or jump to a blame game, but use them as stepping stones for us all instead.

Best wishes
Clare
Clare Parker
Executive director of nursing, healthcare professionals and quality governance

Let's celebrate our fantastic women

Women all over the world are celebrating International Women's Day today.

I was surprised to hear that the day has been going for over 100 years. It originally started in Soviet Russia after women gained suffrage in 1917 and March 8th became a national holiday there. It has since spread to the rest of the world, and certainly seems to have ramped up its profile over the last few years. #ThePowerOfSocialMedia.

This year's campaign theme is ‘Balance for Better’ which promotes gender balance and asks how can we help forge a more gender-balanced world; one in which we celebrate women's achievements, raise awareness against bias and take action for equality.

My husband is very ‘right on’ so I was a bit taken aback when he asked whether we actually need a women’s day. It made me ponder, but only momentarily before I gave him short shrift and a curt reply which included the words ‘Yes!’ and ‘still a long way to go’.

But his point was not about whether we should be promoting gender equality, as a trade union representative he has been passionate about equality for all his working life. It was rather about the value of a dedicated day when this is such an important agenda it should be part of our mainstream business and we should be supporting all areas of equality.

Of course he is right, equality, diversity and inclusion should be one of the bedrock principles that underpin how we develop and deliver our services and as such, be in our hearts and minds always.

However, campaigns such as international women's day and others, such as LGBT month which has just finished, are massively important ways of raising the profile of these issues and celebrating what has been achieved and the progress being made, but also highlighting what more is needed.

Whilst today is a great way to focus on gender balance, we should be focused on equality and balance in its broadest sense.

If you think about our organisation, women make up over 70% of our workforce and 10 out of our 15 board members are women, so we’re doing OK in terms of girl power. We still have a bit of a gender pay gap so there’s work still to do, but we need to take a wider approach to equality and our Board is keen to support balance in all areas.

We know that the experience of some of our minority groups is not as good as it should be, and our latest staff survey results for example show that we still need to make improvements around discrimination and fairness of career progression.

We want our organisation to be a place where difference and diversity is welcomed and valued for the richness of experience, strengths and views this brings. We want our workforce to reflect the diversity of the local communities we serve so that we can bring a real understanding and appreciation of their lives to our work. And we want to create an environment which is fair, inclusive and non-discriminatory so that everyone's contribution counts.

We’re doing a big piece of work about diversity as this needs a much bigger profile within the organisation. Earlier this year, we held a board session specifically about equality, diversity and inclusion where we talked about the issues, what we currently have in place and what more we need to do.

Yvonne Coghill, national director for the NHS Workforce Race Equality Standard, is coming to do a follow-up session with our board which is brilliant. Yvonne’s a former mental health nurse and has also helped the Institute for Healthcare Improvement in the United States develop their inclusion strategy, so she brings a wealth of expertise.

We’re also re-launching our equality and diversity group, and the plan is to launch our new equality, diversity and inclusion strategy later this year, and then work on embedding good practice across all our teams.

You’ll know already that I’m very interested in how we create a positive culture in the organisation, where we live and breathe our values, and this is a fundamental element of it.

There is a tendency to see cultural change as 'soft and fluffy' because of the large people element.

But an essential part of cultural change is ensuring that the systems and processes we use are aligned to our values and our expected behaviour. For example, it's no good saying we are an organisation that is fair, when some of our processes such as recruitment are seen as biased and unfair. So we do need to focus on improving our key systems and processes.

This links in with the Just Culture national initiative which we are also launching today, which is focussed on one of our most important processes - dealing with, and learning from, patient safety incidents.

I’m at our first Just Culture event today, and we’ll share more about this next week as we’re one of the first NHS trusts in the country taking this forward. But in a nutshell, the Just Culture approach recognises that any error or problem is seldom the fault of an individual, but the fault of the system.

The single greatest impediment to error prevention and learning is that we punish people for making mistakes. The Just Culture framework supports a consistent, constructive and fair evaluation of actions when people are involved in patient safety incidents.

So, here’s to International Women’s Day. Let’s celebrate the achievements of women everywhere; but here’s also to our wider equality, diversity, and inclusion approach which we will strengthen over the coming months.

Best wishes
Claire Molloy