What is it about your job that you feel would surprise the public?
Although I’m employed in a hospital, I’m actually there to support improving population health, looking across and outside our trusts to build new models of care. I’m helping make plans and decisions for the hospitals to make a contribution to our wider population. That’s quite an unusual job at a hospital, I guess!
What’s been the biggest change you’ve seen since you started working in health and social care?
I started about 18 years ago as a management trainee. The biggest change I’ve seen is what we can do with data and information. It’s a lot more sophisticated in knowing how the system operates, how we can use past and future trends, and in thinking about things like patient flow. When I first started working in hospitals it was literally pink and blue cards in a drawer with patients’ names written on, curling up at the edges, whereas now we can now go onto a mobile device and look at all the patients, collectively and individually, with the power in many cases to predict their needs. And while that’s often just the institution and not yet across the system, that’s come on leaps and bounds. With better, more rapid information and measurement for improvement, we know a lot more quickly, when things go up and down or get better or worse, and when it matters.
If you could make one change to the NHS and social care over the next 10 years, what would it be?
We should be developing a new kind of workforce across both health and social care and the wider local economy, and having a ‘blurring’ of those lines between them – I’d have a big focus on a community-based health workforce and harnessing the power of primary care for prevention.
Innovation is important, but I don’t think we need many more ‘big ideas’ over the next 10 years. I just think we need a better understanding of why some take hold and show success in some areas and others don’t, so we can build capability for the ‘how’ of change and improvement in our local systems.
Change from the top
If you could give Matt Hancock one piece of advice, what would it be?
It’s all about the workforce. We haven’t got enough cards in our hands to make people want to come and work for the NHS at the moment, and he can influence that. I would say to him, ‘show that you identify with our staff, show your face, start putting yourself in their shoes’ – and try to align all the necessary levers that are available. And, while I lead on and advocate for several innovation and digital projects, ultimately if you’re going to be a secretary of state talking loudly about tech and digital issues, I don’t think that will hit home quite as well with the service. We also can’t assume we will import a solution – most of our future resource is already with us.
What do you wish people at the top of the NHS understood?
That most people at the front line have exactly the same values and aspirations as they do. We are aiming for the same goals and understand what is important, and the top needs to trust in that more. There’s so much time and energy spent on assuring that things are being done – we need to do that more intelligently and value real delivery and outcomes. It would be also good for the centre to consider how we can encourage teamwork and collaboration within that.
Policy in practice
What policy have you seen successfully implemented, and why did it work?
The care home vanguards. Of the new care models, it would be the one I’d say has been intuitively and culturally the most successful in sticking across localities. It was totally responsive to real needs today. It was an idea in the Five Year Forward View, there wasn’t a model for it already prescribed, or set ideas of how it would work. The local teams who applied for the programme themselves came up with the model, and they already had all the components because they had made them happen as good practice in their areas. They were all passionate local people with a clear vision – I think that made the difference and brought a focus to the population group. Everyone saw a real need for things to be better.
What policy have you seen fail, or not be as successful as first intended?
The National Programme for IT – I think that’s a well-documented failure, with lots of reasons why. What we’re trying to do now is find lean software and digital solutions to key problems that we can iterate and co-design with the service.
I also think people struggled to maximise the opportunity of the Better Care Fund.
What policy and/or change in behaviour are you currently trying to implement, and how’s it going?
We’re investing across our trusts in our core clinical, operational and corporate teams’ leadership and behaviour, taking cues from Developing People, Improving Care and approaches to organisational alignment, in partnership with the Dartmouth Institute and the NHS Staff College. It’s really important work, but it is proving really hard to make the argument that investing time in it at the moment is the right thing to do. Everyone wants to do it, and it gives colleagues energy and ideas when they get there, but releasing staff is so hard. The time pressures are worse than I’ve seen them in my whole career, and we need to be realistic and show we appreciate that. We have tried to develop flexible approaches that help us learn bigger lessons from real life – applying principles like considering what is in your power to change and trying to be your best self on a bad day. And when that’s in the middle of an NHS winter, then taking time next year to reflect and learn together.
And finally
The NHS is under pressure because...
In addition to neglecting senior workforce planning, there are clearly massive cutbacks in local authority spending, which is having a knock-on impact on people not receiving the right care and support in many ways outside of health care. We talk about it affecting the elderly quite a lot, but I think it’s starting to show in children now too, such as in mental health and lifestyle risk factors – that’s the next big issue starting to keep me awake at night.
We also haven’t harnessed the full untapped potential cited within the Five Year Forward View – we could get more out of what we’ve already invested in, by scrutinising where we are adding value and where not.
Charlotte is Group Director - Strategy and New Care Models at Basildon & Thurrock, Mid Essex and Southend Hospital Group. Keep your eyes peeled for the next in our new Q&A series in early January!
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