Things come together – a blog about my mum

Our Managing Director, Deborah Evans shares a candid insight into the final moments with her mother…

I’ve always been struck by the title of Chinua Achebe’s novel Things Fall Apart.

My mum died recently and in her case it was much more like Things Come Together.  Mum lived in a brilliant Brunel Care home called Saffron Gardens. The care home is an amazing place where people, like my mum, with dementia are cared for by first class staff.

Right up until January, Mum was able to visit us at home and enjoy our company. However, in more recent weeks she stopped eating. She would hold my hand and gaze up at me, or touch a colourful scarf I wore.

As her body became weaker, infections would start to impinge on her health. The staff and I would try to discover what was wrong with her. We used all our foibles to try to give her medication or take her pulse, temperature and, most challengingly, her blood pressure. She was highly resistant, not understanding the strange sensations. It’s one thing to let your daughter put a temperature probe in your ear, but another when she starts squeezing your arm! We had a secret weapon; a kind-hearted Polish team leader from the other unit would come over and give my mum a big hug and tell her that he loved her – and then quickly slip her liquid medicine down her throat.

This kind of deterioration isn’t rare, which is why colleagues in Kent Surrey and Sussex AHSN have a ‘test bed’, which aims to harness technology to address some of the most complex issues facing patients and the health service and help support people with dementia at home.

Our team in the West of England are also working on how to take a complete set of vital signs and calculate a National Early Warning Score (NEWS) from a person who doesn’t easily comply with examinations and tests. We are also looking at ‘wearable’ devices, which can take and relay vital signs from people in their own homes to staff working in rapid response teams, out of hour’s services, GP surgeries and ambulance services. This would greatly help the GP, paramedic, out-of-hours and nursing home staff to understand how best to help a person who can’t describe and can’t comply with care.

At a time when the NHS is so stretched, I was so proud that her GP practice at Lawrence Hill Health Centre, BrisDoc, and the South Western Ambulance Trust fielded skillful and clinically astute staff to support us in helping my mum die at home surrounded by her family.

The evening before she died, we sat around her bed and sang songs they would sing at ‘Singing for the Brain’ and Mum would lift her arm as she recognised them.

The love and care of women of every colour and nationality at Saffron Gardens care home, and of committed NHS professionals, meant that everything came together for my mum at the end of her life.

Thinking outside the STP box

Our Patient and Public Involvement Manager, Hildegard Dumper looks back to our annual conference and the delights of playing Partneropoly…

If you happened to be walking through the corridors of the Swindon Hilton back in October, might have been surprised to find yourself in a room of shoeless health professionals screeching at each other in competitive excitement. You’d have seen the entire floor covered by a vast colourful quilt, which, when your eyes adjusted you would have recognised as rather like a Monopoly board.

This was the Partneropoly workshop at the West of England AHSN’s annual conference, which was given over to the theme of Sustainability and Transformation Partnerships (STPs) and brought together all those involved in delivering the three STPs in our area (Gloucestershire; Bristol, North Somerset & South Gloucestershire; and Bath, Swindon & Wiltshire).

The Partneropoly workshop was an interactive approach to getting the different stakeholders in the STPs to think ‘outside the box’ and see how they could share resources and expertise to make their plans more effective. Inspired by that well-known game Monopoly, Partneropoly was the brilliant brain child of Jan Cobbett at Bristol Health Partners, originally designed to encourage their Health Integration Teams to work more collaboratively across their ‘silos’.

In our workshops, we divided participants into teams based on their STP footprint. Each team could be made up of any combination of people from all kinds of organisations: commissioning, trusts, public contributors, industry, education, and voluntary sector. Just like in the traditional game, teams got to choose their playing piece – there was a boot, iron, top hat, car and so on – the only difference being these were huge! They threw the two massive dice and picked up their boot, iron, car or whatever and physically walked it around the board. Instead of landing on real estate like Mayfair, Oxford Street and the like, our teams landed on a possible partner organisation. This could be the AHSN, your local trust, clinical commission group, housing, police, education or just about any other potential partner. On picking a Chance card they’d be asked to think through how their STP might work with that specific stakeholder organisation on a specific area of work, such as equalities, patient safety or making better use of estates or workforce development.

I was fascinated to observe individuals being made to leap (in stockinged feet) well out of their comfort zone and interact with people they would not normally have reason to talk to. Then to top it all, they were actually having to listen to each other. I watched one group being dominated by two commissioners who were assuming they had to have all the answers. Eventually the penny dropped when they realised they had a valuable resource in their voluntary sector team member.

Afterwards, several people said it made them realise that there is a wide range of organisations out there that might play a meaningful role in delivering the vision of our STPs. Someone from a large trust told me they really had no idea there were so many organisations that could be working with. Those from industry said it had helped them understand what STPs are all about and how they could work more effectively with the health sector.

We are planning to use the game as a tool to get people from all disciplines interacting with each other. One of its next ‘outings’ will be with our Patient and Public Leads in the region to see how it can be of benefit to them.


Why the AHSN is like a honeycomb helmet

In follow up to her last cycling-meets-leadership blog post, Deborah Evans reflects on the beauty of a new cycling innovation and draws comparisons with how we work here at the West of England AHSN…

Talking of cycling, I was fascinated to read an interview with a woman who had invented a cycling helmet made of paper. In a classic case of design mimicking nature, it used a honeycomb structure.

I’m not sure whether I’ll wear one until someone else has tested it (not just a dummy) and definitely not until it’s been waterproofed.

But I’m enthusiastic about the concept nonetheless, because like cycling itself, paper is very eco-friendly and makes for happiness.

It made me reflect on the similarities and differences with the innovation processes we use here in the AHSN.

Firstly, it’s a great example of ‘innovation pull’.  In this case the unmet need was a lack of helmets to go with the ‘Boris bikes’ which we can pick up on the streets of London and ride at will.

Our equivalent in the AHSN is that we ask clinicians what problems they would like to solve. Sometimes we work with them to identify innovations that are already on the market, having been tested and are ready for use. And sometimes we issue challenges for innovations that are still in the developmental stage. Our favourite, perhaps, is the Small Business Research Initiative (known as SBRI) which is nationally funded. Our latest initiative in this programme was called General Practice of the Future and we called for innovations responding to demand management in primary care; self care and diagnostics and earlier triage.

Another similarity is that we like to invite people who use services to help us design innovative products and services – such as our crowd sourcing project Design Together, Live Better, which in its first phase famously resulted in a prototype child  car seat which you can fasten with one hand.

As far as I could tell from the newspaper article, the honeycomb helmet results from the inspiration of a lone inventor, and we have plenty of those in health – especially clinicians. But Lars Sundstrom, our Director of Enterprise and my innovation muse, tells me that the future for innovation is largely about collaboration and open source activity. This seems to be most effective (many minds are better than one) and quicker. This is a feature of our Diabetes Digital Coach test bed project, where we have a hearty collaboration between a number of small and larger companies and the support of Diabetes UK to create an online service hosting a range of digital self management tools for people with diabetes.

Another reason to love the honeycomb helmet of course is that it’s cheap, and surely that’s what the NHS needs. Effective, cheap and recyclable innovations.

Get folding that paper!


Freewheeling leadership? Not likely…

Last week our Managing Director Deborah Evans won an NHS South West Leadership Award. Here are her reflections on leading system transformation…

The last time I won an award was the cycling proficiency. Perhaps it’s a fitting analogy, as that’s what I did then and still do. Every day.

The same applies to system leadership – it’s just been what I do for many years at work. It doesn’t feel half as free as when I’m on my bike, and unlike being a cyclist and enjoying unconscious competence (that’s my claim!), system leadership needs constant, conscious work.

I felt happy and honoured to have won the South West Leadership Academy’s ‘Leading Systems Transformation’ award and now I feel it’s my responsibility to reflect on Leading System Transformation.

It’s not just about positional power: the ten years as a PCT chief exec and the four years leading the AHSN. It’s about being able to use those positions, in concert with others, to make large scale change. A few examples:

  • It was re-commissioning community children’s services across Bristol and South Gloucestershire to create a national exemplar service worth £100 million over 5 years;
  • It was working with all the chief executives in the South West to re-commission (and decommission) a variety of specialised services, such as bariatric surgery, plastic surgery, specialist paediatrics, low secure mental health
  • It was a number of large scale public health programmes in Bristol and beyond
  • It was chairing the multi agency children’s trust in Bristol in support of a talented city leadership team and councillors
  • And more recently it’s been about working with passionate clinicians and talented managers to bring system wide improvements across the West of England in quality, safety and the use of data for patient benefit.

So what were the scars and what are the lessons from my personal experience?

Firstly it’s about being prepared to commit to a shared enterprise even though it’s tempting to put your own organisation first. I remember feeling very apprehensive when an assessment of Bristol City’s Children and Young People’s Services in about 2002 said that the Council’s potential for improvement lay principally with its partners. And I realised that meant me; and I had no idea how. But as a group of partners (head teachers, the police, Barnardos, social services, young people) we went on to achieve great things.

It’s about realising that one has to commit to other organisations’ agendas. When we wanted the South West Ambulance Trust to adopt the National Early Warning Score we realised that they needed help first on gaining engagement and support from clinicians and trusts for their Electronic Patient Record. So we worked hard at that. Sometimes you just have to help with a partner’s agenda for no obvious gain. It’s about building relationships for the longer term.

It’s about good, genuine engagement and sound processes. Negotiating changes to specialised services with 14 overview and scrutiny committees across the South West was essential but never quick.

Of course it’s about securing and developing a good team. But, for senior leaders, it’s also about visible partnership, modelling behaviours and being willing to follow as well as lead. In these highly pressured times I sometimes see partnerships fracturing and blame squirting everywhere.

System transformation is also about belief. It’s very hard to demonstrate confidence and hope at the moment. However I’ve seen enormous changes accomplished in my years as a chief executive and I’ve been part of health communities that have worked their way out of huge financial deficits and restored compromised services through radical change. It’s not fun; it requires determination and stamina and it takes years.

However we have the skills we need to make transformational change happen. And its like cycling – the more you do it, the fitter you get. So with system wide working and partnership – the more we practice, the better we become.

If we are to make transformational changes, we need to develop a vision with the widest possible engagement. We need to do things differently, draw on innovation and focus on adoption and spread of pre-existing evidence of best practice.

In the 50 years I’ve been a cyclist I don’t think I’ve fallen off my bike more than half a dozen times. But in system leadership it happens a lot, and sometimes there’s a full blown road traffic accident. And when that happens we have to get out on the road again, quickly.

Put your helmets on!

Donald Trump to save the NHS!

In his latest blog post, our Enterprise Director Lars Sundstrom reflects on leadership in times of change.

So have I finally gone insane or is there is any substance to this statement? Of course not. But then again, not much of what Trump has promised will materialise: he just said it to win votes, and you can quote me on that.

Being an American, I am saddened by the lack of ability of many of my fellow citizens to distinguish reality from a reality show. But I guess, as that great voice of the nation Homer Simpson said: “I don’t believe in facts. You can make them say anything.”

Now that I have your attention though, I’d like to keep you here to talk about the importance of leadership in times of change.

Last Thursday, David Constantine received his honorary doctorate from the University of Bath and gave the 48th Annual Designability Lecture. What an extraordinary life he has made for himself and so many others despite being wheelchair bound, having broken his neck in an accident at the age of 21. Not only has he over the years been at the forefront of designing mobility equipment for those with disabilities but has managed to travel the developing world and set up local wheelchair factories that continue to make lives better for hundreds of thousands every year who have more to complain about than we do.  And just to cap it off helped set up the charity Motivation to implement new financial sustainability models that employ locals to do it.

You are a truly inspirational leader, Dr Constantine, even though you apparently don’t seem to accept it was anything special.

And then to other inspirational leaders. On Friday night, our MD Deborah Evans received the NHS South West Leadership award for Leading System Transformation; another well deserved accolade to someone who doesn’t think they deserve it. All I can say is that Deborah is one of the most inspirational leaders I have ever met and have had the pleasure of working with.

It’s a beautiful autumn day as I write this blog post, but we are now bracing ourselves for what will probably be a harsh winter in more ways than one: pressure on healthcare to deliver more for less resource has probably never been greater.

Even the most hard-nosed Brexiteer accepts that the economy will initially suffer as we exit the EU and public finances will be tightly squeezed. It’s hard to feel optimistic at times, when some use deception to triumph over reality and make things worse for those of us left to cope with the real world. However, I really believe it’s in hard times that true leaders and true innovation arises.

We will of course cope. The US and the UK have given mankind many of the greatest inventions and lead the world in innovation. In fact, many of the great American reforms and indeed the NHS itself were born out of severe austerity. So this is the time for great leaders to emerge and take the stage. Next week I am teaching a leadership course for university academics and I will be telling them to expect and embrace change. Don’t suffer it. Lead it!

So Trump is not the kind of leader we need right now, and he won’t care much about equality or healthcare. He won’t save the NHS, but I do remember a certain Mr Farage a little while ago…

Lost in translation

In his latest blog post, our Enterprise Director Lars Sundstrom reflects on the need for AHSNs to be multilingual.

When I first joined the AHSN three and a half years ago from my previous job at the University of Bristol, one of my esteemed colleagues at the time said I was crazy.

“Don’t go there,” he said. “I’m warning you as friend. People in NHS land speak a different language. They aren’t like us. You really won’t like it there, trust me.”

After being there a week I understood that he was probably right. I had no idea what my colleagues were on about in meetings and they soon got very fed up of me asking the same question, “Why are you doing it like that?”

I had to undergo an induction the following week. I had visions of magnets and coils but instead I was introduced to the patient safety lead.

“What’s patient safety?” I asked. “Is that something to do with making hospitals safe?” She smiled at me and said,  “Well it can be but it’s really about reducing variability across service providers.” I was none the wiser.

Then I was introduced to the improvement lead. “Hi, what do you do then?” I asked.

“Well,” she said, “We apply quality improvement support working in the local workforce to ensure they have appropriate skills to spread best practice.”  “Geez, sounds complicated,” was the only thing I could think of to say.

I feel like I’ve landed on Mars among a bunch of aliens! I have no clue what you guys are talking about in our team meetings.

After my first month our MD called me into her office for a chat. “How are you finding it?” she asked.

“Well, I feel like I’ve landed on Mars among a bunch of aliens! I have no clue what you guys are talking about in our team meetings.” “Don’t worry,” she said, “You’ll soon pick it up.”

I wasn’t so sure. However I was clearly amongst a new tribe of very bright and talented individuals with a passion for what they were doing, so I thought to myself, “Wow, this is great. I have so much to learn.”

“So, tell me about your plans for the wealth creation remit of our AHSN license,” our MD asked. Now, this I understood so I launched into my thoughts about translational medicine and the importance of building trusted partnerships to achieve effective co-creation in an open innovation environment, while encouraging horizontal innovation from multiple sectors and especially the importance of achieving joint value creation rather than operating merely in transactional mode with the private sector.

“Interesting,” she replied, looking at me with an air somewhere between bemusement and intrigue. “So what exactly does that mean then?”

Last week we had our third annual conference on the topic of innovation for sustainability and transformation. This morning I was having breakfast with one of our newest recruits; a bright young chap from a corporate finance background.

“So James, what did you think of the event last week?” I asked.

“Well,” he said tucking into a bacon sandwich, “Honestly, I was totally lost most of the time, didn’t understand what was going on. It’s a different world, clearly.”

“Don’t worry,” I said, “You’ll soon pick it up.”

Between bites he then added, “Well actually, the only bit I really got was when our MD spoke about how adopting open innovation and co-creating value leads to cost savings and the importance of partnerships across multiple stakeholders. What’s all this sustainability and transformation stuff all about anyway?”

“Well,” I said, “It’s the local road maps for delivery of the five year forward view.”

“Hmmm,” he said, and I could see from his expression he was none the wiser.

We are what you might call an eclectic mix and what I am looking for most is people who can bring their own perspective on what we do and are not afraid to question what we are doing.

So I realised that our AHSN has now become truly multilingual. I understand NHS speak, though my accent is apparently still a bit rough, and my colleagues now also speak a very different language too.

I have always tried as far as I can to hire people to our team that are as different to me as I can possibly find. We have people from many backgrounds: education, finance, health and government.  We are what you might call an eclectic mix and what I am looking for most is people who can bring their own perspective on what we do and are not afraid to question what we are doing.

The point is diversity of thought; the ability to see things in a different way. Feeling empowered to question the status quo and feeling empowered to do something about it is what really matters if you want to achieve truly sustainable transformation.

As a famous person once said, “We will not solve the problems we have by applying the same thinking that created them in the first place.”