The Loop - IHSCM Quarterly E-magazine

Stolen Lives

I'm Excited About the Future

ISSUE

1

APRIL - JUNE 2021

The Loop

IHSCM Quarterly E-magazine

Reflections on Burnout

Contents

ISSUE

1

4.

6.

10.

I'm excited about the future

14.

What are the biggest challenges of General

Editorial

Working apart - growing together

Practice Management?

16.

18.

The impact of gratitude in the workplace CQC consults on its future role – a lawyer’s perspective

20.

Reflections on burnout

23.

IHSCM upcoming events

24.

26.

28.

Watch the 20 Minute Social with Alex Winstanley

30.

Some thoughts on ‘decompression’

34.

38.

42.

Summon the Care Heroes

Stolen lives

The NHS Workforce: Humans After All Welcome to the World of Digital Choice Do I have anything in common with Caroline Flack?

CEO: Jon Wilks, Chairman: Roy Lilley, Director: Dr Terri Porrett, Strategic Advisor: Shane Tickell, General Manager – Social Care: Jane Brightman, Membership Manager: Pauline Bolt, Executive Administrator: Jade Maloney, Social Media Administrator: Rachel Jury, Digital Content Consultant: Luke Farmer

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EDITORIAL JO I am absolutely delighted to be launching our new quarterly member’s E-Magazine today.

It is packed with interesting articles and analysis, all of which have been written by our members, and this will continue to be the case in future editions.

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L ON WILKS Chief Executive

For our launch edition I want to reflect on what you have all achieved over the last year. It doesn’t matter one jot what your role is, I am confident that you will have had to adapt and acclimatise to a whole new set of challenges and issues.

at some stage – and that’s what makes me all the more determined to pay tribute to the straightforward compassion and thoughtfulness of members, which I have been privileged to witness on countless occasions.

It is testament to your abilities that you have been able to come through it all.

No doubt in the near future there will be a major public enquiry to explore what was done and why, but this will not be representative of the detailed human factors that you have individually faced.

Thousands of you have attended IHSCM events, workshops, conferences and meetings over the last year and at every one, somebody has done or said something to offer support and encouragement to a fellow member. I find it immensely moving to have watched and heard these small interactions and gestures, often tiny in the big scheme of things, but mighty in their immediate, personal impact.

I am guessing that they will include anything from the following list: anxiety, sleep loss, irritability, family crises, physical fitness, mental resilience, grief, tearfulness, isolation, fatigue... the list goes on.

It is easy to look at the head and shoulders of someone on a Zoom or Teams call and ignore the unseen in our rush to complete a project, event or task. The superficial projection of confidence and efficiency masks the very real difficulties that we have all faced

This Institute, through its members, has achieved great things during the pandemic but none more important than giving members the opportunity to support one another. Bravo to all of you who have taken that opportunity so selflessly.

If you have a view on anything to do with your work or a general comment piece on aspects of health and social care then do please email me and we will publish. 500 words is the limit on content and feel free to provide a photo or two as well.

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I’m excited about the futu Andrea Gibbons Quality Improvement Evidence Lead Somerset NHS FT

This feels a brave statement to make.

It’s been an incredibly tough year for health and social care.

One of the phrases that sticks with me is that we are all in the same storm, but not the same boat. I don’t know about you but in my boat it’s been exhausting. I’m exhausted from the firefighting and frantic paddling just to stay afloat. I’m disorientated and sea sick from the lack of direction and uncertainty of knowing what’s coming at me next.

I am hopeful that we are now in a position to to take those first baby steps towards looking at how we can improve all of our health and care services 006

ure

My official role is ‘Quality Improvement Evidence Lead’. It means I specialize in providing the improvement community with knowledge, evidence and best practice. Quite rightly, in the last 12 months non Covid related improvement projects taken a back seat in the tsunami of Covid related activity.

So why am I excited?

I’m excited because I can finally see the light at the end of the tunnel. It’s a long distance race, and endurance run, to get there. But I for one am hopeful that we are now, finally, in a position to begin to take those first baby steps towards looking at how we can improve all of our health and care services, not just those that are Covid related.

I’m excited because whilst we may all be exhausted, the stigma and taboo around talking about our mental health has been largely swept away. We know we have a collective, societal problem, and recognizing that problem allows us to put plans into place (complete with change ideas and Plan Do Study Act cycles).

I’m excited because we are stronger as a health and social care community than ever before. We have all, collectively, learnt so much from our pandemic journey to date. We have worked together across geographies and siloes like never before. We have a new found commitment to sharing and learning from each other.

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We have formed informal communities to share and learn from each other. Working from home has prompted us to connect outside our local networks. Initiatives to bring people together in this virtual world, like the Evidence 4 QI Randomised Coffee Trials have taken off (see: https://q.health.org.uk/blog-post/sharingevidence-4-qi-through-randomised-coffee-trials/).

These extended networks that we have built provide us with a wealth of understanding, knowledge and support.

I’m excited because there has been a realization about quite how important evidence, and sharing it is. We have a duty to share what we know. We have seen first-hand what happens when you don’t and learnt from it.

We have been generous and shared our experiences of what has and hasn’t worked. And we have learnt how to get it out to everyone who needs to know it in lightning speed. We haven’t been hampered by publication and review cycles or costs of access to research.

We’ve been creative about how we share knowledge and learning.

We’ve supplemented ‘traditional’ academic routes of sharing learning with ‘alternative’ social media channels. These channels have been replete with nuggets of learning, freely and immediately accessible.

So as we emerge, tentatively, from what we all hope will be the worst of the pandemic, I believe we have reason to be hopeful.

I’m optimistic that our (eventual) post pandemic world will be knowledge fuelled, evidence based and networked – enabling improvers across the health and social care system to learn the lessons of others and not reinvent the wheel.

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OVER 2.1 MILLION ISSUED IN GRANTS DURING 2020 SO FAR TO CARE WORKERS IN NEED! Knowing someone is there to help can be just the lifeline needed.

This is why we will never stop.

We are now raising funds for our new Mental Health Grants appeal.

Research shows that the mental health of care and support workers was suffering before the coronavirus existed. Since then, social care workers have experienced challenges that most of us cannot even imagine. The toll on mental health is massive.

THIS IS WHY THE CARE WORKERS’ CHARITY IS WORKING ON CREATING A MENTAL HEALTH GRANT STREAM AND WE NEED YOUR HELP TO RAISE FUNDS FOR IT.

HELP US, PLEASE DONATE TO MAKE A DIFFERENCE TODAY.

https://thecareworkerscharity.enthuse.com/cf/mental-health-appeal Anyone looking to learn more why not book an information session about the work we do and the grants available. Email to book your session here info@thecwc.org.uk 009

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Working Apart – Growing Together Jim Little

Improvement Advisor

Care Quality Commission

I saw this phrase in another blog referring to a HR Conference being held soon.

I immediately thought that we all need to work on growing together whilst we live and work remotely.

Then I came to the crux of the matter, how on earth do we do it?

I believe that there are a number of ways that we can grow together, many of us have been doing this during the pandemic. At the beginning I introduced an afternoon chat ‘Tea@3’. After a period of time people moved on to other things.

I met up on calls with others in the first lockdown, on a Friday some of us celebrated the end of the week with a beer or a wine. I now go on to a call with some non-work friends for a quiz, chat and a few drinks on a Friday evening. My sister, who lives in Australia and I have a Sunday evening (Monday morning for her) Alexa video call every week. We talk more now than we ever did before the pandemic.

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We are all in slightly different places now and have different needs. I do believe that a common issue is the need to listen carefully to people. I have been known to respond to ‘How are you?’ with ‘bloody awful!’ and people have said ‘good/great to hear that’ or something similar. Why? We know they were not really listening, it is force of habit to ask and to simply expect a positive response, something many of us are guilty of. With close friends my response is often ‘Fighting fit; fighting for breath and fit to drop’ which usually gets a laugh.

I believe we can grow together by listening to each other and really taking notice of what is being said, we often need to rely on the spoken word as the non-verbal signs are less obvious over Zoom/Teams etc. How else can we grow together?

I suggest that making time for the odd five or ten minute chat, the type we would have when making a tea or coffee in the office, or the chance meeting in a lift or a corridor. We have set aside an hour for ‘no meetings’ around lunch time but we need to make time for the occasional informal chat over the day to give ourselves the opportunity to share the latest gossip, how we are feeling and hopefully, some good news.

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I am sure most of us are looking forward to getting together in a face to face situation as soon as things change. For me, a couple of beers after a day in the office sounds perfect just now.

On a personal level, going out to dinner with a group of friends to a favourite brasserie, having a steak (apologies to the vegetarians) cooked rare with a hollandaise sauce would hit the spot perfectly for me.

How would it be for you, your first time out with friends or colleagues postCovid?

I have a couple of other podcast suggestions for you. I promise you I don’t spend my life listening to them, I prefer to dip in and out of different ones depending on my mood. The first is a local one that people from the North East might enjoy. The Geordie Guide to Happiness which features interviews with local people. The other is ‘The Happiness Lab’ with Dr Laurie Santos, a Lecturer at Yale University.

Finally, whatever you do, please do try to make an effort to stay connected with family, friends and colleagues, it is far too easy to allow ourselves to grow apart and only connect for essential purposes when we really do need to Grow Together.

It’s been an extremely challenging time for everyone working in Primary Care and we feel it only right to acknowledge and celebrate the truly remarkable work that is continually being performed by you and your teams. That’s why Williams Medical and the Institute of Health & Social Care Management have teamed up to create the Primary Care Awards 2021.

For our first award, we’re inviting submissions for…

Primary Care Team of the Year Then click on the link below to make your nomination today.

It takes less than 10 minutes to enter and there are some amazing prizes up for grabs.

How it works...

Click here to make your entry today.

There are only a handful of questions to complete The panel of judges will review entries and a shortlist of finalists announced on June 1st The winners will be announced at a very special Virtual Awards Celebration on the evening of Wednesday 23rd June

All of the finalists will receive bespoke trophies, goody bags and complimentary IHSCM membership... plus the lucky winner will also receive a special Team Celebration Meal worth up to £1000!

Enter Now!

Click here to make your submission for Practice Team of the Year 2021

Hurry! Deadline for entries is Friday 14th May

About the judges…

Chaired by Roy Lilley, the judging panel will comprise of a number of leading authorities across Primary Care

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What are the biggest challenges of General Practice Management?

With over 13 years experience of managing and leading GP Practices, where do I begin...?

Tracy Green Head of Primary Care QCS 0014

As you can imagine I shall start with the enormous challenge that COVID-19 has bought over the last year. As with all health and social care providers, this put tremendous strain on practice managers to make sure that practices were covid secure, clinicians were split between hot and cold clinics, PPE was sourced and delivered, patients were involved and updated, innovation was implemented maybe years before the ideal time and of course they were the go-to people to make sure that all team members were looked after, risk assessed and deployed accordingly.

Then came the vaccinations which were so welcome but also created new challenges.

These have been commissioned at Primary Care Network (PCN) level meaning that many larger clinics have been set up in places such as sports halls bringing many teams together from various practices to deliver this incredible service. The challenge does not stop there as there have been vaccine shortages, short dated vaccines, media messaging prior to information being shared with vaccination centres and there have been delivery issues causing clinics to be cancelled and changed at short notice.

Are you tired yet? Well that was the additional work!

Practice Management can be a lonely place to be as the role reports to the partners, but practice managers also manage upwards and run the GPs business for them. Whilst the CQC Registered Manager is usually, but not always a partner, the practice manager tends to be the lynchpin in the organisation ensuring that policies are in place and being followed, audits are carried out

and evidence is being gathered to demonstrate compliance with the CQC whilst keeping a diverse team engaged and productive.

I liken Practice Managers to CEOs of small businesses who hold an NHS contract. As any small business, there are many areas to manage including recruitment, retention and development, finances, strategy, premises, contracts, HR, IT, and of course patient satisfaction. The NHS contract is the main income for the practice, and this can sometimes bring its own headaches.

Private work is minimal, and the patient expectations have grown exponentially at a time when employees are struggling with their own mental health through periods of lockdown, and family issues such as home schooling due to COVID-19.

Finance is very different in general practice. There are claims for so many services that it is imperative for practice managers to hold a detailed list of all income and expenditure. Anticipated payments are made on a monthly basis and then reconciled at year end based on the practices report submission and the clinical system is used to run searches to claim for these funds from a number of places including NHSE, the local Clinical Commissioning Group, the council and now Primary Care Networks. Deadlines for claims are generally tight and some commissioners are more lenient than others so if a practice is late with a submission, you run the risk of reduced income; no one wants that.

Practice Managers are unsung heroes who are having a really tough time. Please be kind to them, check in and ask them how they are while they are looking after everyone else.

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The impact of gratitude in the workplace A recent survey by the NHS Confederation stated that 9 out of 10 members were concerned about the long-term impact of COVID-19 on their staff’s wellbeing. While according to the Care Workers Charity, 51% of social care workers have considered leaving their role in the past three years because of the effect of the job on their mental health.

These are worrying statistics.

It's no secret that being praised makes us feel good and increases feelings of self-esteem and wellbeing.

This positive effect, however, is relatively short-lived, and for praise to have a long-lasting impact on staff wellbeing, it needs to be given regularly: “Recognition is a short-term need that has to be 0016

satisfied on an ongoing basis".

Workplaces where thanking is prevalent, result in a number of benefits: • Enhanced well-being. Staff feel more valued, have greater optimism and increased energy levels.

• Better stress management. Staff become more resilient which is critical in challenging times such as now.

• Improved job satisfaction. Staff are more motivated when they feel appreciated.

• Improved patient experience. Staff are better equipped to give patients the care they need.

We’re seeing this in a number of TAP’s healthcare organisations for example United Lincolnshire Hospitals NHS Trust

We at TAP are believers in the power of gratitude. It’s a simple yet transformative act, that can have a profound impact on our mental health and wellbeing.

and The Adam Practice. TAP’s social thanking platform is complementing their existing wellbeing programmes by providing a regular way for their staff to receive messages of appreciation.

The impact of gratitude is acknowledged

by Sharon Kidd, Patient Experience Manager at the Trust, “We know that when our patients say thank you to our staff that it boosts morale so much and it makes it more valuable in these very difficult times. We all know that happy patients make happy staff.”

Matt Findel-Hawkins CEO, TAP (Thank And Praise)

TAP’s social thanking platform enables people to: • Thank members of staff privately, via a secure messaging platform, to improve their wellbeing • Praise health and social care organisations publicly, via a bespoke Thanking Wall, to boost overall workplace wellbeing • Raise funds for charities, through a match funded donation platform If you’d like your health or social care organisation to access TAP’s free-to-use thanking platform to

While Clare Mechen, Nurse Manager at The Adam Practice says, “It’s great to see how much the public appreciate what we are doing to keep them safe. TAP’s thanking platform is the perfect place to share their positive messages of support.”

help improve your workforce’s wellbeing; please visit www.thankandpraise.com

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CQC consults on its future role – a lawyer’s perspec On 7th January 2021, CQC published a consultation paper on its proposed strategy for the next five years: The world of health and social care is changing.

So are we. It is due to run until 5pm on 4th March. It is based around four themes: • People and communities.

• Smarter regulation.

• Safety through learning.

• Accelerating improvement.

Running through each of these themes is a welcome commitment to tackle health inequalities and a desire to hold local systems to account given “It’s not enough to look at how one service operates in isolation.”

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The Health and Care White Paper reinforces this system level oversight by proposing CQC regulates local authorities in terms of how they discharge their duties under the Care Act 2014 in relation to adult social services.

The document contains a good deal of rhetoric, and is short on specifics, so the sector will have to see what transpires when CQC provides its response to the consultation around May. However, what is proposed is a radical shift in the way CQC regulates the care sector which to a large degree is informed by the new remote and virtual ways of working that CQC has had to adopt during the pandemic.

CQC wants its new approach to be targeted and dynamic, moving away from a set schedule of inspections.

“We’ll change our assessments to be more dynamic, and update ratings more often, so that everybody will have an upto-date view of quality.”

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Neil Grant Partner Gordons Partnership LLP

Real time regulation would be welcome as the results from an inspection can quickly become out of date.

However, the challenge for CQC will be to introduce a system that is not burdensome on providers, while offering the public up-to-date assessments of the quality of registered services. It is an ambitious goal that has never been achieved before.

CQC wants to introduce digital channels that will make it easier for providers and partners to work collaboratively with CQC. There will be a far greater focus on capturing and analysing information as part of the ongoing monitoring of services.

There is, however, an issue about the quality of data that CQC will receive, particularly in social care. If CQC is going to focus more on feedback from people using services and their families, how will that data be tested to ensure it is accurate and justified?

Additionally, will a greater reliance on provider self-assurance be an effective way of regulating settings? Will providers be self-critical when writing to their regulator?

Finally, CQC states it wants to continue with the more supportive role it adopted at the beginning of the pandemic.

However, when does support end and enforcement begin? Talking to my clients, their experience of CQC visits over recent months has been mixed.

Some have found their inspectors supportive, but others have found them to be demanding and officious.

Often it comes down to the personalities and competence of individual inspectors.

Rather than spending millions of pounds on new digital systems, perhaps they should be investing more in their inspectors to ensure they have the skills (professional and emotional), the experience and the requisite training to do the job to the highest standard.

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Submitted by a member who has suffered with burnout and prefers to remain anonymous

Reflection on burno One may ask what is burnout?

To my mind it means an extreme form of stress due to negative work / life balance.

The World Health Organisation says it is a syndrome resulting from chronic workplace stress that has not been successfully managed.

Some of the symptoms are: • Demotivation and detachment from work • Depleted energy levels • Detachment in personal relationships • Lower productivity • Physical, mental and emotional exhaustion In my experience causes of burnout included: • Toxic work environment • No control over work (workload) • Lifestyle - taking on too many responsibilities • Not feeling valued at work • Perceived lack of support & help 0020

I am a big fan of Mayo Angelou’s words as follows:

,,

ns out

And all of this before we even consider issues such as moving house, finding a parking space or going shopping with a partner!

People will forget what you said.

People will forget what you did.

But people will never forget how you made them feel.

,,

We have all had negative lived experiences from time to time and my suggestion is to use these as a tool to help with your personal resilience and empathy as a leader.

Covid 19 has tested my personal resilience but I do think that I am now better at ‘walking in the shoes’ of the people I lead, enabling me to make better decisions that benefit the team. Empathy is a terrific behaviour to harness and, I believe, by doing so I have created a happier, more positive environment for my staff which increases morale and wellbeing for all.

I’ve created an ABC model for myself which I would like to share with you:

A B C

Action and accountability - take responsibility for your health and take action to preserve and nurture it.

Bold and balance - Be bold by challenging yourself to do something you have never done. Balance your work and life.

Courage and commitment - Having the courage to sit with yourself. Commit to your passion and what will make you happy.

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IHSCM upcoming events April: 14th – Scotland Integrated Care Roundtable; for our Scottish members: 5pm 19th – Personal Confidence & Empowerment Workshop with Helen Bevan: 5pm 19th – IHSCM South West Regional Meeting: 6pm 20th – Power Hour: Long Covid Workshop: 8am 21st – No Going Back 2 Virtual Conference: 2pm 22nd – IHSCM Scotland Regional Meeting: 12.30pm 23rd – Workforce Wellbeing Round Table workshop: 12pm 26th – IHSCM Wales Regional Meeting: 12.30pm 26th - Primary Care Workshop: 3pm 26th – HealthChat with Mark Britnell: 5pm 27th – Power Hour: workforce redevelopment post-Covid: 8am 29th – IHSCM Northern Ireland Regional Meeting: 12.30pm 30th – Digital Health Round Table Workshop: 12pm

May: 3rd – IHSCM Outside of UK Regional Meeting: 6pm 6th – IHSCM Outside of UK Regional Meeting: 8am 6th – HealthChat with Andreas Haimboeck-Tichy: 5pm 11th – HealthChat with Tracey Bleakley: 5pm

To register: please visit www.ihm.org.uk/conferences-events 0023

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Summon the Care Heroes Our decision to formally welcome colleagues and friends from Social Care into our Institute has been very widely welcomed by members.

Not only are we all being given the opportunity to understand and learn about the opportunities and challenges which social care presents, but we are also starting to develop ideas for how the IHSCM can contribute to meeting and overcoming them.

One of the central issues for social care is workforce. The full complement of the social care workforce is 1.6 million people, but there are around 150,000 vacancies right now – nearly 10% of positions are vacant. The big question then: How do we recruit and retain talented people coming out of our schools and universities to a career in social care?

Stop 3 people in the street and ask them to name well known personalities from the world of health. I know that you will get a variety of answers, but you will get immediate answers from Florence Nightingale to Sir Magdi Yacoub. Now ask them to name similar personalities from the world of social care. I suspect the reaction will be blank expression and silence.

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Our newspapers and news channels are full of revelations about inadequate care, but there is a hopeless absence of genuine good news stories – and an absolute absence of reference to the people who are achieving some wonderful successes.

Today, we start to do our bit to remedy this with the launch of a new IHSCM campaign – SUMMON CARE THE HEROES. Each week we will highlight the work of an individual or team delivering genuinely heroic social care work.

To kick off, today, it is our pleasure to introduce you to an intoxicatingly positive and uplifting individual. We give you: ALEX WINSTANLEY Alex is an award-winning social worker with international experience of working with children and young people. His years of experience as a teacher, carer and SENCo led to him setting up a not-for-profit organisation called Happy Smiles Training.

Happy Smiles Training CIC empowers disabled young adults to create positive social change, by delivering awareness training across schools, community groups, businesses and more (www.happysmilestraining.co.uk).

He is currently writing a series of children's books to support them to understand a range of long-term health conditions, including dementia, depression and cancer – and he has recently featured as one of our 20 minute social guests.

Alex, you are the first of our Social Care Heroes – someone who inspires and cares in equal measure and to whom anyone considering a career in social care can look at and say ‘I want to be like him / her’.

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Watch the 20 Minute Social with Alex Winstanley

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Join the National Care Forum Make sure you are aware of all the latest guidance, thinking and intelligence in response to the fast changing situation with COVID-19 NCF members benefit from: • Policy updates - we manage and interpret the latest policy and guidance for you • Weekly Zoom Calls and Regular Briefings for your senior team • Dedicated Forum groups • Real time peer support across the membership - NCF is the leading voice for the not for profit care and support sector

MEM BE

- NCF is a trusted voice working with the government, DHSC, LGA and PHE to ensure, regulation and guidance is relevant and reflects the needs of the care sector - NCF will be ensuring that the voice and experience of members influence the critical social care reform agenda, advocating for experience led change with the Secretary of State, Minister and senior policy makers - NCF members are supportive, collaborative, connected organisations - NCF are strategic leaders in Digital Social Care and have dedicated digital transformation staff to support your digital transformation journey - NCF #HeretoCare Campaign is ensuring the amazing work happening in the sector is being recognised at national & local government and in the media Not-for-profit and voluntary sector care providers face different issues from private and statutory sector agencies.

NCF is the national association that represents only notfor-profit and voluntary sector care organisations.

Get in Touch & ask about joining the National Care Forum

F RSHIP • NOT FOR PRO IT

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LEA • TISE Y ALIT • INN O VA T I O N • Q U

NCF is the leading voice for not-for-profit care providers

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www.nationalcareforum.org.uk @NCFCareForum info@nationalcareforum.org.uk 02475 185 524

NCF works directly with not for profit care & support providers across the UK supporting members to improve social care provision & enhance the quality of life, choice, control & well-being of people who use care services.

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Stolen lives

Ed Smith

Chairman,Trustee & Non-executive Director

I so much enjoyed my time with clinicians, managers, volunteers and trust leadership when I was privileged to chair NHS Improvement.

Quite a few things irked me because they also irked the people working day in day out to deliver health and care to the people we serve.

At the system level it was constant tinkering and micromanagement from the centre (in which of course I was involved, although not committed to the centrist style!) Another was the lack of alignment between incentives and purpose. This is evident both within the NHS and in other non-aligned “systems”- with a tariff mechanism and data that were outdated and outmoded but “experts” said would take five years to change.

Well you have to start sometime and we are still in the mire - with tariffs often misaligned with costs both positively and negatively. Tinkering is not reform. The moves to population health models, and to vertical and horizontal alignment around local populations, are to be applauded but, as with actions to combat climate change, pace cannot glacial and actions must be seriously joined up.

At the more local level there was a frustration about patients - often our senior citizens who were ready for discharge into community settings, but for whom the handover was elongated and often debilitating for them.

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This is, of course, colloquially called “bed blocking' which is what it causes, but more officially known as “Delayed Transfers Of Care”.

Importantly it is more often than not unhelpful to the patient's physical and mental well-being.

There will be some good reasons for delayed transfers - clinical assessments of both physical and mental well-being are right and proper. But having made progress from 2016-2018 in reducing stranded patients, the numbers have risen again.

In December 2016 DTOC days were 195,445, in December 2018 they were 128,799 and in February 2020 they were 155,782. And now with COVID-19 data collection has stopped.

The causes of the increase in days are reported as: Dec 2018 Feb 2020 Awaiting completion of assessment 13983 20214 Awaiting public funding 3586 4139 Awaiting further non-acute NHS care 21361 28746 Awaiting care package in own home 27550 32464 Housing patients not covered by Care Act 5757 8027 72237 93590 Other reasons 56562 62192 Total 128799 155782

This increase represents in aggregate 3,855 weeks of people's lives. I know, as readers will, that health and social care workers in our NHS and our local authorities will have been doing their best to keep each patient safe and to get these numbers down within the limited resources they have been allocated.

So perhaps a discussion for IHSCM members is, despite these efforts from so many frontline health and care staff, how do we get the numbers down and save 3,855 weeks and more of people’s livelihoods? Perhaps only those in the front line of duty can really tell us what needs to be unblocked and how to do it?

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You may have seen recent suggestions that NHS staff should be offered military style ‘decompression’ to help them deal with their experiences of the national COVID-19 crisis.

Indeed, our own Roy Lilly recently offered his views on the topic in his NHS Managers blog.

In times of national crisis, it is not surprising that some parallels are drawn with the military and military operations – it probably helps convey

the threat, scale, and extremity of the situation.

Looking for comparators and examples of best practice in other organisations to help us get through a crisis makes complete sense; however, these comparisons are not always helpful or relevant because the organisations and the challenges are not necessarily comparable.

For a start, the NHS and Defence are quite different organisations driven by different

purposes and objectives – we do different things often for different reasons, in different ways and in different contexts.

These differences are important when it comes to trying to apply the military decompression model to the NHS and its staff. The model applied by the military is designed around the nature of and how we conduct military operations – the NHS’s role and structure is

Some thoughts on ‘decompress Group Captain (OF-5) Paddy Mckillop-Duffy 0030

different and simply does not have the reserves of people and time to be able to apply the model in the way that the military do. That said, there are elements of the military decompression model such as education, signposting and support that could prove useful in supporting NHS staff in the coming months.

Moreover, many of these probably already exist and should be kept in place (and expanded) to aid recovery.

The focus is now shifting from the acute crisis to a more chronic one - the demands and pressures associated with longer waiting lists, backlogs, reconnecting with patients and rebuilding treatment pathways, and all at scale. Many of the staff support services that have been put in place during the acute crisis are like those used in decompression and can help with this follow-on challenge.

We should keep the ‘wobble-rooms’, outdoor

quiet spaces, staff support and counselling services, peer support groups and ‘buddying’ in place as they will likely continue to offer opportunities for support, contemplation, distraction, grieving and learning. We must, however, be straight with our people and manage expectations – this recovery will be difficult. The COVID-19 experiences of our NHS staff are hugely varied and complex and there is no quick

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fix and recovery from this extraordinary crisis (whatever that looks like) will take time. It may not be linear, predictable or ordered, but we will work together to get through it. This is where leadership (and followership) is critical.

All clinical, health and social care leaders will play vital role in the recovery of not just the backlog but

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also our people. The foundations of this already exist in both the NHS People Plan and the NHS Leadership Model. Compassion, inclusion and humility in leadership has never been more important if staff are to feel valued, appreciated, and motivated to continue to serve the NHS. Moreover, I would add that compassion, humility and challenge

can exist in times of high pressure, urgency and ‘command and control’ – you just apply it differently. Every leader must consider the vital contribution of their leadership (and leadership choices) driven by the NHS’s core values and shared vision and purpose, and the role of respect, inspiration, engagement, empowerment and learning.

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The NHS Workforce: Humans After All As we reach the anniversary of the beginning of the first lockdown in the UK as a result of the COVID-19 pandemic, we can all agree that the year was impactful in many ways.

Some of the most commonly words heard throughout the year in relation to frontline NHS staff include “burnout”, “stress”, “fear”, and “safety”.

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Mamta Dhand Head of Workforce Transformation Liaison Workforce

However, one positive which has come out of this situation has been the focus on putting wellbeing at the forefront of the agenda for the NHS, and ensuring breaking down the existing taboos for self-care and mental health support. One example of this has been the Nursing Times’ “Are You OK?” campaign, which emphasises the power of those three words to recognise and address the impact of the pandemic on staff.

What have we learnt during the pandemic?

Covid-19 has increased recognition and acknowledgement of the NHS as the UK’s most important institution, and the sacrifices made daily by clinical staff to treat and care for our communities.

However, it has also highlighted that NHS staff are humans too, not immune to stress, burnout, illness and the coronavirus itself. Physically and mentally, NHS staff have put themselves on the frontline for the UK on a daily basis and as such, the question we should all consider is

who is looking after the carers?

Back in April of last year, a guide was published in the European Health Journal which described labels such as “heroes” or “angels” when describing NHS staff as “problematic”, as it made it harder for staff to describe how they were feeling during the pandemic and put undue pressure on them.

Prior to 2020, those joining the NHS were unaware, as we all were, of an incoming pandemic, and there are many motivations for entering the healthcare profession.

From joining the family profession, to wanting to help others or make a difference, regardless of the initial motivation, all healthcare workers will require support to maintain their motivation and to be asked how they are.

But who should be the person to ask this question?

Is it team members? The wellbeing guardians within a trust? Friends or family?

The NHS has clearly shown its commitment to

ensuring the wellbeing of its workforce is cared for, but there remains a key role in making a real difference, the line manager.

Have you had your health and wellbeing conversation?

The NHS People Plan states: “From September 2020, every member of the NHS should have a health and wellbeing conversation and develop a personalised plan. These conversations may fit within an appraisal, job plan or one-to-one line management discussion, and should be reviewed at least annually. As part of this conversation, line managers will be expected to discuss the individual’s health and wellbeing, and any flexible working requirements, as well as equality, diversity and inclusion.”

For individuals, this conversation may be one of the most important they have – giving them the opportunity to address concerns and make changes to positively impact their wellbeing.

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The Institute of Health & Social Care Management’s Roy Lilley recently wrote; “How people are treated, involved, engaged and listened to, will be the factors that will determine how the Service recovers from the rigours of the pandemic and copes with the post-Covid challenges of the months to come.”

It is important to recognise that the information given during these conversations can be vital to identifying key areas of concern for individuals and throughout a team, trust and/or region,

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and so the information provided should be recorded accurately and shared securely in order to ensure the following: • An understanding of the impact on wellbeing due to Covid-19, workload and resilience • The required actions needed to reduce negative impact on wellbeing • Understanding on what would help at both a line manager and organisational level.

If you require help digitising your conversation outcomes, in order to effectively track wellbeing outcomes, please get in touch.

I would be happy to discuss appropriate solutions in order to support the ongoing efforts of your organisation regarding staff wellbeing.

To discuss further, please contact Mamta at mdhand@liaisongroup.com

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David Kwo EPR Consultant and Researcher People Source Consulting

Welcome to the World of Digital Choice The uplifting reports of NHS vaccination programme successes are now being followed by reports on the importance of health data to fight the pandemic. Health data is needed to identify patients for shielding and jabs, running vaccine trials and organising virtual consultations and such data needs to be shared freely and securely.

What is not reported is where health data comes from, the fact that data comes from systems, and that good quality data depends on good quality systems.

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When I was working as an NHS IT Director 20 years ago, “good quality systems” for hospitals was defined as “best of breed”: let each department choose their best system and the hospital would operate better. My job was to connect them by trying to extract subsets of data (such as diagnoses, drugs and allergies) from disparate systems into a data repository. It was a blinking nightmare (technical term).

technically naïve and caused clinicians to navigate multiple systems.

Ten years later, the definition of “good quality system” evolved to “enterprise-wide” or integrated electronic patient records (EPRs).

Our clinicians agreed that departments’ needs should be subsumed in favour of the needs of the hospital. Linking (or “interfacing”) disparate systems that were not designed to work together simply didn’t work. Bullying suppliers into “standard interoperability interfaces” was commercially and

Today, it is “ground-hog day” for good quality systems. The current strategy is to implement a “Shared Care Record” system (SCR) in each of the Integrated Care Systems (ICSs). SCRs are trying to extract subsets of data (such as diagnoses, drugs and allergies) from disparate systems into a data repository; but now across hospital, GP, mental health and social care IT systems.

Hospitals had moved from best of breed to integrated EPR systems and some EPRs, such as Cerner, Epic and Meditech are widespread. In the US, over 99% of hospitals use integrated EPRs. In the UK, the trend is towards integrated EPRs but only 63% of hospitals use them.

This strategy for digitising ICSs is

therefore following an idea that was disproven 20 years ago. But, the risk is not just poor data quality. After viewing SCR data, clinicians need to take actions such as prescribing drugs, scheduling appointments/MDTs, requesting tests/ consults with other care setting colleagues, sending clinical data to teams with commentary and alerts. These actions need functionality not found in SCRs and so clinicians are back to navigating multiple systems.

Data quality (accuracy, completeness and timeliness) is not routinely and consistently measured or reported by SCR programmes. Clinicians do report SCR benefits re: novel data from different care settings, but they also report conflicting allergy data in SCRs and data on patients needing shielding to be full of gaps.

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The lesson we seem to be forgetting is that clinicians and carers need data and functionality.

SCRs give data (of variable quality and completeness).

Integrated EPRs for ICSs would give higher quality data (a single set of data definitions) and seamless functionality across care settings. Health systems in Europe, Canada and other countries are increasingly adopting integrated EPRs across care settings. The NHS should create a market of competing integrated EPRs across the ICSs and a market for

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interfacing (interoperability standards) solutions to cover cross ICS flows.

ICSs want innovations e.g. apps, remote monitoring from patients’ homes, patient portals, population health management, research and AI. Such innovations will be more soundly based using integrated EPR platforms (with so-called open APIs to allow links by third parties).

Single Integrated EPRs will not likely be practical or

affordable for all ICSs. But some ICSs are already pursuing them. The vision is that in 5 years, some ICSs will use SCRs, some will use integrated EPRs and a few will follow a bespoke approach (using so-called open platforms).

We should welcome such a mixed approach and assess rigorously what approach works best.

We should not assume that a data repository is the one size that fits all.

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Do I any com Car

On the face of other than our

She was a bea I’m not.

She’s taken he I haven’t.

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I have ything in mmon with roline Flack?

Jane Brightman General Manager – Social Care

f it, no, r rough age.

It’s about a year since she took her own life.

I didn’t really follow her career but like most people was shocked to hear her story.

autiful celebrity,

In a recent documentary, we’ve seen behind the story and it got me thinking. What is it that drives someone to take their life during a difficult situation?

She must have felt like things were so bad that life was no longer worth living.

er own life,

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I think we’ve all had those moments, haven’t we?

Have we?

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I need to learn more about mental health, how it is for me and those around me, are we doing ok?

It got me thinking about that darkness when something goes wrong. Something really important to you.

It could be work, love, failure, bereavement... I feel disappointment in myself quickly, is that common?

When things feel ‘big’ I lay awake at night or even dream about it. It can ‘dog’ everything, that feeling of getting it wrong, letting people down. I’m not sure that at 45 years old, I’ve learned to deal with that properly, is there a standard operating procedure for it?

Can someone email that to me please?

But seriously, if your brain is hardwired that way, can you change it?

And if yes, then how?

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There is depression in my family. My dad told me about how he would come home from school and step over his dad who was laying sobbing on their kitchen floor, he’d been there for days. This was in the 1930s, they didn’t really know what it was. I know he experienced it too, but we never really talked about it as a family.

‘how are you feeling?’.

It lists the various places they can go for support, to prevent things reaching crisis point. What a fantastic idea. Will it expose an epidemic during a pandemic? Will Kent be prepared to deal with that? I don’t know but I applaud them for being proactive about it.

I joined our newly formed special interest group focusing on mental health the other day. I need to learn more about mental health, how it is for me and those around me, are we doing ok? Getting it right?

One thing Caroline has taught me is about stopping and considering what the other person is feeling. In any given situation. Are they ok? Am I ok? Everyone working in health and social care during the pandemic is going to need some extra consideration, that’s for sure.

I learned that Kent have produced a booklet for 800,000 residents called

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