Olivia Butterworth
Hi and welcome to this NHS England podcast looking at how Integrated Care Boards can work really well with people and communities. My name is Olivia Butterworth and I’m the Deputy Director for People and Communities at NHS England. So my job is about how do we really support the system, really support communities to work really well together. Today I’m going to be talking to Sam Allen and Adam Doyle—they’re both fabulous chief executives of Integrated Care Boards—about the approaches they’re taking across their systems to working in partnership with people in communities.
We’re really delighted you’ve tuned in because we’re really, really passionate at NHS England and across the NHS about starting with people, starting with the people who use our services, starting with our staff, our volunteers, our carers and unpaid carers to make sure that we’re really able to hear, listen and work with people in partnership.
We’re going to be exploring what start with people really means in the context of our new integrated care boards. We’ve published new statutory guidance for integrated care boards about what this really means and what we’d like to see. But actually, in reality, we need to bring those words off the page into the context everybody is living and working in.
So to do that, I am delighted that we have got I think, probably two of the best integrated care board chief execs we’ve got in this country who cover really complex areas, huge geographies. We’ve got the fabulous Sam Allen, who’s moved from the south of England to cover I think it’s the biggest ICB in the country geographically up in the north east and north Cumbria.
And the delightful Adam Doyle, who’s down in Sussex. So really different areas but the same job: they are both chief executive of these really complex organisations. So before we dig into the depth of what we want to talk about today, Sam, I’d really like you to tell us a little bit about you. Tell us who you are, where you come from, what makes you really sing and make you happy?
Sam Allen
Oh, thanks, Olivia. Well, it was really interesting actually saying where you come from, because I get asked quite a lot, not least because I’ve just moved 350 miles to the north east. And what I would say is actually it’s that’s probably where I come from. So I lived here as a toddler. I’ve got lots of family connections here.
But my father was in the forces, so I traveled around a lot. So that question, where do you come from? And I think people who have grown up probably with a parent or parents who are in the forces, or a partner, and you’re moving around a lot. It can be quite an emotive question, actually, because you never quite really feel like your roots are anywhere.
But I guess my heart is here. As you know, it’s just an absolutely beautiful place. We’ve got the best of everything. We’ve got beautiful coastline, outstanding rural areas, countryside, and we’ve got some fantastic places as well. So at the moment I’m living just outside of Newcastle, absolutely fabulous city. Real aspects to diversity actually; particularly in the area of Gateshead, the largest Jewish communities in the country.
So there’s lots of it—even though I’ve come here for many, many years—there’s lots of bits about the place that I’m still learning about and still exploring. We’re a large Integrated Care Board, responsible for a population of just under three and a half million. And as I said, we’ve got the urban, the rural and the cities. But actually people will say the size—it makes it really big—is that complex. And of course, it adds a layer of complexity to it. But the whole sort of, I guess, modus operandi of integrate care boards is that you’re focusing on neighborhoods, places and populations. And with our unitary authorities, whilst we look at the Integrated Care Board, we’re one organisation, we’re working really in a system of systems and places. So the best thing about that is we’ve got fabulous people, linked in to these places, working around those neighborhoods and populations who know the population deeply.
And our job really is to make sure that we support them to do their jobs and we can meet the needs of our total population when it comes to health and care.
Olivia Butterworth
Oh, wonderful. And what really makes your heart sing?
Sam Allen
Oh, gosh, well, I’ve got a fabulous Jack Russell called Lola, who every morning wakes me up with a little tap on the forehead. And she’s absolutely adorable but I suppose if I’d been really honest, the thing that’s always made my heart sing is seeing people succeed. So really, having been a leader working in health and care services now for quite a long time, but joining the health care system, probably in one of the most junior roles in health care really making sure that we are seizing the potential that exists in people. Not just those who work in the system, but people coming through education, people at whatever stage there are in their life, seeing where they’ve got that potential and supporting them to achieve it. That’s probably the thing that makes my heart sing the most.
Olivia Butterworth
All that stuff that gives you tingles down your spine, isn’t it, when you hear that somebody has made that next step or they’ve they’ve got a job that they really, really wanted and didn’t think they could ever do.
Sam Allen
It really does. Because I think it’s about really helping people just to have the confidence and belief in themselves. And, I’ve always been somebody that’s thought what I see is, as ever, hard things feel at times, there’s always a way to achieve it, there’s always a way to support others. And I suppose part of our role as leaders working in systems is helping people to achieve their goals, whether that’s in their own health and care, their own wellbeing, but also when it comes to life-chances, opportunities, education and employment.
Olivia Butterworth
Hold on to that thought when we talk a little bit further. Adam, how are you going to follow that as an introduction?
Adam Doyle
Oh, well, I spent five years having to follow that because Sam left our system then to go to her new big gig. So let’s start in the beginning. So I’m the son of two Irish immigrants. My mum moved from Ireland to here and met my dad, whose parents are both Irish. And they both worked in quite of service jobs really.
So I think when people ask where I’m from, I’m from Luton, no one needs to hold that against me. It’s a great emerging town and reminds me a lot of Crawley, which is also a town in the patch that I’m responsible for. So a relatively new town with a lot of immigration within it. I really wanted to be an actor, so I wanted to go into musical theatre. That was my plan. There are times in this job you still can pull that out at times – rarely but it does happen.
Olivia Butterworth
Are you going to burst into song on us?
Adam Doyle
You never know: It’s a Monday morning so I might need to warm my vocal chords up a little bit. But let’s see. I don’t think I was brave enough or probably good enough to do it. So I also then worked in a care home while doing my A-levels and really sort of worked with a number of clients with long-enduring learning disabilities and conditions that sort of were put under that banner about 20 years ago.
Now, thankfully, those people would not be in those kind of facilities now because the work we’ve all done together. But it gave me a sense about sort of justice and things not being right. So I trained to be a physio and loved it. Loved it all and worked in predominately deprived communities in North London for most of my early part of my career.
But for those that know me, know that I also like to be a bit challenging at times. So I used to always say, “Oh, if only these managers got their act together, I’d be so much better”. Of course, then when you do that you realize it’s more tricky than that. But yeah, there’s an element of of youth and maybe naivety that made me think I could change the world.
But I have an opportunity to be responsible for just under 3 million people’s health care, and I take it really, really seriously. And I really enjoy it.
What probably makes my heart sing on a personal basis: I’ve got a great home life and really close to my family, my husband and I both have similarish jobs in the public sector. He works in education, so we often might have a moment of who’s had the most tricky day today.
He always says he wins, I’m never going to be completely convinced, but I’ll let him have that. The thing I do for myself is I actually I’m trained to be yoga instructor. And I love it. And I enjoy it because at the end of a difficult week, I tend to go Saturday morning, and it just helps to reset how and who I am.
But from a work context, what makes my what makes my heart sing is I do like connecting things back together. So I do like to go “I think you’re saying this, I think you’re saying that, I think we can make this work together”. And I see that as a key part of my role in sort of making those connections happen and testing they’re really valid and then letting people get on with things it so yeah, that’s me really.
Son of a plasterer, I’m really proud of what my parents have achieved. Really, really happy to be in the job that I’ve got. Lots still here to fix. A bit like Sam. We’ve got affluence, rurality, coastal deprivation. We’ve got all the gamut of what makes a really exciting job. But it’s only exciting because we get to change the lives of the people that were responsible for. So that’s what keeps me going.
Olivia Butterworth
You’ve both shared so much with us about you as people, which really speaks to why you do the jobs that you do. I’d love to listen in to that conversation a Friday night, Adam, about who’s at the toughest week. I’m now having that conversation regularly with my son who works in a special school. He’s always had the toughest week, every time.
But he finishes at half-past three, just saying.
So let’s talk about involving people, because people who know me know it’s the thing that I am and always have been the most passionate about because people are the biggest asset we have as a country, as an NHS, as a health and care system, and they’re the people who use those services, the people who live in our communities, the staff, the volunteers.
It’s all about people in every single sense and yet we depersonalize stuff and talk about the systems done this. And it’s not, it’s people behind all of those decisions, all of those actions. We’ve had as an NHS a statutory duty to involve since 1972, but we know it’s made a difference to some. We know it’s been a really useful duty to point people to the need to do that, but we know that it’s not really been taken that seriously.
It’s kind of the seen as the soft, fluffy bit on the side and we need to do it to get through this consultation or it’s nice, so let’s have a nice wellbeing day with some people, when actually my belief is involvement of people is the transformation that will drive the NHS into the future. And without those people involved we’ll do what we think is right, while rather than what they actually want or need.
So what’s different now with ICBs and the new guidance that we’ve published, and the environment that we’re now working in because of the different world to 1972? What’s different and I suppose, how are you thinking about that and approaching that?
Sam Allen
It’s really interesting. 1972, my goodness, that was before I was born Olivia. And I’m thinking, what did involvement look like in 1972? And I think particularly when we know that at times health care can be quite a paternalistic model of care of kind of doing to. And I mean, that’s definitely something that’s really changing at the moment.
So look, I’m going to be really honest. We restructure the NHS don’t we? Every few years. We call it something different. So if you’re saying what’s different today to what it was back in June before we technically had integrated care boards? Look, we need to be honest to say, not a huge amount. We’re called something different.
But all things changing? They are. We know that the NHS is still a much loved institution. I say as somebody who’s traveled the world, who’s worked in other parts of the world, I’ve always thought the NHS is like the eighth wonder of the world. It’s there to be cherished, loved and adored. We’re about to head into its 75th year, but it is really, really challenged like most sectors.
But we also know that society is changing, people’s voices are getting louder, people are wanting to be seen as equals, they don’t want to be done to. People want to take control and responsibility in their health care. But also have higher expectations, I think, of health care services. And I say that first and foremost as a patient myself at times and caring for loved ones too.
I think the world’s changing, societies are changing. Yes, we’ve got some new structures. Yes, we’ve got some new statutory guidance. And the way I’m looking at that is that this is about relationships now. This is about building trust. It’s not about doing to, it is all about doing with. And it’s also not something you can just say, let’s be honest, roll out at the beginning, middle and end of a process and think it’s done. It’s an ongoing relationship, and an ongoing dialogue, and ongoing conversation.
Olivia Butterworth
What we’ve seen over the years is we go out to communities, we ask them what they want or what they think. We take it all away. We sense-make that ourselves without them helping make sense of it. And then we never go back to them. Because going back to the restructuring point, we’ve probably restructured and people’s jobs have changed.
So then the new people go back out and ask the same questions and are surprised then when people don’t turn up because we haven’t done what we said we would or nothing’s changed. And then people get angsty and cross because nothing’s changed and we’re asking the same questions again. So that enduring, continuous conversation with people with honesty: we can’t change for them, we can’t make everything perfect. We don’t live in a perfect world. And trust. Adam I wonder if you might pick up on that trust point, because I just think that’s at the heart of all of this, isn’t it?
Adam Doyle
I completely agree with what Sam saying, and taking it forward, therefore, what does that look like then, day to day? So I’ll be honest with you, I think because of the multiple restructures that Sam’s alluded to, I think at times there is a lack of skill in how you listen to communities and just sit with it. With everyone, with a bunch of Chief Executives, we’re all talkers; we like to say stuff. But actually, the real power is to listen and just hear what the community are saying. And then say, and not over promise, and most times that I’ve met the communities in Sussex, or in other jobs I’ve had, most people, I think, want to feel they matter. And therefore when you hear someone’s lived experience, it’s really, really key and important.
So I spent awhile two weeks ago with the Chinese community in Hastings who are larger than you would expect and therefore have been missed. They’re easy to reach, but they’ve been missed. And I had to sit with how and why we missed them, and I went back to the basics of any sort of problem you have as a leader.
Do we have the right relationship? Do we have the right skill and do we have the right knowledge? And quite clearly in my system, we didn’t. So therefore that’s really easy to change as long as you want to change it. And only when you do those things, do I feel you build the trust. Without that, I think it’s slightly meaningless.
The other thing—I’ll say it—is the NHS likes to be a little bit like “we are the NHS”, so therefore we can come and have a conversation with you as the NHS. There are so many better trusted community leaders in my system who can give me tips, clues about how to engage or speak to people in a way that I just wouldn’t have thought about it.
So you’re both looking at me, but people are hearing this, aren’t they? Like sometimes, Adam, as much as I love to wear a tie; take the tie off, wear your jeans, put your trainers on, go out at seven in the evening and speak to people. And when I spoke to all the sex workers in Brighton about six months ago, going out in my suit was not the right manoeuvre. And I was told very clearly, we’ve heard about you, this is what you need to wear.
Olivia Butterworth
What had they heard about you though?
Adam Doyle
That I like to dress quite snappily in that situation. But we’ve got to have humility as leaders to ask a question and to go “I don’t really often speak to these people, what do they want out of the conversation? What’s the best way to approach it?”
But historically, I think we sort of have these sort of big consultations. We have these big set pieces. But really, go back to the human part of it, have a conversation, speak to people. And actually, it’s really quite easy. It bothers me why we find it so difficult, but that’s partly because we’ve got to free our minds up and give ourselves the time to hear what people’s perspectives are.
Olivia Butterworth
I couldn’t agree more. We’ve almost forgotten it’s our responsibility to sit with and feel uncomfortable and really, really listen about what matters to other people and where they are in their lives. Because health services don’t happen in discreet isolation, do they? Education impacts, housing impacts, the environment impacts, employment impacts, everything impacts on our health, and that then impacts on whether we can access the services.
So are they on a bus route? Do we know where they are? There’s a whole mess of stuff, but we all too often design from our health perspective, and then we’re surprised when people don’t come. They don’t do what we’ve told them to do because actually we haven’t really listened.
I’m often asked, “Oh, Olivia, could you go and engage with these people? We need to know what they think”. And I’ve got to the stage in my career never to say no unless the people who are responsible for that thing that they want me to talk about are with me. So I’ll work with people who want a conversation with those communities, but they’ve got to be there in present and in the room, because otherwise they don’t hear it because when you do the board report or the paper, the words don’t actually convey the real meaning of what people have said because you pick up so much more. And I just wonder, as the leader of your system, what you have thought about in relation to giving your teams the confidence to do that? Because I think going back to something Adam said, I think we’ve lost some of the skills and the confidence to just sit with and to be, to talk about what people want to talk about rather than going with our own agenda.
Sam Allen
Yeah. And I think also we need to use the opportunity, having had two years of obviously living with COVID and moving beyond, where everybody’s adapted and worked in some really different ways, working online. And how people haven’t spent as much time as perhaps they would have done having some of the more face-to-face, formal conversations and also going somewhere.
So I think that we have lots of different learning styles, you can listen, you can hear, but actually could you go and sit with somebody? Can you go and be with somebody in their day-to-day reality, whatever that is, whether they’re working in a charity, whether they’re a person who is caring for somebody in their home, how do we actually get a greater understanding of the lives of people in our neighborhoods and our communities?
And so certainly from an integrated care board perspective, one of our first development sessions, we identified that actually as board members, we need to be spending time out in our communities listening, learning from others. So that’s something that we’ve embarked upon. I have to say, with the very early stages of that.
I think also people who work in health and care, I mean, the vast majority of people are delivering frontline services, they’re seeing this day-in and day-out. But are we connecting up people whose role is to design services, working with others? Do we really understand the problems, the multiple hand-offs, the what it is like to try to access urgent care out-of-hours? Well, of course, the other thing you can do is bring in your own lived experience from that. And I think that also having lived experience as practitioners, peer support workers, right across health and care has got to be fundamental too, because every conversation you have, you learn something. When I’m out shopping, if I’m in Tescos having a conversation with somebody at the checkout, I’m asking them a question, I’m looking on and observing. The amount of things I find out through those conversations, even I find it a bit shocking sometimes actually.
How do we draw on that and bring that in without it just being anecdotes? So this is a constant thing. It’s not something you can just do. You have to live and breathe it. And I think the first thing we as all leaders can do is promote the importance, the value of this.
And so I think having that as part of our values as an integrated care board, the fact that we will work with people, listen, evolve right throughout all we’d say is quite fundamental, really, and something we’ve got to pay constant attention to.
Olivia Butterworth
Sam, this is why you make my heart sing. Because I couldn’t agree more. We’ve got to bring it off the page, haven’t we? And it should be fun, because people are just brilliant and they come out with stuff and you go, “I’ve really never looked at it like that before”. If we’re open to not being locked-in to our view of the world.
Sam Allen
We’ve got a fabulous charity here in the North East, called Children Nnorth East, and they work with schools and they do something called poverty-proofing where they they go into a school, they interview every child in that school to understand what it’s like to go to school every day, all the nuances about the school lunches, the break-times, through the eyes of the child.
And we’re trying to take that methodology now and apply it to pathways of care. So why is it that we have such high numbers of people who don’t attend an appointment in a morning? Well, because actually there isn’t the public transport that runs from the local community in the morning. So I think we’ve organized services in a way that predominantly fits the lives perhaps of people working in those services or a much more traditional approach to service delivery. Actually we need to shift our thinking completely, and the whole way we design pathways, the way people access the care that supports people in their lives, not what suits people working just in health and care. And I don’t think that has been the case, but it’s much harder for some people. This is what gets us to the point of healthcare inequalities; access to services because of certain barriers that they’ve got in their lives that perhaps other people don’t have.
Olivia Butterworth
Let’s talk about health inequalities. So we know from all of the work over many decades now, Michael Marmot’s work that he published ten years on, just before COVID hit. We know who experiences the worst health inequalities and then they tend to be the people we label as hard to reach. Well, we know they’re not hard to reach. Actually, it’s us in the system that’s hard to reach because largely where white, middle-class, well-educated folk, we just have no connection or understanding of how different people who don’t look like us live their lives and what matters to them.
So how do you see the sort of the approaches we need to addressing health inequalities which can’t just be done by the NHS? I mean, we all know that. But how do we do that relationship between those health inequalities, priorities and involvement? And I think just picking up on something else you said, we’ve talked to lots of people and we know that actually what they experience is assessment, handover, assessment, handover, assessment, handover without ever getting any access to care because it’s always “You’re not ready for this service”, or “No, we can’t deal with you.
You’re too complex”, or “Well, no, I think you need to go here”. And then people are repeating their story time after time after time with different services. The whole integrated care model is a real opportunity. I wondered Adam, you mentioned that you’d spent some time with with sex workers who are always overlooked and hugely stigmatised by society as well as services. Just wondered if you’ve got any sort of insights into that?
Adam Doyle
My overriding view is and we have to first accept that the data tells us health inequalities are not getting better in this country generally. Therefore, the approach that we have put for them can’t have worked. So therefore every ICB, every ICP has to challenge themsevles to say what’s going to be different?
Olivia Butterworth
What’s an ICP? Sorry to interrupt but it’s important.
Adam Doyle
Integrate care partnerships. As part of the the new act, there are two statutory bodies that are responsible for each of the 42 integrated care systems, the ICB with a predominant function about the NHS and how that operates. But it’s also to deliver the plan that the Integrated Care Partnership, a wide range of statutory and non-statutory partners across an integrated care system who come together to pull their overall strategic plan in place.
So, so sorry, I’m typically doing an NHS manager here and using a three-letter acronym.
Olivia Butterworth
I think that’s the first three-letter acronym we’ve used so far without explaining it. So I think we are doing alright.
Adam Doyle
So we’ve got to agree that it hasn’t worked. So in our system, we are actually working with our three great universities to say help us shape how we do this differently with international evidence that are very different ways in how we engage communities.
There are three main platforms for that, first of all. Let’s accept the communities are there and let’s be clear where they are. They do have people who know them well, so don’t use their skill, actually embrace their skill and potentially consider funding their time and energy to help you access those communities. It has to be clear, though, that in doing it, you’re doing a positive intent, but you are also doing a data-driven exercise. So rooting public health into that just has to happen as you go forward, so that’s as we’re tackling it.
You’ve then got also parts of when you speak to people, they tell you what it is like. So, for example, in Brighton we have chosen to have a homeless GP practice. They do a great job that practice for the homeless community. But we haven’t chosen to do anything for our sex workers who don’t access general practice. So I would ask myself the question, why is that? And therefore I think it is because we don’t yet get all of our leaders across the public sector to understand completely the true population that they serve.
So what we’re doing, linked to how Sam’s described it, all of our integrated care partnership partners and our integrated board members are out meeting the communities. We’ve had a conversation with each about who they are, and we’re particularly targeting them to meet people they probably would not meet when they’re doing their Tesco shop, or their Waitrose shop, so they’re going to meet someone that just won’t come past them, to understand things better. My worry is these things take time and you’ve got to allow people to build their confidence speaking to people they don’t normally speak to.
And then once you’ve got that, that’s where trust is built. And then you start to redesign the pathways. So it’s a much more anthropological, psychodynamic approach we’re taking here than a typical where’s the action plan, how to get it done. But I think it does create the right platform for change.
Olivia Butterworth
I think that’s really powerfully described and it is that holding it in that emergent space as opposed to moving to action, coming up with the solution too quickly. We need to sit in that slightly uncomfortable space where we don’t know, we need to be honest that we don’t know, and we need to talk about it. People find that really uncomfortable, don’t they? It’s really tricky thing to do because we’re meant to know the answer.
Adam Doyle
I’m not always brave to say, “Oh, I didn’t know that about a population that I serve”. And I find that particularly with NHS partners who’ve been here for a long time, doing a great job, to be vulnerable to say, “I might have done this for a long time, but I still don’t really get those wards in Brighton. I think we do understand it. I never go there.” But that’s okay. We all have blind spots, don’t we? I think the job of people like myself and Sam is to create the environment where people can say, “I’ve got a blind spot” and there’s no judgment there. That’s, I think, the difference in an integrated care system that might be different to what people might see as a traditional chief executive kind of role. our job is to encourage people to see difference and create the right environment where they can feel brave to embrace that.
Sam Allen
I think we need to be realistic as well around health inequalities and I find it’s a term that use quite interchangeably around a number of things. So if I think about health inequalities, I think about things that are unjust, unfair, they’re systemic, are in communities, whether that’s associated with poverty. Whether that’s also a particularly relevant here in the north-east, in a particular post-industrial era, what we would maybe described as left- behind communities, communities that don’t have so many civic assets within them. They haven’t got the digital connectivity. And we know that people’s health outcomes can be a lot worse in those areas. And for us, we measure that in terms of life expectancy, but maybe even more important, years of quality of life lived, living with multiple long-term conditions in your forties is very different to not getting your first long term condition so much later in life. So people’s quality of life. And if we think about children as well, unfortunately here in the north-east, this is going slightly backwards in terms of children living in poverty, two in five now. So if we think about the health inequalities, we need to be honest to say the NHS is not going to be able to address all of these on our own and I think that’s one of the most critical kind of benefits of working together with system partners actually. No one part of our health and care system, local government, the NHS, education, the business sector: we’ve all got to come together to solve these things together, to also have the best available research.
The bit we really can do something about using population health management approaches is a healthcare inequalities. So the way people access care, the way they experience it, what their outcomes are and we can really target interventions using the Core 20 Plus Five approach to really focus on. And as Adam said, if we know our communities, if we understand them, then we can target those evidence-based approaches to them. But it’s a bit of a bugbear of mine, Olivia, because we talk about health inequalities, we talk about health care inequalities, we talk about population health management. And I know it drives our public health colleagues to distraction, because we’re kind of like the new kids on the block as integrated care boards, and people have been at this for decades. This is not new. But it’s how do we use our combined strengths to do the best we can, really as Adam said, really understand our communities and we use the data. But we’ve also got to get out there, we’ve got to see it through their lens, walk in their shoes, listen. And actually the vast, vast, vast majority of solutions rest through those people with that lived experience, not from us sat in our offices thinking that we know best about our communities.
Olivia Butterworth
You’ve both really sparked something that I wanted to just bring up, and I think that’s might be the last thing we talk about, but it kind of speaks into a lot of what you said about real-asset based approaches and that whole approach of the NHS as an anchor institution. The NHS is the biggest employer in this country, but we all too often really don’t tailor our employment approaches, our recruitment practice to attract people, who don’t work in the NHS, who don’t have a degree from a great university, they don’t already have that training and they’ve perhaps never aspired. They’ve perhaps always thought that’s not for me, they could never do that.
And thinking about what you saying about sort of post-industrial area and communities where actually the employment opportunities have gone but the NHS is struggling to recruit workforce. So what opportunity is there in our involvement approaches to not just be going, asking people what they want and how they’re experiencing their care, but what do they have to contribute to their care and would they like to work for us?
Because you’ve mentioned employing people with lived experience and peer advocates and so on. But I wonder if we could challenge ourselves to go one step further and go, actually, we need you as our nurses, as our physios, as our occupational therapists. We want to see you enter the NHS to bring your skills, your knowledge, your experience of your communities as health care providers. Not just as your label of lived experience or your label if you’ve been homeless or your sex worker because those label stick, but that they’re people with amazing skills. If you’ve claimed benefit, oh my goodness, you have got some skills to be able to navigate those systems because they are so complex.
So how do we harness those? Adam, you’re looking really excited, go and jump in.
Adam Doyle
There is a whole other podcast on NHS historical rigidity. So I could start on that and I wouldn’t stop. Let’s be really clear. This is why I love the current model that the national team have negotiated with the Department of Health and Social Care for the new act, which is permissiveness, locally, because people are different. And I think sometimes maybe there are many models of thought about ICSs, the number of them and the size of them and there’s a lot of that.
But what I love the most about this change is that I have got the permission to do things differently here. So Sam’s context, whilst we may have similarish parts of our system, there’ll be different economic issues in Sam’s area to mine. So the way she will approach workforce should be different. So a one size fits all model isn’t correct.
I think what this speaks to though for me is if we’re going to make our engagement approach much less rigid, much more humble, with greater humility led by all layers of the organization that creates, I think, also some really exciting opportunities about employment. But we then have to then recognize that we might be doing things – I heard one colleague last week suggest an any-hours contract. I’m really thinking that through actually. If you can do five hours and that is at Thursday starting a four, I know there is one part of the system that could do more of that, but how do we match that together to make it work for people? So I think we need to utilize it to hear it. And I think what would be great is access the community with an ask, but also an offer because then it becomes a real trusted conversation of how we go forward.
I’d say my system, we’re a little bit in the foothills of that, to be honest with you. So we’ve got some significant work through to get that piece right. But I’m seeing my Chief People Officer next, so it is on his list for his 1-to-1.
Olivia Butterworth
Amazing, amazing.
Sam Allen
Just to echo everything that Adam said, which I fully support, I think we’ve got a real skills and workforce shortage in health and care, but actually so do a lot of other industries. So we cannot deny the fact we are competing now for essentially the human capital that exists out in our system and when it comes to health and care that’s a global competition. And you’ll know that we are still actively recruiting internationally, which is amazing that people are coming to live and work here, and I think it makes our NHS a much richer NHS for that. But we quite simply need to make sure that we’re able to provide rewarding, fulfilling careers. I think we need to have a good look at ourselves, it needs to be much easier to get a job in the NHS than it is.
Navigating NHS jobs can be a bit of a challenge sometimes; it’s not particularly user friendly and if you’ve got onboarding taking longer than two, three, four weeks, then you’re likely to lose the person. So the Amazon warehouse that’s cropped up down the road and once we get people, we’ve got to be able to support them. So I think the easier that we can make here to navigate across the NHS and care, I think we’ve got massive opportunities really with that.
The easier that we can make working environments flexible, supportive, inclusive for all the better. But I think we’ve got huge potential and I think the way in which we grow the health and care service will support economic recovery and development too. So it’s kind of a win-win for everybody.
You’ve got to ask yourself what gets in the way of it, so maybe we should focus our energies there rather than the next initiative or the next big idea to open up. If we build something that will keep people and easy for people to come to work in and pays people living wage, then we wouldn’t have a problem, would we?
Olivia Butterworth
I couldn’t agree more and recognizing and valuing our people, not just as deficits, units of need that we have to provide a service to, but as people who can provide those services in our employment and to their peers, to their families, because people are brilliant and I have to say, you to are utterly brilliant. I feel really humbled that you’ve gifted us a whole hour of your time this morning to talk this through.
And I feel more humble at your commitments and passion for really putting people at the heart of your new systems in the way that you lead them and in the way that you support your staff and your teams and your partners to really connect with your communities so they feel valued and we can start some different conversations. So thank you enormously.
We’re going to follow this up with some other podcasts, so maybe we should do a podcast about how we involve people to raise their aspirations as our future workforce. That would really excite me. So on that note, thank you so much for listening in. If you want to hear more, see more, we’ve got a whole series of webinars, I understand, although I can’t see this at the moment when you access this podcast, there’ll be a load of links underneath it and you can find out loads of more information.
And if you do want to work in the NHS, go chat to somebody because there is loads of jobs available that you don’t need qualifications for, because the NHS can support you to get those. It’s about your values.
So thank you so much Adam. Thank you very much, Sam. I wish you well for the rest of your week. It’s been a pure delight chatting with you this morning.
Thanks so much for listening to this episode of the NHS England podcast. Today I’ve been talking to Sam Allen, chief executive of North East and North Cumbria Integrated Care System, and Adam Doyle, Chief Executive of Sussex Integrated Care Board, about the approaches they are taking to working in partnership with people and communities. If you’ve enjoyed this podcast, you can listen to more episodes available by searching NHS England on Spotify, Apple Podcasts and SoundCloud, and it’s also available from www.england.nhs.uk/podcasts.
Look forward to you tuning in soon.