The Loop | Issue 3 | October - December 2021

Data Driven Leadership

Debunking Climate Change

ISSUE

3

OCTOBER - DECEMBER 2021

The Loop

IHSCM Quarterly E-magazine

Social Care Reform

Contents

ISSUE

3

4.

Editorial

8.

IHSCM upcoming events

10.

Social care reform is...

14.

Data Driven Leadership? Not so fast

18.

Debunking Climate Change

22.

The Registered Manager Job Description

25.

Person-centred informatics in social care

28.

Powering Up Thought

30.

Retirement – it’s great but not without its challenges

34.

Insights on the NHS Graduate Scheme

38.

We're all in it together

40.

Dementia research needs to focus on both care and cure

42.

Who would want to be a Head of Procurement?

CEO: Jon Wilks, Chairman: Roy Lilley, Director: Dr Terri Porrett, Strategic Advisor: Shane Tickell, Membership Manager: Emma Caton, Operations Manager: Jade Maloney, Social Media Administrator: Rachel Jury, Digital Content Consultant: Luke Farmer

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EDITORI As I write this the first leaves on the cherry tree in my garden are beginning to turn from bright green to autumnal bronze and there are already a handful gathered beneath.

Dew coats the grass first thing in the morning and last night at 8.20pm I watched the international space station pass by overhead, its shining whiteness perfectly marked against the night sky.

Its officially Autumn. We can expect the lovely sunshine of recent weeks to give way to Atlantic storm fronts and what the forecasters delight in describing as unsettled weather. Can’t be long before the first ‘named’ storm causes a rush of leaf falling.

If you work in the NHS or social care you’ll have been watching the weather for weeks now, knowing that the shorter days and lower temperatures combine to prewarn you of the impending flu season and what we refer to as ‘winter pressures’.

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IAL Chief Executive

JON WILKS Already GP surgeries are entreating citizens of a certain age to get their flu jab, many of us scan the press for news about C-19 booster vaccinations and we are urged to maintain our C-19 discipline, whatever that means.

Last weekend I was in Brighton and saw precious little evidence of people ‘maintaining discipline’. Masks were a novelty and social distancing utterly forgotten.

Irrespective of the spectre of C-19 baring its teeth as we all retreat indoors for events and celebrations, winter pressures are nothing new for us.

So I thought that I would use this editorial, penned on the cusp of winter pressures beginning their ‘warm up’, to reassure you of your abilities, irrespective of what might be hurled at you.

For a start you have just navigated yourself and your team through at least 18 months of what history teachers will still have as a set curriculum topic in 100 years’ time. Think back to what you were doing and how you were doing it in January 2020 and, I promise you, marvel at what you and your teams have achieved and how you have achieved it. From digital transformation to patient flow and from workforce wellbeing to infection control, you will all have the most incredible and positive testimonies to share in the future. You have found a way.

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Secondly, you will all have some idea of how to cope with what Winter brings.

It is my privilege to have in the archives various copies of ‘The Hospital’ (what used to be the Institutes in-house magazine), so how about this from December 1967: “Medical work in a hospital cannot be managed in the conventional sense from above…. It is amenable if the medical staff are prepared to manage themselves and have the appropriate machinery.” 1967, remember!

Even back then the Institute understood that the way to really get the best out of people was to show them what good looks like and then to give them the support and tools to enable them to figure out how to do it. High performance leadership and management today absolutely embraces this approach. You will have people in your team and organisation who have there, seen it, done it and earned the T-shirt across any range of thorny problems. Go and enlist their support and insight.

Thirdly, and on a similar theme, we have a combined 2.9 million brains across health and social care with experiences, ideas, solutions and practical examples around what to do in any situation and how to do it. If you use your own networks and those of the Institute to seek help if you are unsure or uncertain, then I guarantee you will receive it. You don’t need to be on your own and if you seek that help, be assured that someone, somewhere will have tackled that problem and secured a successful solution. We are at our best and most efficient when we use our collective knowledge and experience.

I dare say that it is easy at this time of year to grow anxious and even fearful about the shortening days and the woes of the world. I don’t for one second want to be flippant or be accused of lacking empathy for any of you for whom such feelings are a daily reality. But the fact is that help in the form of advice and support is available – and even reflecting on your own achievements of the last 18 months should give you renewed confidence and empowerment.

Finally, do please consider our upcoming National Conference, scheduled for November 17th in the light of this editorial. If you would like to present your own solutions, ideas, examples or case studies around what you do then we would love to give you the opportunity to share it with the wider membership. Please contact either myself jwilks@ihm.org.uk or our fabulous Operations Manager, Jade Maloney jmaloney@ihm.org.uk and you will find you a time.

Stay safe, stay strong and thank you for the brilliant work you are all doing.

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More full and short qualifications coming in early 2022, including leader and senior leader apprenticeship routes

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IHSCM upcoming events

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IHSCM Learning Disability Services Conference

GSTT COVID Response: Children's Services & Cancer

12th October 2-4:30pm

13th October 12:30-2:30pm

IHSCM National Conference 2021

GSTT COVID Response: Data Driven Aspects

17th November 9:30-3:30pm

1st December 12:30pm - 2.30pm

About the IHSCM National Conference 2021 The IHSCM is growing, vibrant, successful & relevant. Come & find out what is being achieved across the whole of health & social care.

This conference is a celebration of your achievements. Come and listen, contribute, encourage and applaud as you and your fellow members explore the fantastic work that you have done.

There will be presentations and streams across the membership activity, including workforce wellbeing, primary care, social care innovation, frail older care, digital technology, greener care & environmental sustainability, mental health and integrated care.

Speakers include: • Mervyn Eastman, Member, and co-founder of Change AGEnts Co-operative • Tanya Clover, Senior Dementia Consultant, HammondCare & Head of Dementia and Personalisation at Porthahaven • Janet Smith, Head of Sustainability, The Royal Wolverhampton NHS Trust There will be 5 stages: Main Stage, Regional Hubs Stage, Innovation Stage, Skills Stage, Workforce Stage.

You can expect some awards and recognition for individuals, teams and organisations as we salute all that you have done.

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

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Jonathan Freeman MBE, CEO, CareTech Foundation

Social care reform is...

At the time of writing, the very public debate about the scale and means of social care funding is reaching a fever pitch.

Whatever and whenever the outcome of this political wrangling, there is one cast-iron certainty: additional funding will be subject to major reforms to the way in which social care is organised and delivered. To make sure that the sector is driving these reforms will require a step change in leadership at all levels of social care.

If the sector is to make the most of this once-in-a-generation reshaping of social care, it will need to invest in a transformative new approach to talent and leadership development. There is a very real risk that, without investment in management and leadership roles across the sector, we will simply be pouring more water into an increasingly leaky bucket. More of the same just isn’t the answer!

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The social care sector urgently needs to attract high-calibre talent and significantly address leadership skills to instil long-term change from within.

Despite the best efforts of many, the reality is that nothing has yet shifted the dial in a meaningful way. As the recent Adam Smith Institute report on social care powerfully argues, “To be genuinely sustainable, reform will have to be disruptive.”

The approach of schemes like Teach First, Frontline and Now Teach offer powerful examples that can be tailored to deliver a game-changing ‘Now Care’ talent recruitment and leadership development campaign.

We can learn from the experience of these Transform Society alliance members who over the past 17 years have shown that across teaching, social work, policing and prisons, you can successfully change a generation’s view of professions never previously considered by top talent in the past.

All five programmes now appear in the Top 40 of the Top 100 Graduate Employers, recruit over 3,000 graduates a year and have become a magnet to our country’s top graduates due to the training, development, support and critically the ‘visions’ of each charity to not only deliver inspirational practitioners today but the leaders of the future tomorrow.

Alumni from all these programmes, now totalling over 23,000 collectively, are steadily and impressively moving into leadership positions, whether still in the sector or not (and around 70%+ stay for ever), still caring and driving change towards the vision.

As well as approaching talent recruitment differently, there is a parallel need to create viable and attractive career structures within the sector. In the same way that other sectors have recognised the value in creating specialist cadres within their sector, there is a need to work with providers to develop clear career paths across the sector, with individuals provided with effective development support.

There are great examples in the sector of individuals who have reached senior management roles after starting as frontline care workers and of care providers developing routes to career progression, but all acknowledge the need for greater action on this front.

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The CareTech Foundation commissioned Transform Society to undertake a feasibility study to test this ‘Now Care’ proposition. Over 50 leading sector representatives were consulted, feeding in to an Advisory Group chaired by Professor David Grayson, Chair-Elect of Leonard Cheshire.

We have been delighted at the welcome the proposition has received from this group and the commitment of so many to making a reality of this approach.

It is vital that ‘Now Care’ is driven by the sector, demonstrating to the Government and society that the sector recognises the need for change and will roll its sleeves up to support reform. Providers across the sector are stepping forward to back the establishment of ‘Now Care’, including with significant financial pledges. We need more backers from the sector and, to match the scale of the challenge, we need Government support.

Providing a great leadership career path in social care for ambitious graduates and career-switchers would be a fantastic response to help rebuild our sector, our economy and our country after the difficulties we have all been through. If we don’t want reform to be ‘done’ to us, we need to be leading the debate with the brightest and best delivering change across the sector for the benefit of all.

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Data Driven Leadership?

We are seeing a significant surge in the use of data analytics in the context of leadership.

But is it all good?

Could this be a trend that makes life harder?

I recently interviewed a candidate for a leadership role - he gave a compelling description of how he tried to only make decisions based on data - how he always measures what matters for the business and then makes decisions based on so called "data points". Measuring client satisfaction is clearly important. Measuring employee engagement and satisfa ction is essential for retention. But there are so many ways in which reading data blindly can lead to bad decision making.

Here are three types of bad data use: measuring the wrong thing, using bad data, surfacing non-actionable insights.

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Nuno Almeida, Founder & CEO, Nourish Care Systems

Not so fast.

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1. Measuring the wrong thing Our government just produced and communicated a plan for social care.

As in previous attempts, the government is showing a complete inability to understand the care sector. At the heart of how this government operates is a data driven approach. One that tries to maximise voter support. The hypothesis is simple: if they monitor voter support as they leak key messages and measures to the press, then they can tune the message and measures that are eventually announced and rolled out, while they patch a plan together to fit the messages that were announced. Sounds back to front, doesn't it?

Surely what we should be measuring is people's quality of life, not voter support?

2. Using bad data We have seen the proliferation of artificial intelligence applications. If there is a large enough dataset of assets or people there will be a potential application in classifying that data - for example, using data from medical records to try and find individuals who are at higher risk of a heart attack giving them statins to reduce their risk, or using website navigation data to propose products that are more likely to meet a person's needs. But data is not perfect - datasets are biased, or incomplete. Most of AI is developed by younger white male teams, their decisions and the information they use is a reflection of their point of view of the world, which often doesn't translate into other contexts.

3. But so what?

As digital transformation moves at pace in care services, millions of records are created da ily across the sector. Exploratory discussions with regulators, local authorities and care providers lead to an overwhelming sense of opportunity. Do you want to analyse the correlation between lunch being given late and falls? Sure. Do you want to study the correlation between pressure ulcer healing and gaps in achieving hydration targets? Absolutely.

But it will become too much very quickly.

Data analysis at scale is creating big opportunities to improve how we manage in the care sector.

We need to remain vigilant, not letting tools guide us in the wrong direction. If we are careful, good analytics will deliver great results for everyone.

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Care Quality Commission Regulation Legal Issues Facing Care Operators

“A highly professional team. Excellent communication. In-depth knowledge of Adult Social Care Sector. Flexible, well connected, very responsive.”

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We offer specialist advice on: Regulatory Maaers Involving CQC and Care Inspectorate Wales Safeguarding and Police Invessgaaons Embargoes by Commissioners Contract Disputes and Fee Recovery Inquests and Safeguarding Adult Reviews Employment Issues Empl The Sale and Acquisiion of Care Businesses For a free, iniial chat about the issues you are facing, please contact Neil Grant on 01483 366069 or at

sols@gordonsols.co.uk www.gordonsols.co.uk London 020 7421 9421 | Guildford 01483 451 900

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Debunking Climate Change I know you know about climate change, but are you worried that you aren’t worried enough? Do you think that there’s not much that you can do, and reassure yourself that there must be a lot of clever people out there who simply must be sorting it out?

Check out the IHSCM Greener Care Special Interest Group, chaired by Elaine Mead 0018

Or are you one of those people who worries all the time about what sort of legacy of a planet you are leaving your kids? Worried but dare not watch anything because it is so desperately upsetting. Those poor koalas…..!

I hope by now that there are no members out there who want to argue that climate change is not real - because it is, but I know that there are lots of people who are confused about the language and the possible solutions.

I know because I was one of those people and, although I do not in any way profess to know much, I definitely know more than I did two years ago and want to save you some of the same effort and anxiety.

Eco-anxiety or climate grief is now a recognised phenomenon. In 2017, the American Psychiatric Association (APA) described eco-anxiety as “a chronic fear of environmental doom” and I can understand how this might impact on our mental health.

So what is climate change and what should we be worried about?

First, maybe I should explain that I found out that climate change and global warming are not exactly the same thing.

Global warming is the description of the planet getting warmer over time.

Climate change does include global warming but also included other changes that are happening, such as like melting glaciers, heavier rainstorms, or more frequent drought. What I now understand is that when you hear politicians and experts talking about “global warming” they really mean those changes that are due to human actions.

Elaine Mead, Executive Director of Improvement, Care and Compassion, IC&C

And sadly yes, the planet is getting increasingly warmer due unequivocally to the behaviour of us humans.

The greenhouse effect describes the impact that our actions have had on the ozone layer which protects us from being fried by the sun. Well, it used to protect us.

According to scientists from NOAA’s (National Oceanic and Atmospheric Administration) National Centers for Environmental Information (NCEI) the world’s five warmest years have all occurred since 2015, with nine of the 10 warmest years occurring since 2005.

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This has happened because of the way that we have utilised our natural resources, in effect putting us out of ecological balance with the planet unable to cope with the increasing level of pollutants from industrial activity which is raising the temperature.

Sustainability is the avoidance of the depletion of natural resources in order to maintain an ecological balance, so that is not only the air that we breath, but the water, the soil, the minerals, in fact anything that makes up the planet.

The waste from our lifestyle, from factories, mega-farming or drugs being poured into our water systems have impacted on our oceans, with plankton now unable to convert carbon-dioxide into oxygen, just at the same time as we have cut down many of the natural oxygen producing green spaces around the world.

As a health and care system we use many of these every day in our work, and to support the environments where we give care. They are the hidden resources that we have come to expect to just be there.

So this is why the buzz work ‘sustainability’ keeps popping up everywhere now.

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And because we have so much rain in the UK, possibly one of the least known and most scary facts are that the oceans and becoming more acidic and global demand for fresh water will exceed supply by 40% in 2030.

However, healthcare worldwide accounts for 4% of global CO2 emissions. First do no harm. Why healthcare needs to change | World Economic Forum (weforum. org) Doesn’t sound that much?

Health care without Harm describes that if health care was a country, it would rank as the world’s fifth largest emitter in absolute terms – after the United States, China, India and Russia, but ahead of Japan and Brazil.

• Stay nearer to home and reduce air travel • Eat less meat, maybe try one day a week or before lunchtime • Waste less food and buy local seasonal goods • Mend, reuse and recycle as much as you can • Demand less plastic and request opportunities to recycle • Turn off taps and deliberately use less water • Plant trees and develop green spaces • Look at ways to introduce more sustainable actions into your workplace • Encourage others to do something too The last word must go to Greta.

So now you know some of the lingo, the facts, and the impact how long have we got? Great question. Not long really.

In fact, no time at all. In April this year, at a summit of World Leaders 2021 Boris Johnson UK Prime Minister said “If we actually want to stop climate change, then this must be the year in which we get serious about doing so.”

"You must unite behind the science, You must take action. You must do the impossible. Because giving up can never ever be an option."

US Congress, Washinton DC, 17 September 2019.

Greta Thunberg

So it’s time to get serious. What can you do? Now, this week, today?

Here are a few ideas and please, stop worrying and just do something. Anything really, but be intentional and positive in your action.

We know that catastrophising makes the point, but it is beginning to stop people engaging with this vital agenda. Don’t be one of those people, and take some action based on the science and know that you are making an impact.

Ralf Lotys (Sicherlich), CC BY 4.0 <https://creativecommons.org/licenses/by/4.0>, via Wikimedia Commons

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The Registere Manager Job Description I’m often asked about job descriptions for Registered Managers in adult social care and sometimes I even spend time reading through JDs online.

Do we get them right and are they really reflective of a role that has become so responsible and complex?

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Let’s start by looking at what exactly a Registered Manager is, here’s what CQC state: A registered manager is the person appointed by the provider to manage the regulated activity on their behalf, where the provider is not going to be in dayto-day charge of the regulated activities themselves.

As a registered person, the registered manager has legal responsibilities in relation to that position. A registered manager shares the legal responsibility for meeting the requirements of the relevant regulations and enactments with the provider.

The purpose of the registered manager requirement, is to regulate the person managing the regulated activity on a day to day basis at the location where the regulated activity is provided, rather than a

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Jane Brightman, Independent consultant and IHSCM member

more senior manager who is not in day to day charge at the location.

They also state that the Registered Manager must be of good character, be able to properly perform tasks that are intrinsic to the role and have the necessary qualifications, competence, skills, and experience to manage regulated activity.

Skills for Care data tells us that 75% of registered managers have been in the sector for 10 years or more and have an average of 7.9 years in their current role.

Around 68% are between 25 and 54 years of age (32% are aged 55 or over). 16% are male, 84% are female. Around 85% are white and 15% from black, Asian and minority ethnic backgrounds.

The most widely recognised qualification for Registered Managers is the Level 5 Diploma in Leadership and Management for Adult Social Care (currently undergoing a much needed review).

How on earth do you begin to capture all of this in a job description? If you attempted to, it would probably end up being a deterrent to any applicant. On top of the legal implications, Registered Managers are responsible for people’s lives, health and wellbeing, recruiting

and managing teams, HR, running businesses, organising finances, planning marketing, managing resources, quality improvement, governance…I’ll stop there but the list is almost endless! Then factor in Covid-19.

But for me, it’s the word responsible and as I said above, the Registered Manager shares the legal responsibility with the provider.

Job site Indeed states that the average annual salary for a registered manager is £36,139 per year in the UK. In a recent survey we ran, nearly 40% of care managers told us they are seriously considering leaving their role.

I’ve thrown out a lot of facts in this article and am no closer to creating a truly honest job description for a Registered Manager, but I hope it makes us sit up and think about the pressures they face in their day-to-day work. We need to get better at succession planning, education (watch this space from our partnership with Arden University) and the support provided. I also feel strongly that CQC should consider how stressful the role is and what they can do to improve that.

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Personcentred informatics in social care A carer, a registered manager, a nurse, a social worker, an occupational therapist, a business analyst, a support worker, an admin assistant – the roles that use informatics in social care is almost endless. The issue is that not many use the word informatics, even if it is key part of our jobs.

Tommy Henderson-Reay Digital Transformation Lead| National Care Forum

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Using technology and digital more broadly is becoming more and more common place across the sector. Think monitoring a resident’s hydration levels, using information to prevent risk of falls, using apps to engage with friends and families, creating specific COVID19 care plans, use of acoustic monitoring, passive sensor technology for residents, integrated health and care information… and so on.

The list of examples is endless, the point is that informatics is a term to describe the analysis, use of and reflection of technology. It’s also a way of practising in a person-centred way, thinking about using tech in ways that best suit people and connecting with others through an exciting career pathway.

There has been a significant technological revolution over the last 15 years so it’s absolutely right that those who are working in social care and those receiving care are empowered to make clear decisions about what is the right tech for them. In the same way that the way we talk and engage with people can be more or less person centred – the exact same principle applies to the way we think about, implement and use technology. No one wants a clunky bit of kit that doesn’t work – informatics can play a central role in guiding people through these decisions.

The drive for digital tech in social care is likely to increase – so the sector needs people who understand both care and tech whether you’re a front-line worker, analyst, manager or board member. The challenge is how we connect, engage and empower people.

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As a social worker I didn’t receive any training in informatics, my network of support has come through my membership of the Faculty of Clinical Informatics and British Computer Society. Likewise, IHSCM and FEDIP also exist to help support people interested in informatics to shape how technology is used in social care.

The ability to connect with fellow professionals, share ideas, learn from each other and understand what good person-centred informatics looks like is invaluable. We know the choices facing care organisations can be intimidating and many can’t afford to get it wrong. Being part of a community of likeminded ‘informaticians’ offers the sector a very tangible effective platform for peer learning.

We know there are informaticians galore throughout social care, it’s just that they don’t identify as ones.

Given the rapid rate of healthcare developments as well as time and financial pressures understanding how informatics improves care outcomes is key to how social care engages with care in an increasingly digitised world.

Social care informatics presents an opportunity to truly tell the story of the value of social care and how it enriches lives. Active communities of social care informaticians can and need to play a significant role going forward to ensure this happens.

Find out more about the work of the Faculty of Clinical Informatics and how to join here: https://facultyofclinicalinformatics.org.uk/

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Powering U At the suggestion of the IHSCM Workforce Wellbeing Special Interest Group, we held our first poetry lunchtime event in July 2021 and recently held our second poetry event.

Designed to share member experiences, inspire, network and connect, we have heard members share their experiences of the pandemic, day-to-day thoughts and recited our favourite poets.

We invite you to join us at our next poetry event and leave you with this powerful thought written by our very own Operations Manager, Jade Maloney.

Jade Maloney, Operations Manager, IHSCM

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Up Thought It’s early I’m on time but ill prepared I’m scared I’m worried I’ll be asked What do I think of this?

What do I think of that.

I sip my coffee to power up thought I know this, I learnt it before Why do my thoughts take so long to surface Does my brain do this to me on purpose?

Concentrate.

Take some notes.

Get back on track with a sip of gold roast Don’t start day dreaming about the sun and coast You are prepared, but maybe tired You’ve spent so long learning you’re just needing to be rewired.

Sit up in your chair Ground yourself Stop thinking about Christmas and Mischief the Elf.

It’s your turn now Speak up Tell them what you’ve been doing No, not day dreaming Working hard Trying your best Taking time to get things right Tell them about the thought you had last night.

Doing this may benefit the team You’ve been working with ‘X’ to rebuild the dream Your team is doing amazing And it’s all down to the success Of powering up a thought and leading them to take care of the rest.

You’re not ill prepared You may be slightly tired But you get there in the end And the power of thought is much to be desired.

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THE LOOP John Glynn, IHSCM Member

Retirement – it’s great but not without its challenges I loved my job, particularly knowing that I was respected, and the advice I provided on legal issues was well received by people at all levels within the NHS trust where I worked for forty years and a day.

I guess things are different for those who have grown to hate their job and are glad to be out, but for me retirement created challenges that I hadn’t envisaged.

There are swings and roundabouts depending on the individual.

For me it’s fantastic not needing to get up early in the morning and having the time to become involved with any activity that may take my interest.

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On the other hand there have been some feelings of isolation without the social interaction of being around people who recognise my value, i.e. some loss of identity - people in general aren’t too interested in the reminiscences of pensioners.

I suppose what is coming through is that while we tend to give lots of thought to planning for the financial aspects of retirement, we can’t really plan for the psychological impact of retiring from work.

Although it’s not always easy I believe that the best thing to do is seek out positives from any situation. For example by taking part in the IHSCM’s Retired Members Special Interest Group (SIG) your reminiscences can be used to good effect for the benefit of others – both working members of the Institute who can learn from lessons of the past, and other retired members with shared experiences.

Moreover, I think we become defined by what we do for a living. After retirement, we need to find new ways of being defined through non-workrelated activities such as taking part in the aforementioned SIG and joining in with social group activities if that’s your thing.

Personally, I’ve continued my interest in walking/trekking in a more gregarious manner by walking, and leading walks, with The Ramblers to complement my enjoyment of solo walking. The local walking group has a thriving social scene; also walking is a way of maintaining a reasonable level of fitness. I believe that social interaction and fitness, both physical and mental, become increasingly important in retirement.

In practical matters I confess that I have found it all too easy to become complacent in terms of getting on with things I want to do – all this after being very driven for years! While I guess it’s fine to relax and I feel I’ve earned the right to do so, just remember - and this is advice to myself as well, is that there's plenty more to be done and you now have the opportunity to get on with it.

My conclusion, whatever challenges you face in retirement or as you prepare for this new chapter in life, is to see it as another stage in your journey and not as arriving at your final destination.

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Insights on t NHS Gradua Scheme What is the Scheme?

The NHS Graduate Scheme (GMTS) promotes itself as the training ground for the future leaders of the NHS, and counts the outgoing and current NHS CEOs amongst its alumni: no pressure, then!

Samantha Barker , NHS Graduate Scheme Trainee, Maternity/Neonatal Network, South Yorkshire & Bassetlaw ICS

Over two years, participants have core placements in two different areas, with a short ‘flexi-placement’ in the middle that can be in any organisation, from another trust to consultancy, marketing, or finance. It’s one of the most competitive schemes in the country to enter, despite the negative press surrounding the NHS. Online tests, multiple rounds of interviews and a trip to London/Leeds are in store if you hope to be able to take part! Up to 500 people per year are lucky enough to get an offer, and in March 2020 I was one of them.

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the ate The Challenges of Covid Yes… March 2020, the month where the world turned on its head, was the month when I, along with hundreds of other naively optimistic graduates, formally signed the paperwork and trundled off to Leeds for a day of talks, networking and free cake.

None of us realised that was the last time we would see each other in person, but a few weeks later the entire country was shut down. Called back from our orientation month to help in our ‘home’ organisations, a huge number of graduates found themselves redeployed to helping in acute services in a sink-or-swim situation.

All of our education was cancelled, our Trainee Support Team themselves redeployed, and no confirmation of if/when the scheme would restart. I didn’t see another graduate again for 9 months, and the only upside many of us could find was, having started in March not April, at least we had employment security.

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What Needs to Change As with many areas of the modern world, covid pulled back the tarpaulin and exposed numerous holes in the foundation in how GMTS functions. With the scheme having existed for over 50 years, cultural norms had become embedded that didn’t reflect the world of 2020 and certainly not the post-pandemic 2021 we are all in now.

The educational element, and much of the front-facing media, still functions on the expectation you will be a Service Manager in an Acute Trust. Having spent my first placement in Primary Care and my second in an Integrated Care System, it’s definitely not been the case for me! I only have a perfunctory idea of what that role entails, as it’s not something I plan to go into.

Attraction is also an issue, as despite the scheme being fairly ‘open’ and only requiring a 2:2 Degree in any subject (although I don’t think a degree should be 100% necessary, this is admittedly below what a lot of schemes ask for) getting the right people aware of and applying for the scheme remains a challenge.

The most represented group are the 20-somethings not long out of university, and as a former nurse I have only found a few compatriots in my position. I would love to see the Grad Scheme aim for a 50/50 split of clinicians and nonclinicians, but with the pressures on frontline services as they are, there are challenges in looking to ‘poach’ clinical staff.

Looking to the Future For March 2020, the time has passed to be able to change our whole experience of the programme, but we can only hope that our experience of having survived the pandemic will pay dividends in our future career.

Inclusion has an increasing focus, but certainly more focus on ‘developing our own’, both administrative and clinical staff, would be a welcome evolution.

As for me, I hope to continue with my work within Maternity, Paediatrics and/or Mental Health, but keep a toe in the water of GMTS and ensure future cohorts benefit from all that we have learned in this strangest of years.

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We're all in together

Carole Challen, Practice Manager, London

As Practice Managers we can solve most problems and overcome many challenges but we’re human not robots. The pressure of keeping services running, staff engaged, motivated and cared for whilst dealing with a barrage of patient anger and abuse is demoralising. It has been getting worse and seems that now not only patients but the Government, media and even our NHS colleagues feel it acceptable to vilify primary care.

Much has been said and written about the challenges and experiences everybody has been through during the pandemic, both personal and professional. The NHS has been under pressure but our leaders have been slow to react to this inaccurate and consistent onslaught (thanks to IGPM for initiating and BMA for your much needed letter of 21 September).

We know health and social care is broken - it is not just about money but also about systems, processes and infrastructure. We love innovation and new technology, still looking forward to interoperability but until we get the basics of working computers and networks, we daren’t dream of anything more; and don’t get us started on premises.

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n it We are not hiding (Telegraph) but have been working differently along with most of the country but yes we are and have been open (change. org) although our door is closed and we allow access to patients with a need to come in so that (a) we can maintain a safe environment; and (b) so our receptionists feel more protected against the physical threats they’re experiencing (e.g. the poor staff in Manchester who have suffered physical harm) along with practices that have been vandalised, have had bomb threats and excrement left inside and outside premises.

We get on with the job, helping more patients than ever, whilst social media thrives on the demonising and undermining of primary care.

Patient demands, expectations and perceived entitlement has increased.

No, we cannot call the hospital three times a day chasing your referral and no please don’t keep calling us asking us to. Patients inform us COVID has gone and that our infection control measures are ridiculous and why should they think about other more vulnerable patients; they want letters for this, that and the other all by the end of day.

Why doesn’t dandruff need an urgent same day appointment/why should I go to a chemist I’m here now so you have to see me and so it goes on.

We continue with both face-toface and digital appointments as appropriate to patients – we know one size does not fit all and are offering choice (Daily Mail take note).

We want to see those patients that really need us and need our help.

We want to work smarter as we can’t work any harder but need the backing of our leaders and support and integration with our partners and stakeholders for this to happen, more action and correct public message, less bureaucracy and platitudes.

We all know that scandal is generally the only story that everyone wants to hear and the increase in patient consultations is ‘boring’ but enough is enough. Doctors are walking away, and admin staff are downloading Amazon driver application forms.

I hope it will not become one of those situations where you only appreciate how valuable something is once it is gone.

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Dementia research needs to focus on both care and cure Jackie Pool, QCS, Dementia Care Champion 0040

We may not have a cure for dementia yet, but every year exciting scientific breakthroughs take us ever closer. Only a fortnight ago, researchers discovered that sending extra oxygen to the brain could delay the symptoms of dementia.

But, as life-changing as the advances like this could one day prove, I believe that a significant proportion of the funding that is ploughed into research each year should be allocated to care as well as cure. By doing so, we can further develop the field of ‘rementia’, which can help those already living with the condition to live well for longer.

Approaches that result in rementia seek to make a profound difference to people’s lives by helping them to reduce the symptoms of dementia, and also, in some cases, supporting them to restore lost cognitive functional ability.

Inspired by the late Professor Tom Kitwood, an early pioneer who revolutionised the way we now view dementia, it is a school of thought that I have devoted my entire career to. Like Professor Kitwood, I believe dementia symptoms are influenced by many different neurological factors, but also by a person’s personality, their life history, their physical and mental health and most crucially, the quality of person-centred care that they receive.

However, studies have shown that nutrition, emotion and cognition also play a major role in determining good brain health. Take diet for example. A person living with dementia may struggle to eat and drink well. They may have issues swallowing food, or might simply forget to eat and drink, which can have an adverse effect on their physical, mental and brain health.

Supporting a person’s emotional health is vitally important too. Outstanding personcentred carers enable and gently nurture those living with the condition to express themselves, which, studies have shown, reduces anxiety, while having a positive impact on brain function and wellbeing.

The final piece of the jigsaw is cognition.

To help professional carers to fully understand an individual’s unique set of cognitive abilities, functional challenges and, their life story, I developed the Pool Activity Level instrument. Over the last 25 years or so, it has helped care staff to assess the level of functional ability of people with cognitive impairments and ensures that support is delivered exactly the right way to match each individual’s level of ability.

But, while extremely effective, the Pool Activity Level Instrument only equips professional carers with one of the tools they need to transform the assessment and management of care provision for those living with dementia.

With the support of Quality Compliance Systems (QCS), the leading provider of content, guidance and standards for the social care sector, I have created the QCS Dementia Centre, which includes Mental Capacity Act Assessment examples, a QCS Dementia Compliance Index, a Competency Rating Tool, which help carers to instil a culture of conditionbased support and action-based learning.

Not only does it ensure that rementia flourishes, but that people receive the right care to live well.

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Who would w to be a Head o Procurement?

“Never has the role of Head of Procurement for an acute hospital trust been so in the spotlight than during a global health pandemic. Overnight those in the role became critical in the fight against COVID-19; attaining the right equipment and PPE was essential to ensure we not only continued to deliver care but kept our patients and thousands of frontline healthcare workers safe.

It's not a time anyone will forget, we pulled together, supported each other, moved quickly, learned lessons and realised the value that we all bring to the NHS. The role of a Head of Procurement is easily summarised in one word: varied. That isn’t a negative thing, it’s a reflection of the expectation, speed and flexibility required in running Procurement services.

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There are two key factors that drive the focus of what my team does - our patients and our staff – we must deliver the best products and services for them.

It’s not about getting the cheapest; the old adage “buy cheap buy twice” can be true and whilst we keep a close eye on costs delivering quality patient care is our absolute priority.

Our clinical teams are often developing innovative projects aimed at further improving patient care, and our close working relationships ensure that the procurement team are involved right from the start. That not only means we can advise on value and benefit to staff and patients, but it also means that we are directly involved in providing the best possible care to our patients and that is extremely satisfying to be part of.

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The daily ‘to do’ list can be anything from reviewing multimillion pound contracts, to assisting the Trust’s Charity in finding value for money items that will improve patient experience and reduce the stress our patients may be feeling.

As we all know these are unprecedented times further exacerbated by other factors for example supply and workforce issues as well as other factors like PPE shortages, transport problems and the fuel crisis. These along with the potential changes to NHS Procurement all ensure that the workload is always busy and diverse. Despite the challenges of the pandemic it is clear that there is a brilliant network of support not

Chris McNamara Head of Procurement, Procurement Department, St. Helens and Knowsley Teaching Hospitals NHS Trust,

just within the Trust, also amongst the Heads of Procurement in Cheshire and Merseyside and via professional bodies such as the Health Care Supplies Association (HCSA). We have many challenges but we all work together to deliver the best possible service.

It is by far and away the best job I have ever had, I may not be clinical but I know I make a difference to patient care and I’m incredibly proud of that.

I have often had it said to me, “who would want to be a Head of Procurement at the moment”, I find that very easy to answer... Me- and it’s great!

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Cheryl White Apollo Care, Liverpool