Talk Health and Care

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A report by the National Audit Office (NAO) early last year on the adult social care workforce in England concluded that “Social care cannot continue as a Cinderella service – without a valued and rewarded workforce, adult social care cannot fulfil its crucial role of supporting elderly and vulnerable people in society”.

Fast forward to today and we need to reflect, be honest with ourselves and ask if the sector has moved on.

Here at the Association of Directors of Adult Social Services (ADASS), we are challenging ourselves to think about some of the key issues. In the absence of a Green Paper, we need to be more positive in thinking about what we would want to see from a workforce strategy. We ask that employers and employees use Talk Health and Care to do the same.

Whilst there will be debate about how change can be delivered, what we can all agree on is that change is needed. It is shameful that social care is often viewed and referred to as a low-skilled profession, when the people who work in care are highly capable and accomplished.

We need to be ambitious for the sector and its staff, consistently reminding ourselves and others that a highly skilled, dedicated, compassionate and appropriately remunerated and appreciated workforce is a key component in supporting people to live safe, well and fulfilling lives.

We must debunk the myth that there are no career opportunities in the sector and promote the different entrance routes into the profession, progression opportunities and career pathways.

If we allow ourselves to have an overstretched workforce, with insufficient training and lack of career opportunities we risk staff not feeling the reward that comes with caring for people. We want to aim high and to be ambitious for care staff, so we need to acknowledge and reward the challenging roles they have.

Join the conversation and add your thoughts today to the challenge ‘How does your employer value the work you do in social care?’.

Julie Ogley

Director of Social Care, Health and Housing at Central Bedfordshire Council and President of the Association of Directors of Adult Social Services (ADASS)

Being able to see the new resources, equipment and facilities we’ve funded being delivered and making a difference on the NHS frontline is one of the great aspects of my job. 

During my visit to Devon, the South West Ambulance Service showcased 63 new ambulances hitting the roads to treat patients across the region. These state-of-the-art vehicles will help ambulance staff cover their huge 10,000sq mile patch, attending hundreds of thousands of emergencies a year.

I’m continually inspired by the compassion and enthusiasm of heroic NHS staff and the call handlers, ambulance crews and operational leads who all work as part of these teams and Exeter was no exception. They taught me about the challenges of being part of a rural ambulance service and importantly, the incredible role their thousands of volunteers play in ensuring timely care for patients facing life-threatening emergencies.

I look forward to meeting more of you across the country to hear about the elements of your role and the unique challenges you face.

 See the video from the visit here

South West Ambulance Service had an innovative approach when it came to
getting rid of one of their old ambulances for the newly-delivered model - they
kept it. They sprayed it a multitude of bright colours and parked it proudly
out the front of their HQ.

It is now their go-to vehicle to attend LGBTQ+ pride events across the south
west of England.

Pride is a fantastic way of celebrating diversity within workplaces and
throughout society, providing a great opportunity for employers to champion
their staff.

I visited the team just as they were gearing up for Exeter pride and there was
a real buzz about it from the boardroom to the frontline.


The pride ambulance is a great initiative and I’m backing SWAS to be the envy
of the parades! Tweet me @S_Hammond if you see a pride ambulance on a road near
you this summer #TalkHealthandCare.

Rewarding employment…

Posted by Vic Rayner 1 week ago

Those who work in care understand just what a privilege it is to really support people to live the life they want – to deliver great quality, timely and valuable care and support, and to offer care that respects the dignity and rights of the individual.

It is skilled work. It is hard work. It is work that is both emotionally and physically demanding.

There are many excellent employers out there who do understand just how important recognising and rewarding staff is. In regular surveys of employers by the National Care Forum, members have highlighted the success of schemes which have incorporated some or all of the following approaches:

  • Annual bonuses
  • Employee referral reward schemes
  • Schemes that reward attendance, long service and outstanding acts
  • Peer voted schemes to reward individuals or teams
  • Discount and loyalty schemes for local services or retail outlets

However, I know there are a number of additional things that great employers are seeking to do, and that we must do more of in the sector as a whole.

 

Paint the Bigger Picture

We know how hard it is to attract people to work in care. It is important for employers to paint the bigger picture of what individual staff contributions achieve. Great social care is about social justice and human rights. A powerful reward for many is being part of a movement that is transforming not just individual lives, but societal opportunities and expectations for communities that have previously been excluded or ignored. Great employers will tell this story through their external and internal communications, so that people can rightly feel proud of the work that they do.

 

Flex the opportunity

The sector employs nearly 1.5 million people, many of whom work part time and on variable hours contracts. However, it feels like there is more that we can do to reward staff with flexible working practices. There are, for example, many other comparable sectors where practices such as compressed working hours, greater use of job share across all roles, part year working (employing people only for a fixed number of months), offering greater flexibility of work location, or enabling short term movements are on the table for employees. There are lots of models of flexible working out there and the technology in care is catching up to enable these to be managed seamlessly.

 

Person-centred employment

The social care sector prides itself on the delivery of person-centred care, yet there is less evidence of a commitment to person-centred employment. Everyone who works in care is an individual, with their own life and their own commitments outside of work. The approach employers take towards recognition and reward should also concentrate on what is offered to support the person in and out of work. Strategies that recognise the financial pressures, health and wellbeing challenges and caring responsibilities of employees will go a long way towards staff feeling that their employer not only provides care for others but also, very importantly, cares for its own too.  

Join the conversation and add your thoughts today to the challenge ‘How does your employer value the work you do in social care?’.

 

Vic Rayner is the Executive Director of the National Care Forum (NCF).

The NCF is the strongest voice for not-for-profit care providers in the UK. More details about the NCF can be found at www.nationalcareforum.org.uk Stay connected to Vic via @vicrayner or vic.rayner@nationalcareforum.org.uk

It's the look on the face of an elderly person when I make them smile, as we joke and play games; or the pleasure I get when I support a person to improve their health and wellbeing. These are the reasons why I love the work I do: looking after people and putting smiles on their faces every day.

There is nothing quite so rewarding as being able to make the lives of other people better.

I started working in social care as a part-time job but soon realised that caring for people is where I feel most fulfilled and useful. For the past ten years, my jobs have included being a live-in care worker, a personal assistant, a homecare worker and supporting people in care homes. Working in social care can be hard at times but is also very rewarding. It comes with a huge responsibility for people’s daily lives which makes it a profession that requires many skills.

It is a job like no other.

People do not enter social care to make big money, but I think we can only expect care workers to deliver care with respect and dignity if employers extend that same treatment to their teams. Part of this is recognising the difficulty of the job and the skills required and rewarding that properly.

The Professional Care Workers Day on 4 September, which celebrates care work and recognises its contribution, is one way of rewarding staff. The day encourages the social care sector and wider society to acknowledge the fantastic contribution that care workers make.

Showing appreciation can be achieved in different ways, not all of which must include spending a lot of money. ‘Thank you’ cards and emails are a good start and I hope that many organisations use them. It is so easy to focus on problems and mistakes and forget about celebrating success. We want to encourage moments of positivity where great work shines.

There are many great examples in the industry of perks for care workers - from salary stretching schemes and discounts on shopping to bonuses for taking on last-minute shifts.

I urge you to share your great practice in rewarding success and hard work. I would also encourage you to share new and innovative ideas of what can be done further to reward excellent care work.

Join the conversation and add your thoughts today to the challenge ‘How does your employer value the work you do in social care?’. 

Karolina Gerlich

CEO National Association of Care & Support Workers

Knowing how to motivate people to do challenging jobs is an issue that is pertinent to managers across social care. We know from careers experts what the elements are that keep people fired up: feeling appreciated; sharing values with your organisation; colleagues – and chances to socialise with them; opportunities to develop and progress; and support to do your job well. How then, to apply this knowledge to the question of rewards and recognition – and when money is tight, can the sector show thanks to a hard-working workforce?

Manchester City – a football club whose wage bill could solve the social care funding challenge in an instant – upset one star player when it failed to mark his birthday with a cake. Even the highest-paid want personal touches that make them feel valued. And things like a birthday card from the boss – with a meaningful message – can mean a lot.

The point about shared values is important. Social care is about supporting people, and if we support recipients of a service, we should support providers too. Getting a work/life balance matters to staff, so where possible employers should allow some home-working. Staff wellbeing should be promoted, rather than simply relying on their resilience: with the chance to buy extra leave, with wellbeing days, or with relevant health support, like physiotherapy sessions.

Social care is rooted in the community, and that could be expressed in reward schemes – like giving volunteering days or establishing discount schemes with small local retailers or coffee shops. And, social care is about choice so apply some personalisation to any discount scheme.

Personally, I’d take the cinema over the gym any day.

We are motivated by our colleagues. Team lunches, fun away days and Christmas parties do bring people together. No-one understands the pressures and pleasures of work more than our peers, and the chance to relax and form bonds with them matters.

Another great way to form good bonds – which feeds into a fundamental part of working for any social care employer – is having a varied training and development programme. Here at the Social Care Institute for Excellence, we consistently find that access to good quality supervision, training courses, shadowing opportunities and support with professional registration is the biggest motivator an organisation can provide its staff. Because, ultimately, people want a chance to do their job well. Professional development helps with this – it brings people together, away from the coalface, and it shows that they are valued.  

Reward schemes and discounts are a useful part of the bigger picture and, when thoughtfully provided, can be a big help in motivating and retaining staff. But the key principle remains that if a workforce – which cares about what they do – is given the right support and working conditions they will do the best job that they can. 

 

Hugh Constant

Senior Manager in Consultancy & Training

Social Care Institute for Excellence

This almost certainly won’t be the first blog you’ve read on the subject of workforce, which is a challenge facing almost every local authority.

In Oxfordshire, ensuring that we have enough people working in social care is our number one priority.

Despite our strong local economy having very low unemployment rates, adult social care faces strong competition from other sectors such as retail and the area’s high living cost is off-putting for many. In the South East, the number of adult social care jobs will need to increase by 48% by 2035 to keep up with rising demand – that’s another 125,000 jobs.

Making social care staff feel valued and rewarded has formed a key part of our approach in addressing these issues.

We are fortunate that in Oxfordshire we have two associations who represent a significant proportion of our providers. It became clear in our discussions with them that sometimes it’s the smaller things that make a real difference to their staff and mean they are more likely to stay in their roles.

As a result, we’ve focused a lot of effort into looking at what could make the difference in someone deciding to stay in the sector. This has included key worker housing and supported care leadership programmes, alongside our value-based approach to training programmes, which are designed to help providers choose candidates who are more likely to remain with them.

We’ve also spent time looking at how else we might make the lives of care providers and their staff easier, with one example being the agreement to provide a number of parking permits for use by carers within central Oxford. Whilst this may not seem like a ground-breaking solution, it actually made life easier for the carers who didn’t have to worry about trying to find a parking space or getting a parking ticket. As our care providers told us, sometimes at the end of a long, hard day it’s the small things that can make the difference!

It’s important to recognise that the challenges we face aren’t just issues for Oxfordshire as a local authority:  they also affect our health partners and care providers. Several providers have created a comprehensive package of employee benefits as part of their strategy to tackle workforce issues. We strongly believe that it is essential to work as a system across health and social care to tackle these challenges, and that our care providers are key to making this a success.

In Oxfordshire we feel that we have started our journey  to improving recruitment and retention by making staff feel valued, but we realise there is still a way to go. We would love to hear what steps you’ve taken – however big or small – to address your own workforce issues and make your staff feel more rewarded.

Join the conversation and add your thoughts today to the challenge ‘How does your employer value the work you do in social care?’. 

 

Lucy Butler

Director for Children, Education and Families and Interim Director for Adult Services

Oxfordshire County Council

Annette Baines, Programme Manager for Recruitment and Retention at Skills for Care, talks about people who need care and support being the ultimate beneficiaries of a settled staff team.

Like the thousands of adult social care employers, Skills for Care knows that attracting the right staff with the right values, behaviours and attitudes is vital.

At Skills for Care, we don’t deliver direct care, but we do invest in the culture of our own organisation to show how we value our staff.  One of the ways we do this is through staff-wide wellbeing initiatives which show how much we value them and what they do. Initiatives have included a month-long campaign focusing on the mental or physical wellbeing of our team; peer and other support for those who are also carers; or even supporting people to get their work/life balance right.

We know that the great majority of the 1.47 million workers in adult social care experience far higher levels of job satisfaction than in many other sectors – not least because every day can be different and rewarding, as shown in the government’s recent national recruitment campaign. But turnover rates in the social care sector are still far too high, with factors such as pay, working environment or not feeling valued influencing people’s decisions to leave.

Skills for Care spends a lot of time talking to employers who have low turnover rates to find out what they do to retain their staff. We then produced our ‘Secrets of success’ report, sharing many of the smart things those employers do to keep their very best people by making sure they know they’re valued. They include:

  •  Investing in learning and development as well as embedding the organisation’s values and celebrating achievements;
  •  Involving staff in decision-making and paying above the local minimum wage so staff feel valued for the work that they do;
  •  Being as flexible as possible when setting working hours and shift patterns;
  •  Supporting staff by taking into account their responsibilities outside of the workplace as these can affect performance at work. 

Making sure your staff are physically and mentally fit for work goes hand in hand with providing a positive workplace culture, so listen and act upon what your team tells you.

There’s no magic solution to keeping your best people but employers who have used ‘Secrets of success’ say it has helped reduce their turnover rates.

Which employee benefits and reward schemes mean that you enjoy working for your employer? Are there any employee benefits or reward schemes you would like to see introduced in social care? Share your ideas now.

Find out more about support for your organisation’s recruitment and retention at www.skillsforcare.org.uk/randr

Thanks to everyone who participated in our latest challenge on improving perceptions of working in the community. Your engagement with this challenge has underlined everything I already thought about how passionate and committed our community workforce are.

It’s heart-warming to read that so many of you really enjoy what you do.

Throughout the challenge you have shared some of the advantages that come with working in the community. Amongst these, what clearly emerged was how delivering informed personalised care allows you to make a difference to patients, made possible by the very fact you provide care in the home; it gives you the autonomy to make the right decisions for patients; and it never gets boring, with its variety of cases and patients.

Your main ask on this topic is for greater visibility of roles in this setting amongst students, other professionals and the public. You suggest this could be done by placing more students in the community and improving understanding of community health services across the wider NHS workforce. Many of you suggested we could run a campaign could run to showcase the benefit of these roles. These are great ideas, which I will look at further with officials.

I care deeply about ensuring community staff are supported in their day-to-day work. Your comments are helpful in showing how we can do this better. They show we need to improve access to reliable technology; ensure travel is properly supported and reimbursed; provide better training and developmental opportunities; protect you against violence and the risks that come with lone working; and improve career paths in the community. We are committed to making progress in these areas.

We are already taking action to improve access to mobile technology and better protect staff against violence. This includes a new programme to tackle violence and a commitment to ensure all community staff have access to mobile digital services over the next three years, as set out in the NHS Long Term Plan. We will also now explore what action can be taken in the other areas you highlighted. Thank you, again, for this invaluable steer on what matters most to you.

It has been great to read your comments, and, while this challenge is now closed, Talk Health and Care will continue to host further, important challenges. I would encourage you to keep engaging with these, so we can continue to turn your knowledge and ideas into policies that make your working lives better.

By Matthew Winn, Chief Executive of Cambridgeshire Community Services NHS Trust

I have the privilege of leading an organisation providing community health services across the East of England and I see outstanding individuals and teams make a huge difference every day.

Working in community health services provides our staff with the opportunity to work as partners with GP’s, mental health professionals, social workers and the voluntary sector (to name but a few).

The services often co-ordinate the care for patients and, as a 365 days-a-year operation, the teams provide a continuity of professional care that is not found elsewhere in the NHS. They operate with a high level of autonomy and responsibility.

Community health services is a catch-all description for a wide range of very important services and staff who predominately work in the homes of residents or in community clinics. To give a taste of what happens every day:

  • Children’s nurses, therapists, doctors and support staff see every child and their families at least five times in the first years of their life. They also support families and children as they grow up with their developmental needs, complex disabilities or the impact of a single long-term condition.
  • Specialist dentistry staff provide clinics for children and adults with complex disabilities; they often undertake minor oral surgery for local patients who are scared of going to a high street dentist.
  • Sexual health and contraception doctors, nurses, pharmacists and counsellors provide vital treatment and preventive care to all ages.
  • Community nurses, therapy staff and GPs work together to support the most frail and unwell members of our communities – a high proportion of whom rarely leave their own homes.

If you are starting out, returning to the NHS after a gap or looking for a fulfilling role to finish your career community health is the place to develop and stretch yourself, in a wide variety of stimulating roles. As a Chief Executive of a NHS Community Trust I would encourage anyone interested in working in community health services to get in contact with your local NHS provider and ask to spend some time with local teams to see if the opportunity is right for you.  

 

A review of winter performance – April 2019

This winter Minister of State for Health, Stephen Hammond, has met with staff up and down the country. In his blog he reviews the achievements of the previous year, reflects on the challenges of winter and looks at what is still to be done to improve ways of working in the NHS.

Since becoming Health Minister I’ve visited Luton and Dunstable Foundation Trust and met some inspiring staff, spoken to paramedics and call handlers at East Midlands ambulance trust, visited Queens Medical Centre and saw their rearranged A&E and seen first-hand some of the improvements put in place thanks to the government’s winter funding allocations in North Middlesex. In all of these visits, plus visits to Great Ormond Street, Kings College and Kettering General, I am in awe of the tireless hard work, dedication and passion that everyone demonstrates daily.

You should all be extremely proud that performance against the 4-hour target for A&E this winter has, overall, been better than last winter, even with the challenges of another busy flu season and higher demand than the previous year.  The number of type 1 attendances increased by 5.1%, but despite this, 3,100 more patients per day were seen within 4 hours compared to last winter.

The patient journey has seen an improvement in terms of flow; handover delays and 12-hour trolley waits are significantly down and delayed transfers of care and extended length of stay are lower which have in turn helped to reduce pressure on bed occupancy.

I am proud that in the past two years the NHS has:

  •  Seen more patients than every before in A&E;
  •  Rolled out evening and weekend GP appointments nationally; 
  •  Enhanced NHS 111 so now over 50% of calls receive a clinical assessment ensuring immediate advice or referral to an appropriate clinician; 
  •  Rolled out over 100 Urgent Treatment Centres and the ability to book patients in via 111; 
  •  Introduced new standards for ambulance services to ensure the most critical patients receive the quickest response time, and that all patients receive a response in a clinically appropriate timeframe;
  •  Introduced comprehensive clinical streaming at the front door of A&E departments, so patients are      directed to the service best suited to their needs on arrival;
  •  Reduced the number of people delayed in hospital – reducing the length of stay of patients who remain in hospital for more than 21 days, and freeing up nearly 2,000 beds

I know that winter is always challenging, and that is why the government provided £420m of additional funding in advance of this winter.  This funding has been spent improving hospital urgent and emergency care facilities, buying additional ambulances, and delivering additional adult social care packages.

Even though improvements have been made in a number of areas, there is still more to be done to support staff in coping with growing demand, whilst still ensuring the best possible care for patients. The Long Term Plan will look to go further in reducing pressure on emergency services in 19/20 by:

  •  Embedding a single multidisciplinary Clinical Assessment Service (CAS) within integrated NHS 111, ambulance dispatch and GP out of hours. In 2019, England will be covered by a 24/7 Integrated Urgent Care Service, accessible via NHS 111 or online.
  •  Embedding the Same Day Emergency Care (SDEC) model in every hospital, in both medical and surgical specialties. All hospitals with major A&E departments will provide SDEC services at least 12 hours a day, 7 days a week by the end of 2019-20.
  •  Continue to reduce unnecessary long lengths of stays in hospitals and achieve and maintain an average Delayed Transfer of Care (DTOC) figure of 4,000 or fewer delays.

Once again, thank you all for your hard work this winter. As ever I am committed to listening to your views to better understand how I can support you and look forward to meeting with many of you on forthcoming visits.

By Austin Chinakdizwa

I am a Community Matron working in Luton alongside “At Home First” care co-ordinators, who support our intensive case management model. There are lots of advantages to working in community care. On any given day, I can communicate with all the different parts of the health and social care system to access the services my patients need. This allows me to pull together packages of care that help older people (in particular) to stay safe and healthy in their own homes, which is often exactly where they want to be.

It’s so rewarding to work across teams and organisations to help patients achieve their goals. Another great benefit is being able to see the positive impact of our work over a longer period of time.

Austin (left) and his colleague Sue, a pharmacy technician.

Austin (left) and his colleague Sue, a pharmacy technician.

One disadvantage of this model is that, across the broader NHS, community clinicians don’t get a lot of recognition for the work we do. The preventative role we play in people's health is becoming increasingly important to the health and social care system, so we need to shout about it more.

Raising the profile of our work is key to encouraging more staff to work in community settings. It is also important to emphasise the training opportunities, innovative projects and good work life balance that we can offer. We also need to work with students and universities to train and recruit for a range of roles. We don’t just need nurses – we need co-ordinators, healthcare assistants and health trainers too. The NHS is at a crossroads, shifting from hospital to community care, taking a more preventative approach. This means there are many attractive and exciting opportunities to try out new approaches and ideas, which we need to better publicise.

In Luton we’ve been making special efforts in the last six months to work more collaboratively with the Luton and Dunstable Hospital, Luton Council, GPs and all the other players that support the health needs of our local population. Thanks to daily huddles, weekly multidisciplinary team meetings, and many other measures, we can now go above and beyond to improve care for our elderly patients who might otherwise end up in accident and emergency. More support for schemes like these will be essential if we’re going to make patient care safer. We also need to make better use of clinical expertise for system improvement projects, enabling us to think differently and be more creative. If we have all this, then we’ll be able to succeed at building the new service model that our health system and our patients need in order for it to thrive.

By Jenny van Maurik, Clinical Lead and MSK Physiotherapy Specialist at Cambridgeshire Community Services NHS Trust.

Our First Contact Practitioner (FCP) pilot is part of a national NHS England directive to establish musculoskeletal (MSK) practitioners in primary care. We run daily clinics at Granta Medical Practices in Cambridge where patients with musculoskeletal conditions, who would ordinarily have been seen by a GP, are now able to see a MSK specialist physiotherapist instead.

Working in the community offers numerous benefits to GPs, patients and practitioners. Between 20-30% of GP appointments are MSK related and having an MSK expert on site has helped to reduce GP workloads. In addition, patients get quicker, direct access to MSK specialist assessment and advice, and tend to be more relaxed in familiar surroundings, closer to home. Patient satisfaction rates are also high.

We can request MRI scans, x-rays and blood tests, and also refer patients for physio and link with GPs for prescriptions. Patients are able to be directed to the right person at the right time, enabling them to be directly referred onto hospital for surgery when needed. Our initial findings show fewer patients are referred to secondary care and more than 70% of patients simply require guidance to self-manage their condition.

There’s been mention of the pilot leading to fragmented physio services as experienced physios are taken into GP practices while junior physios are left in physiotherapy departments. Concerns have also been raised that moving specialist physiotherapists out of the hospital setting will reduce their knowledge over time. However, these risks can be minimised by assessing the skills mix and ensuring MSK specialists maintain links with hospital orthopaedic teams.

Emphasising the benefits of early intervention – in terms of reducing unnecessary appointments and investigations and speeding up patient access – is key to encouraging more physios to work in the community. The FCP initiative offers an exciting opportunity for physios to upskill themselves and having a forward-thinking, dynamic multidisciplinary team within the primary care setting will entice more staff to this role.

Two factors that would enhance our day-to-day life working in the community are improved IT and better links with hospital imaging departments. We’ve experienced issues getting acute hospitals to accept referrals for investigations. MSK specialists working in the community should have the same rights as their hospital counterparts. Fundamentally, it’s about putting patients at the heart of care.

***CONTRIBUTE YOUR IDEAS ON HOW WE CAN IMPROVE THE PERCEPTIONS OF WORKING IN THE COMMUNITY***

A few weeks ago, I spent the morning shadowing district nurse Liz Alderton. I was inspired to see first-hand the challenging, rewarding and vital role district nurses play in our care. This comes as a reminder that we need to do more to change perceptions about what the NHS truly represents.

If a person is hospitalised from a fall, they might have their arm put in a sling and their head stitched up, but this isn’t the end of their care journey. Once they step out of hospital it's community health workers like district nurses and physiotherapists who help often elderly and vulnerable patients to recover. Community healthcare staff do this, and their work does not stop there. They are key to keeping people healthy and independent, empowering patients to better understand their conditions and manage them as close to home as possible. District nurses, for example, can provide chemotherapy in the community and help prevent patients from needing to go to hospital altogether. They are the unsung heroes of our NHS.

We all want to see our loved ones at home, in familiar surroundings, comfortable and close to their support network. This is the golden lifeline that community healthcare workers give to so many of us. And with more people living with complex long-term conditions, we can no longer assume a hospital is the only route to care.   

That's why the NHS Long Term Plan is putting a greater emphasis on these invaluable services, by shifting to a new way of delivering care that provides more services in the community.

For too long the role of community services in healthcare has gone largely unnoticed and often undervalued. We cannot underestimate the worth of a service that helps people to stay living independently at home for longer. I am in awe of those working in community healthcare and I have seen first-hand – when visiting areas like Frimley and Harold Hill – the massive difference you are making to people's lives. I know that in recent years your work hasn't been given the attention it deserves, but I am working to change this.

Meaningful discussions about these issues can help bring about real change, and Talk Health and Care is a good opportunity to do this. We know that community services could be better understood. 

Do you have a solution or an idea that you think can help change this? Have a burning idea on how to attract professionals out into the community? I’d really like to hear your views on this.

Share your ideas now.

It’s been a busy and exciting start for health and social care this year, as the launch of the NHS Long Term Plan, backed by a historic Government funding increase of £33.9 billion in cash terms by 2023-24,set the tone for healthcare in 2019 and in the years to follow.

NHS Improvement’s forthcoming patient safety strategy, which you have fed into by contributing to the Just Culture Challenge, will set out how we can help achieve this and will be published later this year. But if we want to engrain this work we will continue to need your feedback.

Here are a few of my reflections on your suggestions since the launch of the platform and the most recent ‘Just Culture’ challenge.

In the NHS, Joshua Flynn suggests staff feedback platforms like Talk Health and Care should be mandatory at a local level – I would be interested to hear from more of you on how this would help to report safety concerns.

Director Gillian Holden says in a social care setting team meetings and supervision are vital for staff to feel part of the team, which helps ensure the best quality of care. I agree with Care Minister Caroline Dinenage’s response – sometimes it’s about doing the simple things (like this) right.

Andrew Ottaway makes a good point about how the NHS can learn from other industries where they are doing things well. I agree. Like I said in my speech to healthcare professionals a few months ago, I am looking at others to see what learning can be applied in the NHS and I’m open to more ideas and suggestions on this.

A Just Culture can be embedded at all levels and I was interested to hear Karen Martin’s suggestion about sharing staff stories with the Trust board to encourage better communication between front line staff and senior leadership. I believe that strong management and leadership are key and I want to see more talented leaders with good ideas in the NHS. We are expanding our graduate management scheme to help achieve this.

Finally, I’ve heard your concerns – which many of you have similar experiences of – about the need to have a fair recruitment process. One that doesn’t lean in favour of bullies staying in their role. The impact of bullying is one of the reasons I’ve made looking after and supporting the health and care workforce one of my top priorities. I’m committed to continuing the good partnership work that representatives from the national and local NHS, social care and trade unions are doing to tackle the issue. The latest advice and guidance on good practice is available from NHS Employers’ website.

Your ideas over the last few weeks and months have given me plenty of food for thought on what more can be done to help ensure you work in an NHS and social care system that is fair and just. This will go a long way in helping ensure our NHS Long Term Plan is successful. I would urge you to continue to share your ideas and examples of good practice, so that together we can make your workplace the best it can be. 

*CONTRIBUTE TO THE LONG TERM WORKFORCE IMPLEMENTATION PLAN HERE*

Every day, in every part of the NHS, you find acts of extraordinary compassion and breath-taking dedication underpinning the clinical expertise which makes our NHS staff amongst the best in the world.

It’s measured in the small gestures – the reassuring words of a porter, or the nurse staying with an anxious patient beyond their shift – as much as the big moments of heroism, and it speaks of the strength of vocation that holds the NHS together.

Quite simply, the people who work for the NHS are the NHS. They care for us magnificently – and it is only right that we care for them too. But this isn’t always the case.

The challenges of working in healthcare are considerable – and, in some cases, have tragic consequences.

I’ve been profoundly affected by the story of Lauren Phillips, a talented young doctor who went missing last year after working in a NHS hospital. Her father Jonathan has described an insidious culture that “succeeded in sapping Lauren’s strength, undermining her self-confidence, attacking her professionalism, and devaluing her commitment”. His verdict on the NHS is as straightforward as it is damning: “it was not there to give her the help and support she needed to stay alive.”

What I take from this tragedy is a deep sense of resolve to change the culture and a determination to build an NHS that truly values its people. We need to challenge the culture of carrying on regardless, not asking for help, not looking for signs of burn out among our colleagues and thinking everything’s okay as long as the person turns up for work each shift.

And yes, that means looking at the big solutions – addressing the inflexibility in rota planning; and recruiting and retaining the NHS workforce in sufficient numbers. These are fundamental parts of our long term plan for the NHS. As a first step, we have set out ground-breaking proposals which I hope will help people like Lauren in the future.

These include comprehensive post-trauma support to help medical teams come to terms with traumatic incidents, a 24/7 confidential mental health advice service, and priority access to mental health referrals. We will also look at ways of improving the working environment, including making more quiet, comfortable places available for overnight staff to rest.

I care deeply about the NHS and I will do everything in my power to pass on this great British institution to future generations in a better condition than I found it.  And that starts by caring for those who care for us, and making sure that whenever somebody needs help, there’s someone they can turn to.

The approach I have set out is just the start of a journey to make the NHS a world class employer. Frankly, it is the least we can do for people who offer so much.

The part of my job I have enjoyed the most since becoming Health Minister in November has been visiting different parts of the NHS, and meeting the dedicated staff who care for us.

In Luton & Dunstable I was struck by how managers worked hard to ensure they were approachable, allowing staff to feel comfortable raising any problems or concerns they have.

And at Mersey Care NHS Foundation Trust I met two whistleblowers who spoke up against bullying and bad practice.

I have an enormous amount of respect and admiration for each and every person who makes up the NHS, all of whom told me how much they loved their jobs, despite sometimes challenging circumstances.

And I’m also well aware that there’s still a lot more we as government can do to make things easier for you.

Many of you may have seen the results of the NHS Staff Survey that were published on Tuesday, and I’d like to thank everyone who took the time to give your views. Your feedback is essential for us to make the NHS better, not only for patients, but for all staff too.

There’s plenty to be positive about. More of you would recommend your organisation as a place to work and for patients to be treated compared to last year, and more of you feel you are getting the recognition you deserve when you do a good job.

While any act of violence against a member of staff is unacceptable, it is promising to see improvements in this area with this figure at its lowest level for five years. With the Assault on Emergency Workers Bill now in law, I hope this statistic will continue to fall.

However, there are areas which are still a cause for concern and I am determined that we do everything we can to tackle these. More of you have reported experiencing bullying and harassment and feeling unwell as a result of work related stress, and less than a third of you feel that your organisations take positive action to improve your health and wellbeing.

This is unacceptable and I am committed to fixing it.

Our Long Term Plan for the NHS sets out our clear commitment to making the NHS a consistently great place to work. That means promoting flexibility, wellbeing and career development to build a more modern working culture where everyone feels supported and valued. And we are backing up this commitment with clear action.  

Just last week we set out plans to offer NHS staff dedicated mental health support whenever they need it. The proposals – which will be considered as part of the Workforce Implementation Plan – include a 24/7 confidential support service and fast-track mental health referrals if recommended by a GP, to provide day-to-day support with the pressures of a job on the frontline of the NHS and ensure everyone has somewhere to turn in the toughest times.

We will redouble our efforts to address bullying, violence, discrimination and harassment by investing up to £2 million per year in new initiatives to tackle it.

And this Talk Health and Care platform is a direct channel to myself, my Ministerial colleagues and the Health Secretary, where every comment is taken seriously and used to inform national policy making. So if you have an opinion or an idea, we want to hear it.

The NHS is nothing without its wonderful staff and we have a duty to care for you, so you can care for your patients.

I’ve only met a small number of you so far, but I very much look forward to meeting more of you in the coming weeks and months to discuss your experiences – to find out what more we can to do make sure you are supported and valued for the outstanding contribution you make to our health service.

More than 1.45 million people currently work in the social care sector across the UK and according to the government 650,000 more care workers will be needed by 2035 due to our ageing population. Although social care is one of the most rewarding sectors to work in, there is an ongoing challenge of recruiting and retaining care staff within the industry that all providers like ourselves face.

At Bluebird Care, we pride ourselves in delivering quality care to customers that help them to remain in their own homes. We could not deliver this service without our valuable care assistants, and so it is incredibly important that we offer them an enjoyable, varied and rewarding career. Creating a strong company culture and investing in training and development are two important ways we hope to overcome the challenge of recruitment and retention.

 

Our company culture is built upon strong brand values that guide every member of the Bluebird Care team in everything they do, every day. They create the basic building blocks of how we want others to see and judge us, including prospective and current team members. For prospective employees, we want them to be inspired by our brand and excited about the possibility of working for us. For current employees, we want them to feel proud that they are part of an excellent team that makes us a leading home care provider.

Finding and keeping the best care assistants is key, so we offer excellent support and the opportunity to develop our employees to reach their full potential. All our staff receive regular supervision and ongoing training to enhance their existing skills and learn new ones. There are a wide range of training areas including dementia care, end of life care, mental health and more. We are passionate about promoting from within, and so our care assistants have the opportunity to develop and grow within the business, and can work their way up to supervisor, care manager or even run their own business as part of our franchise network.

The new ‘Every Day Is Different’ campaign truly encompasses the rewarding nature of care work and we are proud to be working with the Department for Health and Social Care to help promote the incredible roles that are available within the sector. Through the use of social media, Bluebird Care have been spreading campaign messages to raise awareness of the benefits of working in social care. Our care assistants are at the heart of what we do, and so we were delighted that two individuals from one of our care teams were invited to a photo opportunity at the houses of parliament with the Minister of State of Care Caroline Dinenage. Please unite with us and let’s help to show the world how incredible a career in social care can be, by promoting #EveryDayIsDifferent! 

Staff are the heart of the NHS and we recognise how hard they work in frequently challenging circumstances, delivering excellent care despite rising demand.

That’s why we want to improve the culture throughout the NHS to make it a fantastic place to work at all levels, across every area of the country.

However, I’m sure many of you are aware of instances when this hasn’t been the case.

Last month I visited Mersey Care NHS Foundation Trust, who in 2018 took over the services once provided by Liverpool Community Health NHS Trust. For a long time, Liverpool Community experienced serious problems under a leadership team who allowed a culture of bullying and harassment to spread across the organisation. Not only did this mean a poor working environment for staff, but also led to declining performance and patient care.

I was moved to meet two members of staff who acted as whistle-blowers, calling out instances of bad practice and bullying, kick-starting the road to improvement.

A report by Bill Kirkup into the failures at Liverpool recommended a review of the Fit and Proper Persons Test, which requires all NHS trusts to ensure executive level managers are fit to carry out their roles to the highest standard. We commissioned Tom Kark QC to carry out this review, which was published earlier this week.

We have listened closely to what the Kark Review had to say and are determined to act to create a positive, inclusive culture within the NHS that backs our fantastic employees to provide the best possible care for their patients.

In response to the recommendations made by Kark, we will introduce new national competency standards for NHS leaders, to establish clearer professional benchmarks and help the public and the profession know what to expect of them.

We will also create a central directors’ database where information about qualifications and employment history can be easily accessed – providing a track record of performance for directors.

Chair of NHS Improvement Dido Harding will consider all the recommendations as part of her Workforce Implementation Plan – a key strand of our Long Term Plan for the NHS, demonstrating how integral good leadership is to wider issues affecting the workforce.

However, work is already well-underway to create a positive, open culture from the frontline to the board room. Every trust now has a Freedom To Speak Up Guardian – an incredibly important step for safe spaces for staff to give views, without fear of reprisal.

We will continue to encourage speaking up and embrace those who are brave enough to speak up when they have concerns. Last year we changed the law to protect them, by making it illegal for NHS employers to discriminate against applicants who have blown the whistle in the past.

And the Long Term Plan set out a commitment to creating an inclusive and supportive employment culture for the NHS – promoting flexibility, wellbeing and career development, while redoubling our efforts to address discrimination, violence, bullying and harassment.

It’s crucial that a real change in culture in the NHS starts at leadership level.

I’m a firm believer that leaders create the culture of any organisation and as a government we are committed to creating the right culture to support leaders. Outstanding NHS trusts are driven by the excellent leaders at their core - who inspire the workforce around them and shape the environment in which real success can be achieved. If we’re to create a more just, open and trustworthy NHS we must make sure we give leaders the right training and support to embody and promote this culture.

Visiting Mersey Care ahead of the launch of the Kark review, I saw first-hand how an emphasis on safety and openness within the leadership is already helping staff, leaders and, ultimately, patients.

The Trust told me that more staff feel connected to their managers, being able to report directly to them while being supported in regular team learning sessions.

If we get things right at the top, and support those staff members who have experienced bullying, we can root out this problem, improve patient care and make the NHS the best place to work it can possibly be.

In November last year I concluded a review into what can be done to empower NHS leaders to lead.

There are many key changes I believe the health and social care system can do to support their leaders – both current and future. Some of this work is already underway. For example, NHS Improvement is already taking a more central role in the NHS, evident in its recent decision to create a new Chief People Officer role within the senior leadership team.

 

But if we want to go further – and truly empower NHS staff – we need to ensure the next generation of leaders have the skills they need to take on these challenging roles. There should be a renewed focus on our future leaders and how we support them and NHS Improvement and NHS England should continue to align their work and set a clear and strategic direction for the NHS. I was pleased to see that since my review the NHS Long Term Plan has set clear direction on how the system will work together and the roles respective organisations will play.

It seems timely, now that the NHS Long Term Plan has been published, that these issues be revisited and these changes are made in the NHS. The conditions in which NHS leaders work are often stressful and difficult, with great responsibility and the highest stakes. Over time, this has had a detrimental effect on the working culture. This must change and should be led by leaders at all levels – they each have a pivotal role to play in changing culture, setting the tone within their organisation. NHS leaders should ensure they model the highest standards of behaviour and if they are supported to thrive they can support their staff to deliver high quality care for patients. And to thrive, they must be encouraged to celebrate their successes and learn from their mistakes.

Changing a culture is about people and their behaviours. That’s why I believe the performance management process of NHS leaders should be updated. It should be common practice to get 360-degree feedback and any behavioural issues handled during an appraisal. And, if a national standard for performance management is set, regions can be given more freedom to manage performance locally. In turn this would provide reassurance that this need not be a fearful exercise. Mistakes can be discussed more constructively and learning from mistakes can become a normalised process.  This is one way that by empowering leaders to lead the NHS can change its culture and in turn start to embed a Just Culture.

From your feedback on #TalkHealthandCare it has become apparent that staff across health and care thrive when leaders support you and strive to create open, honest and compassionate workplace cultures. So what else would you like to see change in your organisation to achieve this aspiration? Share your views below or comment on the creating a Just Culture in the NHS and Social Care page.

Hello – I’m Julian Hartley, CEO of Leeds Teaching Hospitals and Senior Responsible Officer for the national workforce group.

Working in the NHS should be the best job in the world. The NHS Long Term Plan is very clear about the importance of giving our staff the backing they need.

We must create compassionate and inclusive cultures focused on improvement, to enable our people to deliver outstanding care that is more productive and efficient, and which achieves the best outcomes for our patients.

Our national workforce group intends to do that - looking at how future workforce challenges can be addressed both as a whole, and also looking at each staff group individually.

The group includes senior colleagues working on:

  • supply, training and development of all staff groups
  • harnessing technology and data and ensuring staff have the skills to use existing and emerging technologies
  • developing the leadership and talent we need now and in future
  • embedding cultures and systems to make staff feel safe and valued, and ensure the NHS really is the world’s best place to work

Thank you to everyone who has fed in their views already – by taking part in the working and steering groups, or by directly contacting our workstream chairs.

I’ve been heartened by the energy and commitment to harnessing all the expertise, evidence and work programmes already underway.

We’re determined that all voices are heard, and we’ve set up a number of challenges here on Talk Health and Care, as just one more way you can share your views. Please do get involved and encourage others to read and post on the site.

So far, we’ve heard loud and clear that:

  • we should use existing networks and channels to engage as widely as we can with all staff groups, stakeholders and partners
  • it’s important to use robust data, both for assessing where we are now and making forecasts
  • our response to staffing challenges must work at a local level

Above all we’ve heard and understood that while some challenges may take years to solve, there are actions we can take now to address the immediate challenges our staff face. Our workstreams will be clear about the impact of their proposals, not only years ahead but in the next few months.

This is a great opportunity to achieve the vision in the NHS Long Term Plan and give our people the support and encouragement they deserve.

So thank you, and please do tell us your ideas, comments and feedback on our challenges.

The programme has five workstreams, which we'd like to your views on. Click the links below to post an idea toward each challenge:

 

Julian Hartley

Chief Executive, Leeds Teaching Hospitals NHS Trust

 

We want to create a culture in the adult social care sector and the NHS where all staff have the confidence to voice their safety concerns. In order to protect the rights of patients and people with lived experience of care, colleagues and staff need to be empowered and protected to speak up.

Fear of being judged or unfair treatment are two of the big issues preventing staff from voicing safety concerns. Our NHS Long Term Plan puts patients at the centre of how we deliver care. That’s why it is even more pressing that we stamp out any issues which are holding this agenda back. 

The change needs to start with a Just Culture. By embedding an ethos where staff feel safe to speak up and voice safety concerns we can put patients firmly at the heart of personalised care.

It’s testament to our hard working and compassionate adult social care staff that people in their care feel extremely positive about it: they are generally happy with the quality of their care, have a very good quality of life and they feel safe and secure as a result. The most recent Adult Social Care Outcomes Framework 2017/18 survey found that two thirds of people who receive care in England are extremely or very satisfied with their care – which for me, as Care Minister, is brilliant to hear.

For the vast majority of clients, the sector is doing its best by them, but we cannot be complacent and we must continue to improve the way in which care is provided. 

Where care isn’t as good as it should be, it is individuals who speak out that help raise the quality of care and improve services for everyone. This is the benefit that comes with embedding a Just Culture in our adult social care and health service.

To reach a point where people feel like they can raise concerns – confident in the knowledge that they will be listened to and won’t suffer as a result – we need to create the correct working conditions and set the right culture. I believe that this is at the heart of achieving high quality, person centred care for everyone. 

For example, in Driving Improvement: Case studies from nine adult social care services, published in 2018, the CQC reported that the Managing Director of the New Deanery Care Home had described how the management culture under the previous owner had been “very controlling, very top down. Front line workers didn’t have a voice, relatives didn’t have a voice, the residents most certainly didn’t have a voice. Nobody was speaking out because some of the poor care that had been going on had been witnessed by good people, but they hadn’t felt able to speak up. The poor culture manifested itself in poor care.” For staff, the change in culture made a huge difference. According to one of the senior carers: “Being encouraged to talk about things was a big change. Now, if we make a mistake we are more than happy to speak up, knowing we won’t be blamed or persecuted for it. We focus on what we have to do to stop it happening again. Before, we would have been hung out to dry.”

We can and should learn from each other on how to embed a Just Culture in the workplace and that’s why I want to hear your suggestions.

How does your organisation achieve this? What can we learn? Join the conversation and leave your comments at the ‘How can we create a just culture?’ challenge.

I am delighted that ‘just culture’ has been selected as a key discussion topic for Talk Health and Care, giving staff an important opportunity to share their views, ideas and reflections on what is happening on the frontline.

In our proposals for a national patient safety strategy for the NHS – which we are currently consulting on until 15 February 2019 – a just culture is identified as a key element that must be embedded across all NHS providers to enable our healthcare service to truly be one that is continuously learning and improving, so we can deliver the safest possible care.  

The NHS is admired around the world as one of the safest and most productive healthcare systems there is. However, we want to make it even safer. Key to doing this is the development of a ‘just culture’ where staff know they will be treated fairly when something goes wrong.

We know that punishing people for making mistakes does not lead to them making fewer mistakes and pushing people to try harder does not improve safety. Instead we should focus on creating systems and processes that support staff to perform their roles as safely as possible. If people know they will not be unfairly blamed, they will be able to be more open and transparent about problems, meaning organisations have a better chance of taking actions that reduce the risk of a patient safety incident happening.

I know from my time as a surgeon that it is difficult to look someone in the eye and say something has gone wrong, but being open is the right thing to do. It is also vital in enabling us to take action to reduce future risks.

Just under a year ago, we released our just culture guide which encourages managers to treat staff involved in a patient safety incident in a consistent, constructive and fair way. We worked with our national partners, regulators and trade unions to get cross system support for this approach. We recognise that this is one small (if still important) part of helping to achieve a just culture. That’s one of the reasons why we are keen to hear from you about what you think stands in the way of a just culture, and what we can do better.

I look forward to reading your comments here

Aidan Fowler is National Director of Patient Safety at NHS Improvement

 *** To leave your comments and ideas join the challenge here ***

Years of research and evidence has shown the positive impact of engaging with staff across different sectors. Many of the most successful businesses in the UK, from John Lewis to BAE systems, have a clear commitment to staff engagement. This has helped them to be more productive, innovative and successful. 

But the case for engaging with your staff is arguably stronger in the NHS than in any other sector. We have evidence that staff engagement is closely linked to patient satisfaction. High staff engagement also helps to improve decision making and reduce staff absence.

The Care Quality Commission (CQC) is responsible for assessing the quality of care delivered by health and social care services in England. CQC has recognised the importance of staff engagement, and now includes it as a central element when they assess a service.

The trusts rated as ‘outstanding’ by CQC have the highest levels of staff engagement recorded in the NHS staff survey. From mental health services in Northumberland to large London teaching hospitals, staff engagement and quality care go hand in hand. 

Engaging staff at all levels

Staff engagement should happen at all levels of an organisation. At team level, staff can be involved in developing ideas to improve quality and solve problems. At ward level, they can help change the way services are delivered. And at overall organisational level, staff can help shape the future of their organisation. 

The ways in which NHS organisations involve staff range from large-scale ‘Big Conversations’, to ward-level ‘quality huddles,’ to simple actions such as senior leaders getting out on the wards and listening to staff.

In addition, many NHS trusts are using technology to improve engagement. Whether through simple mobile apps to rate their satisfaction or more in-depth online feedback platforms, trusts are embracing digital tools to engage large, diverse and often dispersed workforces. 

The NHS staff survey shows high levels of staff commitment and motivation. The NHS has a good record on involvement at ward level but can do more to develop overall engagement and spread good practice. The key now is to build on existing examples and make sure the NHS listens to the views and ideas of staff who deliver its services. 

Steven Weeks is Policy Manager at NHS Employers

Staff like you are the heart and soul of the NHS – an organisation which is rightly one of this country’s proudest achievements. Over a million people rely on its services every day.

Yet the numbers are rising and our growing ageing population presents an unprecedented challenge to its hardworking and dedicated staff.

This week we have launched the Long Term Plan for our NHS. A comprehensive set of proposals, which will ensure it does not just meet this challenge, but secures the NHS for future generations to come.

Any plan for the future of the NHS must be backed up by more money. That’s why earlier this year the Prime Minister announced the largest funding settlement in the history of public services, increasing the budget by £20.5bn a year by 2023/24. 

The bold and ambitious plan is the product of thousands of conversations with our clinicians, patients and the public right across the country to focus on the priorities that matter to us all.

The Long Term Plan will grow and better support you, our hardworking NHS staff, and invest in new technologies to bring the NHS into the digital age – making it fit for the future. 

Matt Hancock speaks to nurse on ward

 

There will be a new focus on prevention, personal responsibility and promoting good health, and more rapid diagnostics and new treatments will improve your care.

In essence the plan will ensure everyone from the beginning to the end of their life will get the best possible support.

Every baby will get the best start in life as we revolutionise maternity safety and new parents will be supported with better recognition of symptoms and access to mental health services.

It is a tragedy that our children growing up now are more likely to be affected by poor mental health. That’s why our plan will see more support for children in schools, faster waiting times for specialist therapies and improvements in how children are looked after in hospital. 

We must take better personal responsibility to prevent ill health throughout our lives. There will be better and more targeted screening and a clear shift towards promoting good health, not just curing illness. We will improve detection, introduce more targeted screening, and build Rapid Access Diagnostic Centres so you can get a diagnosis quickly. We will fund new treatments and technologies such as genomic testing to personalise treatment.

And we will support people to age well – bringing teams from across primary and secondary care together to make sure older people get the support they need to remain independent in their home for longer, avoiding unnecessary stays in hospital.

You, our hardworking NHS staff, will be able to grow as a workforce, as we support opportunities for thousands more doctors, nurses and other health professionals, particularly in mental health, primary care and community services.

We will create a better working environment for you, our NHS staff, with better training, support and career progression and action taken on bullying and violence to ensure our health service has the staff it needs to care for you and your family.

Our Long Term Plan will ensure the NHS continues to be there, from cradle to grave, free at the point of use, based on clinical need and not ability to pay.

I will always champion this, and the hardworking staff who continue to be dedicated to making this happen.  

A health service and workforce that can look to the future with confidence and hope.

 *** To leave your comments and ideas join the challenge here ***

I am Stephen Hammond and I was appointed Minister of State for Health, at the Department of Health and Social Care, last month. As the Minister with responsibility for the NHS workforce, I am pleased to be working with a Secretary of State who has placed such a high priority on supporting the people who work in the health service to provide the best possible care.

My first visits were to St Bartholomew’s Hospital and North Middlesex Hospital. There I heard from staff about the issues they face every day – they echoed much of what you and colleagues from up and down the country have posted to the #TalkHealthandCare platform. That there are issues with the availability of training and development, that there isn’t always enough time to care, that too often people experience bullying at work. None of these things are acceptable.

As the NHS prepares to publish its long term plan, now is an ideal opportunity to describe what will be different for health and care staff working in the NHS in ten years’ time. I am clear that the issues facing staff need to be front and centre in the plan and that the change it will describe must be delivered in partnership – with national organisations working with unions, employers, patients and staff to deliver services that are clinically led, high quality and sustainable.

 

NHS ward

Over the coming weeks you will see me contributing to the discussion here and as I embark on visits to hospitals across the country. I am committed to continuing to listen to your views so I can best understand what support you need. And I am committed to working with you to help solve the issues you face every day.

Two months ago I wrote about the need for NHS and adult social care staff to help save more lives by getting their flu vaccine ahead of this winter.

This crucial vaccine helps protect staff and those they care for from catching what can be a serious and sometimes life-threatening virus.

As we head towards winter, I’m taking a moment to reflect and review on how engaged staff already are with this scheme and how, together, we can increase vaccine uptake even further. 

The latest figures show that during September and October 46.3% of NHS healthcare workers took up the flu vaccine offer – that’s roughly 6,700 more staff than in the same period last year.

It’s positive to see that more NHS staff are getting their flu jab earlier; and I hope this puts us on a good course towards achieving our vision for 100% of frontline health and care workers vaccinated.

Although there isn’t much flu about yet, we can’t be complacent. We need to encourage the 1.47 million social care workers in England, who can access the flu vaccine from their GP or pharmacy for the second year running this winter, to get theirs too.

We know that people aged 65 and over are more vulnerable to the complications associated with flu. That’s why social care workers taking up their free vaccine is vital and can help to protect this vulnerable group. Up to 50% of flu infections are asymptomatic, which means that the infection is easily spread without realising.

I want to ask you – our hardworking health and social care workers – to continue to promote this vaccine to your colleagues and to let me know in the comments section below what you think we could be doing differently to help inspire people to get vaccinated.

Are there barriers to you getting the vaccine in time that we need to know about? Or perhaps your care home is very good at helping staff get vaccinated and you’d like to advise us and the NHS workforce on the practical steps you have taken.

By staff taking up their flu vaccine they can help save lives, so we need your help!

To find out more about the flu vaccine visit the NHS Employers website, where you can also download digital resources such as: campaign planning guidesevaluation guides and a communication toolkit

Matt Hancock meets with frontline NHS staff

As soon as we come into contact with the NHS, most of us can be confident that we will get compassionate, high-quality care from hardworking staff who have trained for years to be some of the best in the country at what they do.

They know how it works and they know what patients want and need. But too often, their many years of vital experience doesn’t inform the way the NHS is run, with too few clinicians making the move into NHS leadership roles.

Some have done it with great success - Professor Jane Cummings at NHS England;Dr Nick Broughton at Southern Health; Professor Marcel Levi at UCLH.

Another is Dr Sonia Swart, Chief Executive of Northampton General, who firmly believes clinicians have a key role to play in always being aware of the need to improve the systems of care in which they work.

But there must be something stopping talented people, who possess the qualities great leaders need, from rising to the top.

A review by the Faculty of Medical Leadership and Management has identified a number of barriers for clinicians considering senior leadership roles in the NHS – a lack of a clear career path into leadership roles; a lack of exposure to management and leadership responsibilities; and the perception that being a leader and being a clinician are “incompatible”.

This has to change.

We want clinical staff to use the invaluable experience they’ve gained on the frontline to drive forward progress at departmental, trust and national levels. To instigate this new approach, we will be identifying the best ways to support staff who want to be on a pathway to senior leadership, as well as providing guidance for easy ways for all staff to engage in leadership activities.

We want this mindset to permeate throughout every level of the NHS. From day one of a junior doctors’ career to the retirement of the most senior nurse, they should be encouraged to think about leading from the front, driving a culture of innovation and striving for better processes at every turn.

As a result, undergraduate and postgraduate education will have a new focus on leadership qualities, enabling clinicians of tomorrow to embrace this new mindset today.

This isn’t about creating more management roles – it’s about making sure those on the frontline know decisions from the top are thought-through, well-intentioned and informed by years of practical, front-line experience.

We need the right mix across the NHS leadership community, combining frontline clinical knowledge and experience with leadership skills and vision to benefit the whole team, benefit the NHS, and benefit the nation.



Roger Kline
is Research Fellow at Middlesex University Business School

Duncan Lewis is Professor of Management at Plymouth University Business School

24% of NHS staff in England report that in the last 12 months they have been bullied, harassed or abused by their managers or colleagues. This does not include the full impact of incivility or of witnessing bullying.

Such behaviours adversely impact staff wellbeing and ultimately the quality and safety of care. Bullying has been a factor in many scandals affecting the quality of NHS care. Bullied staff are less likely to admit mistakes, raise concerns or work in affected teams.

We have made a comprehensive estimate of the financial costs of bullying.  It is at least £2.2 billion annually. We drew on available research and data sources to calculate the impact of bullying on resultant sickness absence costs to the employer, employee turnover, diminished productivity, sickness presenteeism, compensation, litigation and employment relations costs. 

This is likely to be a considerable under-estimate because it excludes primary care, national NHS bodies, legal costs, the financial impact of rudeness, and the impact on those who witness bullying.

Research makes clear that the traditional reliance on policies, procedures and training must change since evidence suggests that in isolation they will not change toxic cultures. Employers must be proactive, not waiting for individuals to raise grievances, exit or go sick. It is organisational climate/culture that allows bullying to be so common so there must be honest reflection on leadership behaviours that permit, encourage or collude in bullying.  Holding managers and staff at every level to account for their standards of behaviour can radically reduce bullying. However, this requires independent voice mechanisms that NHS staff trust and believe will work for them.

It is possible to reduce bullying even amidst funding and workforce pressures. Our work provides compelling reasons why the NHS (and Ministers) cannot afford to look the other way.

The price of fear: estimating the financial cost of bullying and harassment to the NHS in England: https://bit.ly/2qATIuu

 

 



Kim Sunley is National Officer at the Royal College of Nursing

Last month the Royal College of Nursing ran a summit on tackling workplace violence in the NHS. The summit focussed on the new Assaults on Emergency Workers (Offences) Act 2018 and along with hearing examples of good practice on supporting staff following assaults, the RCN shared data on the extent of workplace violence in the NHS. 

The report made interesting reading, but to paraphrase the epidemiologist Sir Austin Bradford Hill “statistics are people with the tears wiped away” and perhaps the most sobering part of the event was hearing from nurses and other emergency workers who had been assaulted.

Whilst physical scars and injuries heal over time, the emotional scars can take much longer to heal and affect both work and life outside. 

We were delighted that Matt Hancock, Secretary of State, joined us at the summit and welcomed his announcement on addressing violence against staff as a step in the right direction. 

We have always been clear that the Act is just one measure and that there needs to be more focus on prevention, be that through safe and effective staffing, design of environments and appropriate training for staff.  We must also be aware of all the environments healthcare staff work in, including the community. 

 The causes of violence in healthcare can be complex so data collection is key, not just the number of assaults, but what type of environments they are happening in, what time of day and information on the perpetrator, so we can target interventions.  

One issue that can be addressed quickly and without the need for major investment is the level of support that is given to nursing staff who are assaulted. Sadly this can all too often be found wanting. The culture of accepting it as ‘part of the job’ needs to change.  

At the summit we heard from organisations who had tackled this head on with a case management system and the Police Federation’s seven-point plan, which calls for police officers who are attacked to be treated like any other victim of assault.  

We look forward to working with the respective system leads and key stakeholders on this issue and making a difference to the working lives of nursing staff.

 

It was the threat of divorce which galvanised me to push for a different style of working. I’d had years of unfriendly registrar rotas, long commutes and difficult exams in order to get to the golden prize of being a consultant.  And now I’d arrived, I was somewhat disappointed.

It felt more like a bronze medal. Other doctors still talked to me as if I were a junior, patients were still waiting too long for beds but worse than that, the rota was still affecting my home life. I had made promises to my wife that all her issues with my working life would be resolved by my new consultant job, but I was still doing shifts that didn’t often coincide with nappy duty and I missed my eldest kid’s first nativity play.

The rota was hard; we were down on consultant numbers and often lacked middle grades. I also felt somewhat aggrieved about the fairness of it all, when I covered for sickness or stayed late it was often done at my own expense.

After 6 months in post, I wanted to decrease my clinical work to do more at the medical school. But the medical school commitments were never fixed and it was hard, within the existing system, to make the job plan I needed work for me, the department and the medical school.

As time moved on, I started resenting what I genuinely love doing: being on the shop floor treating the variety of patients we see, with their multitude of problems and pharmacologically enhanced personalities.

The consultant rota needed to be adapted to take account of increasing out of hours requirements, and to suit the staff better. In addition, the Trust had asked the consultant body (with our agreement) to start doing shop floor nights.

So, a few of us pondered how we could introduce a different way of rostering – annualised self-rostering.  This had to meet the Trust’s requirements, ensure that we got remunerated for what we did and paid us for when we stayed late. We put the idea to colleagues and got the green light of our clinical lead. So, with a crash course in Microsoft Excel and the support of our management team, I went to work.

I’m now proud to say that we now have an annualised rota system, with self-rostering and a whole lot more flexibility for the trust and for staff than we used to have. In simple terms, the way we do it is to:

  1. Calculate for each consultant what they could offer the department. First people decided how many clinical sessions they could work on their contract.
  2. Then we take that and work out how many sessions each person will therefore do annually.
  3. Then take account of other demands on time that will reduce available clinical sessions (everything from CPD time to bank holidays).
  4. We then work out how best to use those sessions for the departmental needs – essentially designing a roster.
  5. Staff then self-roster onto the template according to their preferences.

We pre-allocated weekends and certain shifts to ensure fairness, but otherwise everything was self-rostered. I did lots of evening/night work as it fitted in with childcare. Others did day shifts if it suited them better. People did what suited them and as long as all the shifts were covered safely, then everyone was happy. If you wanted leave, you just didn’t self-roster. 

It has helped us move towards 24/7 working, allowed consultants to go on secondment. We have also used the template to roster for our junior doctors (including middle grades) – and it helps with their sustainability too.

Our experience hasn’t been perfect. The rota doesn’t fix the intensity of the work during the shift, flow problems or difficult speciality doctors, but it makes it easier to deal with.

I think annualisation and self-rostering can help people be persuaded to go into emergency medicine as a career. It increases the attractiveness of the speciality, especially for less than full time staff, and helps with sustainability.

At the college, I have been involved in working with a team developing resources for use by others. We are developing a guide to self-rostering which will be published later this year.

For me personally, I have noticed a difference to my wellbeing. I have cut the number of my clinical sessions, and work those sessions at the medical school instead. I have also had the time to pursue other interests such as writing, being a crowd doctor, running critical appraisal courses and being involved with the Brighton Marathon.

But most importantly, because of the new roster and ability to self-roster, this year I did attend my kids’ nativity plays. It may not have been the traditional nativity story (there was a penguin present at the birth of Jesus) but at least I was there – something my fellow school gate dads, doing traditional 9 to 5 jobs, were unable to do. It was also the first time that I remember other people being  jealous of my rota and my work-life balance.

I am happy to answer questions and how it could be implemented at your work, (or give more info if you want to work in a nice place by the sea with this style of working!). I can also provide more information on the rota software we helped develop and now use. For any questions, please email drrobgalloway@gmail.com

A career in adult social care is incredibly rewarding and care work is a hugely worthwhile vocation with more than 100 different roles on offer. With a growing need for more care workers we want to support providers to recruit the best possible talent.

That’s why last week, following feedback from the sector – including on Talk Health and Care – we announced the launch of two month-long pilot recruitment campaigns to promote jobs in adult social care in Gloucestershire and Tyne and Wear.

There are an estimated 110,000 vacancies nationally, and the pilots will look to test which channels, messages and tactics are most successful in highlighting the variety of rewarding roles which can make a difference every day.

This will help inform the national roll out in the new year, to ensure we have a workforce fit for the future and able to meet the needs of some of society’s most vulnerable.

Find out more information at www.everydayisdifferent.com, visit the Facebook page and share your ideas in the comments section below on how we can encourage more people with the right values to work in adult social care.

 



You may have spotted a red briefcase being waved around on the news last week, and that can only mean one thing. The Budget.

So I’d like to take this opportunity to reflect on what the contents of that briefcase will mean for health and care staff.

Firstly, I’m immensely proud that the NHS was marked out as the number one priority for government spending over the next year, and beyond.

Why? Because this historic £20.5 billion funding increase is vital to the government’s long-term plan to guarantee the future of the health service.

The Budget explained how some of that £20.5billion will be spent – confirming that at least £2billion of the funding with be spent solely on mental health services. This includes setting up new mental health crisis services, including specialist crisis teams for children and young people across the country, along with mental health support teams in schools. It will give staff the resources to continue to deliver life-changing support to patients, and spot the signs of mental illness early for children and young people.

Not only is it welcome news to those of us who have relatives, friends and colleagues who have experienced mental illness – as many of you have raised on this platform – it also shows how important it is to ensure staff and our healthcare systems are equipped to provide the help people need as part of the long-term plan.

Social care funding also got more support with local councils to be given £650 million. Of this, £240 million is for adult social care to make sure more people can leave hospital when they are ready, into a care setting that best meets their needs. The remaining £410 million will enable local areas to improve their social care offer for older people, people with disabilities and children. While there is still more to do on social care, this is a positive first step, coming ahead of the green paper later this year.

There was also funding for specific parts of the health sector.

A Defence and National Rehabilitation Centre in Nottingham will receive £70 million to fund services for non-military patients. This will mean that the public will benefit from the resources of an internationally recognised medical rehabilitation and research facility.

£10 million will also be donated to air ambulance trusts in England. This is excellent news for those of you working as volunteers, or alongside air paramedics, as you know just how essential they are – especially in rural areas.

There’s a lot to digest in this budget. But if you take away one thing away let it be this – through the government’s long-term plan for the NHS, the health and care sector was given more funding than any other public service.

This is all thanks to the tireless work of each and every member of staff. We know how important it is that you have the resources and support you need to do your job, and care for patients day in day out. And I am committed to keeping it that way and guaranteeing the sector’s future.

If you want to know more about the budget check out this helpful summary, and I would like to hear how this new funding might affect your area of work.

 

NEWS UPDATE ON VIOLENCE REDUCTION AGAINST THE NHS WORKFORCE 

Around one in seven NHS employees have experienced violence in the last year. That is why today, Health Secretary Matt Hancock announced a series of measures to clamp down on violence against NHS staff as part of a zero-tolerance approach.

During a speech to the Royal College of Nursing, the Secretary of State for Health and Social Care announced the first ever NHS Violence Reduction Strategy to protect the NHS workforce against deliberate violence and aggression from patients, their families and the public, and ensure offenders are punished quickly and effectively.

Shocking statistics from the most recent NHS staff survey show over 15% of employees have experienced violence from patients, their relatives or the public in the last 12 months – the highest figure for five years.

The new strategy to be announced today will set out how:

  • The NHS will work with the Police and Crown Prosecution Service to make sure victims are supported to give evidence and achieve prosecutions in the quickest and most seamless way possible
  • The CQC will scrutinise violence as part of their inspection regime - and identify trusts who need further support to reduce violence against their employees
  • Staff will be provided with better training to deal with a violent situation, including challenging circumstances involving patients with dementia or mental health issues
  • Staff who have been victims of violence will be able to access prompt mental health support

Secretary of State for Health and Social Care, Matt Hancock said: “NHS staff dedicate their lives to protecting and caring for us in our times of greatest need and for any one of them to be subject to aggression or violence is completely unacceptable.

“I have made it my personal mission to ensure NHS staff feel safe and secure at work and the new violence reduction strategy will be a key strand of that.”

“We will not shy away from the issue – we want to empower staff and give them greater confidence to report violence, knowing that they will see meaningful action from trusts and a consistent prosecution approach from the judicial system.”

The strategy takes into account a number of sensitive and challenging circumstances staff may be faced with when working with some of the most vulnerable patients.

Where prosecution is not the most appropriate result, for example when assaults are carried out by patients with dementia, brain injuries or other mental health conditions, trusts will be supported to improve staff training and access to support. The current training in de-escalation and conflict resolution will be assessed to ensure it it up to date and effective, with improvements made where necessary.

To understand the reasons behind the rise in reported violence, the strategy will include a new system so staff can more easily record assaults and other incidents of abuse or harassment. Trusts will also be expected to ensure every incident is investigated in full and lessons used to protect staff from future incidents.

Plans are being drawn up for violence and abuse data from across the NHS to be reported nationally and analysed so the government and NHS England can determine which staff are most vulnerable to violence and allow for appropriate action to be taken.

The new plans follow the Assaults on Emergency Workers (Offences) Bill, which was recently brought into law by the government and will see the maximum prison sentence for assaulting an emergency worker double from six months to a year.

The new measures demonstrate government delivering on its manifesto commitment to implement robust action against those who target the men and women who work tirelessly to deliver the best care for their patients, at every level of the health service, in every town and city in the country.

UNISON Head of Health and Social Partnership Forum Staff Side Chair, Sara Gorton said: “NHS staff spend their working days caring and saving lives, and their safety should be paramount.

“No-one should be abused, threatened or attacked at work - especially when all they’re trying to do is help people.

“It is encouraging that the government has listened to unions and agreed to review measures in place to ensure staff safety. This includes a more joined up approach between the NHS, police and CPS. Anyone who threatens or abuses NHS staff should be prosecuted under to the new law protecting health care workers.”

All health and care staff are encouraged to continue sharing their experiences and ideas on the Talk Health and Care engagement portal, to improve the health and social care sectors and their own working environments. The portal was launched in the summer by the Secretary of State and currently seeks views on six key challenges, including ‘working without fear of bullying, discrimination and violence’.

Royal College of Nursing National Officer, Kim Sunley said: “Nurses and health care workers understand their roles aren’t risk-free but, to many, it still seems as if the threat of physical violence is a daily reality.  

“These measures are another way to change this for good by increasing the accountability of employers for the safety of their staff and ensuring those who wilfully assault healthcare workers feel the full force of the law. Victims of assault at work have their lives turned upside down and it affects their wellbeing, their families and their livelihood and there’s always more we can do to support them.”

Find out more about the Health Secretary’s announcement here: www.thetimes.co.uk/article/an-assault-on-nhs-staff-is-an-assault-on-us-all-52f2hwp6d

As a consultant anaesthetist with 30 years’ experience in the NHS, providing care and support for patients in Nottingham, I live the daily experiences of any other doctor. The ceaseless resolve of colleagues, the crossed fingers of family members, the sincerity of a patient’s “thank you”.

However, I also have the privilege of being President of the Royal College of Anaesthetists (RCoA) a position that gives me the benefit of feedback from a membership of nearly 22,500 working across the NHS (and indeed in 75 other countries) and a picture of the common issues that emerge.

While I may wear two hats, I have a single view that, in all things, the best work is delivered by teams with a range of expertise and experience. Ensuring that the NHS has the workforce to enable this is a huge challenge.

To overcome this we need to recruit, train and retain a sustainable supply of anaesthetic doctors – but we also need to ensure that these doctors have the other team members that make it all work.

In my specialty, the newest team members are Physicians’ Assistants (Anaesthesia) (PA(A)s).

PA(A)s are highly trained and skilled practitioners who work within an anaesthetic team under the direction and supervision of a consultant anaesthetist. Since their introduction into the NHS workforce in 2003, approximately 180 PA(A)s are already working in the UK, having trained via the PA(A) postgraduate diploma programme.

They can assist in a variety of ways and many anaesthetic departments have already realised the benefits the PA(A) role can bring to their workforce, ensuring high quality, safe care for their patients, as part of the anaesthetic team.

Many anaesthetic departments have already included the PA(A) role within their workforce, but the potential contribution has been limited by a lack of regulation.

But this is set to change following the welcome announcement from the Secretary of State that the Department of Health and Social Care with proceed with the regulation of PA(A)s. 

Statutory regulation of PA(A)s – something the RCoA has long been advocating for – will provide the standardised framework of governance and assurance for the clinical practice and professional conduct that will enable these healthcare professionals to make a greater contribution to patient care.

So, back to my two hats. As President of the Royal College of Anaesthetist I look forward to working with partners at the Association of Physicians’ Assistants (Anaesthesia) in developing the PA(A) workforce and I look forward to the possibility of working with new, regulated, PA(A) colleagues

Matt Hancock speaking at the Global Ministerial Mental Health Summit 2018

This month, not only did we mark World Mental Health Day on October 10th, but we welcomed delegates from across the globe to the first ever Global Mental Health Summit.

This was a landmark moment to help change the way mental illness is perceived worldwide. More than 40 countries sent representatives to the Summit, and we made a global declaration that mental and physical health should be treated in the same way.

During the Summit I announced an extra £30m of funding for global mental health research. And we announced the creation of the world’s first ever Minister for Suicide Prevention, a role being taken up by the excellent Mental Health Minister Jackie Doyle-Price. She will lead a new national effort on suicide prevention to overcome the issues that prevent people from seeking help.

I’m aware that promoting healthy mental wellbeing starts in the workplace. For example, we know many GPs have experienced mental health conditions such as depression, anxiety, bipolar disorder and post-traumatic stress disorder. So we’re doing something about it. Simon Stevens, Chief Executive of NHS England, recently announced funding for a new mental health support scheme to prioritise doctors’ mental health. The confidential NHS GP Health Service provides support to GPs with issues relating to a mental health concern, including stress, depression or addiction – you can find out more details at www.gphealth.nhs.uk.

There’s plenty of advice available on this subject, but if you and your team are facing any issues, mental health charity Mind recently shared some helpful tips on our #TalkHealthandCare blog on how staff can look after their wellbeing.

We’re committed to turning the tide and changing the way mental health is perceived and treated. I’d love to hear your views on what more we can do to support you where you work.              

I'm Beverley Latania - Principal Social Worker at London Borough of Newham and co-chair of national PSW network.

Local authority offices are busy, hectic places where many people are thrown together. Not everyone will get on with each other – that’s ok, that’s normal.

What’s not normal is to turn that dislike into something bigger, where staff start to gossip, impersonate others or isolate a single member of staff. This is bullying.

Bullying and discrimination in the workplace can take place in many shapes and forms. It can come from colleagues or managers, groups or individuals, and it can be subtle or in your face – either way, it is not acceptable.

As a manager, I remember a situation where a fellow manager would constantly go back to an individual worker about their work, stating it was not good enough, telling the staff member to rip it up and start again. At first, I thought that this was harsh but maybe it was how the manager led his team to make sure work was produced to a high standard. I tried to normalise it. However, after a couple of months I started to recognise this was not the case and he was singling out this member of staff. 

Eventually the situation was resolved with help from a supportive supervisor who was able to mediate between the worker and the manager so a beneficial working relationship could be established. Not everyone may be that lucky, but there’s normally one person within a team or organisation who you can approach, share how you’re feeling and who will be able to offer some advice. It’s important to share as the first step in getting some help and support. 

If I were to be faced with the same situation again, I would step in and approach the staff member one to one to offer support and ascertain what was going on, with a view of discussing it further with the manager. Sometimes it takes someone on the outside to raise the concern so it can then be addressed in a suitable manner or to be formally investigated.

There are many stories online about cases where staff have had to put up with the bullying, where they were shut up or pushed out if they spoke up.

It is vital that we do all we can to prevent this from happening, not only because we care about our staff and their wellbeing, but also because of the overall effect this has on how an organisation functions – 11 million days at work are lost every year due to stress at work.

Keeping staff safe and supporting one another

Most local authorities will now have a whistleblowing policy in place. These policies are designed to enable staff to speak up in confidence and report issues that can help to alert HR to poor practice.

Camden Council’s Raising Concerns at Work sets out clear guidance on the expectations from staff, managers and the organisation. More importantly, it offers top tips for staff and managers on how to report a concern. Newham Council’s employee code of conduct outlines that every staff member must be accountable for their behaviour and how it could be perceived by others. As part of supervision, reflective spaces are offered to staff to look at their knowledge, skills and developmental needs. These are just 2 local authorities which have placed an importance on tackling this area, I know there are many more.

However, good policies alone are not enough. We, as social care staff need to support each other, take cases of bullying seriously, question and challenge it when seen and, most importantly, report it.

My name is Emily. I’m a trainee nursing associate and have been working in care at a nursing home run by Amber Care for 8 years. I really enjoy it. Prior to becoming a trainee nursing associate, I was a healthcare support worker and having worked with my manager for six years she encouraged me to apply.

I’m now coming towards the end of 2 years of training. This involved one day a week learning with other trainee nursing associates in a variety of health and care settings. I really enjoyed learning new knowledge and skills while getting to know others with the same motivation as me.

My role supports the nursing team and means that I can provide hands-on care to service users at a higher level than I was previously able to do. It enables me to share my knowledge and skills within the care team. My role as a nursing associate helps me to support the team to provide more hands-on care. It also helps my colleagues feel better supported with increased confidence to develop their skills and knowledge.

I’ve been trained through one of the test site partnerships, as part of the national pilot for trainee nursing associates. It has identified that there is a gap between nurses and seniors where people like me can develop upon skills we already have and learn new ones.

The nursing associate role also makes me feel that our work is recognised as part of the wider nursing and social care professional. I feel proud to be part of innovative and new ways of working to improve the personal care we can deliver in health and social care.

The nursing associate role is a new one which will be registered by the Nursing and Midwifery Council (NMC) who will set standards for nursing associates. 

The nursing associate role will enable many existing staff in care roles to progress their careers through further training, and for those who want it, it will enable further progression on to registered nurse training.

Starting out on my journey to become a mental health social worker last year was really daunting, but I’ve loved it.  

I am doing my training through the Think Ahead programme, a 2-year graduate programme for mental health social workers. I spent my first year working in community mental health services with Tees, Esk and Wear Valley NHS Foundation Trust (TEWV). In my second year I’ll work as a newly qualified social worker in an Early Intervention in Psychosis team. I’m looking forward to continuing learning in the second year, and I’ll be carrying out original research as I work towards my master’s degree. 

I’ve already gained so much training, development and support. These are some of the things which have been vital to my experience.

Access to high quality, varied training  

Think Ahead introduced me to the knowledge and underpinnings of being a mental health social worker, including learning social interventions at 3 levels: individual, family and community. These interventions have become really familiar to me, and are now embedded in my day-to-day practice.

I’ve also had access to a huge range of training through TEWV. I’ve completed training in many areas, including the Mental Capacity Act, trauma and managing emotions, all of which I have been able to put into practice. This focus on training has made me feel really valued as a member of the organisation.

Understanding different teams

Being able to work in and shadow several different teams has also been really valuable. I have mostly split my time between a crisis team and a community mental health team, but I’ve also spent short periods of time working in an older people’s team, children and adolescent mental health services and a hospice.

I also had loads of shadowing opportunities – including Deprivation of Liberty assessments and Mental Health Act assessments. This has helped me understand processes and the nature of teams in different areas.

Support from other staff

I’ve been really supported by my manager and by other staff. Informal support from my fellow trainees on Think Ahead has also been invaluable – they understand best what I’m going through! The social work network within TEWV has also been a great opportunity to get to know other social workers in the organisation.

Weekly meetings

Weekly case consultation meetings were a requirement from Think Ahead, following a format developed by the University of York, who are the academic partner for the programme.

I came to really rely on them for helping me face challenging situations. The meeting format allows application of theory and research to a situation, and enables you to draw on other people’s experiences and perspectives. I’ve been able to develop really robust care plans from those meetings, and will keep having them in the future.

Overall, I’ve really enjoyed my learning experience and although it has been challenging, the training and development opportunities have made that challenge easier. I now feel confident and competent in many areas of my work but I will continue to learn through these opportunities. Investing in and supporting staff is vital for them to feel valued and ensure they enjoy their role.

It is well documented that people with severe mental health illness have a significantly lower life expectancy than the UK adult population. Sadly, the majority of this disparity is due to factors such as smoking. Smoking rates are estimated to be 40% among people with severe mental health illnesses.

At Tees, Esk and Wear Valleys NHS Foundation Trust, where I work as the smokefree lead, we provide mental health services to people in County Durham, Teesside and most of North Yorkshire. My role is to implement a smokefree policy across the trust for service users, staff and visitors.

While the health of our service users is a huge focus, the health of our staff is also important and we need to make sure that our colleagues understand the importance of what we are trying to achieve. It’s not helpful if staff take breaks and come back smelling of smoke when we are implementing a smokefree policy. We encourage staff to lead by example, by not smoking during working hours, and have put measures in place to support this.

There was a lot of initial work behind the scenes. We have an internal smoking cessation and harm reduction leadership group involving staff from a wide range of disciplines along with service users and carers, as well as sub-groups looking at various elements, from information and training to policy and communication.

The trust covers a large area, with a lot of staff and service users to communicate with. We work closely with the communications team to make sure information is cascaded through relevant channels.

The success of the project largely centres on the buy-in of staff and service users. However, it’s our staff that are central to our overall success – it’s so important that they are on board and support our ambitions.

Staff can purchase nicotine replacement therapies from Lloyds Pharmacies on 3 of our main hospital sites. We also promote stop-smoking services and confidential stop-smoking drop-in clinics too.

Myself and smoking cessation trainer and support Lynda Tench communicate with staff directly, through training sessions, as well as supporting corporate staff inductions to make sure that new staff understand the smokefree policy.

We’ve also recruited smokefree champions across the trust, who work with us to promote the smokefree agenda to staff. They help keep up the momentum of the project and are involved in a variety of activities from general awareness sessions to supporting cessation clinics in the community.

We are currently running 2 promotions across the trust in the run-up to and during Stoptober. The first is a campaign to encourage staff to pledge to go smokefree using the British Heart Foundation’s ‘I/we quit at work’ pledge. Secondly, we are also setting a challenge to our smokefree champions for them to come up with innovative ways to deliver our smokefree messages during Stoptober. Both campaigns involve a prize draw for staff and it is hoped that it will give a fresh boost to our smokefree campaign.

Follow @TEWV on twitter

A man at a desk with head in hands looking at a document

I'm Head of Workplace Wellbeing at Mind, where we're helping employers recognise the importance of mental health.

Working within the health and social care sector doesn’t make you immune to developing mental health problems. If anything, the unique pressures can mean it’s more important than ever to look after your wellbeing.

The causes and symptoms vary from person to person, so it’s important to identify your own triggers and the best coping strategies for you. Lots of people find it helpful to make sure they take breaks when they can, ideally outside, don’t routinely work over their contracted hours and get as much physical exercise as much as possible (more information at mind.org.uk/stress).

Workplaces are now recognising it’s time to take mental health seriously, but we have a long way to go. Too many employees still don’t feel able to talk about it or seek support in the way they would for their physical health. According to a Mind survey of nearly 45,000 employees across 74 diverse organisations, nearly half (48 per cent) have experienced mental health problems at their current place of work, and only half of those have talked to their employers about it.

In October 2017 the independent government-commissioned employment review ‘Thriving at Work’ was published. This review highlighted some startling statistics, including that every year, around 300,000 people with a long-term mental health problem lose their job in the UK. The scale of the problem is so great that it costs the economy between £74 billion and £99 billion a year.

The government accepted all the recommendations made, committing to take steps as employers to promote mental wellbeing at work, with positive implications for those that work within NHS and social care, among others.

Mind works with employers to help them tackle the causes of work-related stress and poor mental health and promoting wellbeing. We urge all employers to create mentally healthy workplaces and implement workplace wellbeing initiatives, such as flexible working hours, employee assistance programmes (confidential, 24-hour support line), subsidised exercise classes and buddy systems.

Above all, we want all staff to work within an environment where they feel able to talk openly if they’re struggling with their mental health and know that if they do, they’ll be met with support and understanding, rather than facing stigma and discrimination.

If you do not get the support you need, or feel discriminated against, seek advice from Acas or Mind’s legal line (email legal@mind.org.uk).

Under the Equality Act 2010, employers have a legal duty to provide reasonable adjustments for an employee who has a disability, which can include a mental health problem if it has a substantial, adverse, and long-term effect on normal day-to-day activities.

If you have a mental health problem and you want the protection of the act, you have to tell your employer about it. Adjustments will need to be discussed but might include things like changes to working hours, work space or roles and responsibilities.

Lots of employers and employees don’t know where to start when it comes to workplace wellbeing. With funding from the Royal Foundation, and support from 11 partners including the Work and Health unit, Mind has launched the Mental Health at Work gateway, which has plenty of information from a range of trusted sources.

People working or volunteering within police, fire, ambulance and search and rescue services in England and Wales can also benefit from our Blue Light Programme, tailored to the more specific pressures of 999 workers.

I’ve had a very busy few days in Birmingham, but I’ve still been reading your ideas – we’ve had another great crop this week.

Laura raised a really important issue on recognising the skill and professionalism of care workers on the front line. She is right that it is a job many of us would struggle to do. I know that my colleague, Care Minister Caroline Dinenage, is working hard to make sure that the social care workforce feel valued and have the resources and recognition they need.

I really do want to hear more from the social care sector, so if you agree with Laura, or have ideas as to how we can do better as a government to recognise the essential role they play, then please let me know here.

The issue of rostering has come up again this week – this time the administrative burden is highlighted by PDuncan. He makes an interesting suggestion that skilled admin staff could complete a lot of the heavy lifting of rostering more efficiently. I’m sure wards across the country approach this in different ways: if you’ve experienced alternative approaches then do post in the comments.

Efficiency was a common theme this week. Sarah spoke about the need for a probation period in some NHS jobs, and where perhaps the health and social care system could benefit from a more business-savvy approach. This is the case in Joanne’s comments about use of the internet in the workplace.

Sometimes what makes the NHS and care sector great places to work is that they aren’t like any other workplaces. But I think both of these points reflect that sometimes there needs to be clear professional expectations and behaviours.

All of these ideas reflect the importance of culture and attitudes at the very top. I’ll be sure to reflect this when I meet chief execs in the coming weeks.

Finally, you may have seen that this week I spoke publicly about my dyslexia for the first time. This was a difficult subject for me to tackle, but I am not shy about speaking up where I think it might bring positive change. I hope you won’t be shy about your ideas here either.

Every client is an individual; working in care is about human beings, discussions, empowerment and confidence. As a service we blend these values with an ambition to keep our clients safe and at home, with an emphasis on mobility.

I learnt early on that communication is key to safe moving and handling. Mobility is so important to independence, but there’s more to it than just knowing the right exercises to take someone through or how to use a hoist.

Gentle guidance, patience and discussion ensure that the people we support feel secure and have confidence in us. Talking to people means they are involved in their care, they know what to do and we know what they want. This on-going discussion gives carers confidence and empowers them, as they are part of a person’s decisions.

Imagine returning home from hospital, a very secure place, and arriving home to a carer saying, “come on, up you get”. They’ve already decided what you can do and need to do, and they expect you to be able to do it. That is not how it should be. So much of our work is about trust, so our approach is to ask people what they want to do and what they can do. We listen to them and work as a team.

Primarily this means our clients get to set their own pace. For people who have lost mobility and independence it can be an uphill struggle, so we may have to start with small steps. Similarly, we know that people have good days and bad days, so what someone wants to do and can do each day is an on-going conversation.

This strong person-centred culture is part of how I train and support staff. I’ve been training moving and handling for 9 years and I tell my team that if they are assisting a client to mobilise then the first step is communication.

Training gives people the practical and theoretical knowledge to support someone, but you cannot teach everything in a classroom. So, I visit each carer and their client at the client’s home to make sure that we are all happy with how things are being done and how equipment is being used. It means we can offer support that is tailored to the individual’s abilities and needs.

My approach to communication extends to how I lead my team. As a service we thrive on feedback. We listen to our staff, our clients and their families and have a digital care management system that means we can keep very individualised care plans up-to-date instantly. This includes individualised hoisting and moving and handling plans which are kept in each client’s home for the carer to refer to when they are working on their own with their client. If a carer is having an issue, they are always able to contact either me or another member of the management team for guidance 24 hours a day. 

The feedback we receive from clients and their family members means we know we aren’t just doing a job, we’re making a difference to people and that makes you think, “Yes! We’ve accomplished something!” 

 Care Concern Home Care have been rated as Outstanding by the CQC who praised their “strong, visible person-centred culture” and who noted that staff were “exceptional at helping people to express their views”. You can read the full report here

It’s the time of the year when health and care services take a collective deep breath – flu season is approaching. We can never predict in advance what’s ahead of us.

We’re all aware of the risk to patients and the pressures that flu and wintertime together place on the NHS and social care services. Before flu activity begins to increase, it’s incredibly important that all NHS and social care staff get prepared to play their part, and a big part of that is staying well themselves.

That’s why we want as many staff as possible to sign up for their flu vaccine – which is again being offered to social care staff and this year is also being offered to hospice workers for the first time.  

Fortunately, the vaccine uptake in healthcare workers increased last year from 63.8% to 68.7%, so we’re moving in the right direction – but we cannot be complacent. The sad fact is flu kills an average of 8,000 people every year and places huge pressures on health and social care services.

Flu is unpredictable and contagious and up to 50% of people with flu show no symptoms but may still be able to spread the illness. The vaccine is the most effective way to protect yourself and your patients from this potentially fatal illness.  Last year around 80% of flu outbreaks in closed settings took place in care homes – so social care staff have an important part to play in this.

The way the vaccine is administered is led by individual Trusts, but I urge you to read the why it matters page. There are a range of resources that employees in the social care sector can use.

The Department of Health and Social Care has committed an extra £145 million to NHS trusts ahead of winter to improve emergency care. But the vaccine is still our best defence for ourselves and our patients – so we need all staff to do their bit and take their jab.

Last year there were pockets of excellence across the country, but also some areas where staff uptake was very low. If your Trust is doing well or facing any barriers, please let me know in the comments.

Find out more from the NHS Employers website, which includes digital resources that can be downloaded, including: campaign planning guides, evaluation guides and a communication toolkit

Over 100 ideas

Posted by Matt Hancock 8 months ago

We’ve now had over 100 ideas on the #TalkHealthandCare platform and I’ve been reading them with interest.

Many have focused on culture within health and care organisations.

Rosemary wrote about the importance of shared values that have been developed by staff at all levels within an organisation. I completely agree with this and believe that strong leadership is crucial to developing a strong set of core values within an organisation.

Another issue, raised by Jamie, is the regulation of physician associates. Jamie suggests that statutory regulation of physician associates would mean more rigorous testing and would be better able to support doctors in future.

I know this view is shared by many, which is why the Government went out to public consultation in October 2017 to seek views on the possible statutory regulation of physician associates. We’ll be publishing our response to the consultation soon.

Richard’s comments about the need for social care employers to provide better support and development opportunities for staff knowledge and skills in providing high quality care, and making them feel valued and engaged really resonated with me.

That’s why we want more views on challenge three: having access to training, development and support.

My department is considering ideas for improving training for care workers, registered managers and other staff working across the adult social care sector. If you feel similarly to Richard, or have ideas about how social care employers can provide better support then tell us here.

Last Tuesday I did the overnight shift in Plymouth Hospital A&E where I saw first-hand some of the challenges that many of you face every day.

The compassionate and good-humoured nurses, doctors and paramedics I met all told me the same thing: they focus relentlessly on patient safety.

They said they need safe systems around them. Opportunities to learn from mistakes are crucial, as is a culture where staff are empowered to speak out when things go wrong. I am committed to making sure staff can do this.

Thanks so much for contributing all your ideas and comments. Let’s aim for another 100! 

There have been multiple major reports recently recognising that doctors want the way they work to be different. The foundation programme career destination report 2017 showed that only 42.6% of F2s progressed directly to specialty training. The latest GMC report on training pathways reveals that the 3 most common reasons for not entering training are:

  1. dissatisfaction with the training environment
  2. health and wellbeing
  3. uncertainty about specialty choice or career direction

Feeling some of the above, I thought about Australia, I thought about a masters, I thought about travelling, and I briefly considered training. But really, I wanted to dedicate time developing clinically in a trust I already enjoyed working in, while also having the opportunity to have paid time working on quality improvement, research and teaching – and to continue to live in a city and flat I love, to boot.

Fortunately, such a job exists… Reflecting on my short- and long-term personal and career aims I applied for one of the 12-month clinical fellow posts at Brighton and Sussex University Hospital Trust (BSUH) established by emergency department consultant Dr Rob Galloway (@DrRobGalloway) and the team.

14 months and a further reapplication later, I feel I couldn’t have made a better choice. I chose working for an organisation and department that values me and treats my work and life with equal high importance. I chose fully integrating within a team, making friends, and work colleagues who enrich my life personally and professionally.

I also chose being part of an engaged group of doctors full of quality improvement ideas who, with our split clinical and non-clinical posts, have the time and resource to effectively implement them. Through this post I have been able to support significant and lasting changes within the trust and region, be involved in award-winning improvements having national recognition, such as our single clerking and acute floor model, and learned skills that have opened doors to opportunities I didn’t know existed.

Rotas don’t have to stay the same as they have always been. Our shifts are designed ergonomically, gradually adjusting your body clock – from early, to late, to night. Your annual and study leave is guaranteed. If you want to get married in June next year and have 2 weeks off after, you can. Flexibility and cover is built into the rota, so sickness and absence has less of an impact. A large pool of doctors as fellows makes swaps for study and annual leave much easier and just a simple Whatsapp away. Moreover, we have no locum spend and no rota gaps. For the registrars and consultants, we use innovative software called Health Rota, which makes self-rostering and preserving work–life balance much easier.

Valuing doctors with jobs and rotas that respect and cultivate their personal and professional needs keeps us refreshed and motivated to keep working long term for the NHS, not only benefitting the staff but also the patients within it.

We have just been featured by the British Medical Association as an example of best practice as part of their medical rota gaps campaign and feature. Our video lets you hear more about our experience, and more detailed information is on NHS Improvement.

We need a change in culture and how our employers, regulators and educational bodies design how doctors work. Our fellow-posts and rotas at BSUH are an example of a growing resource of how we can do things differently and for the better for all doctors. We hope this is just the beginning of good things to come. Fourteen months ago I might have left the NHS, but now – provided practice like this is spread more widely – I am looking forward to the future.

@PhilipRankin

 

I'm Programme Head of Workforce Innovation at Skills for Care, a 6-foot plus, white middle-aged bloke and I have been bullied and witnessed discrimination and violence at work at different times in my career.

In each instance I talked to my manager about what had happened to me or what I had witnessed, I followed organisation policy and procedure, and I was never completely sure that the outcome was what I had hoped for.

Each time it was my fear ‒ of those I worked with, of my manager and my senior managers ‒ that had the biggest impact on what happened next.

Fear is not an emotion that many of us like to confront and it takes many forms in the workplace. If I report the person bullying me, I fear they will bully me more. I fear that others look at me sadly, thinking to themselves: “how brave, to stand up to the bully,” “how stupid,” or “it won’t end well for him”. I fear that if I tell others that what they are doing is discriminatory, I won’t be taken seriously.

When raising concerns about violence at work, there can be fear about what people will say. “Well, as long as no one gets really hurt, let’s not say any more about it.” “We are being inspected soon and if they hear about this it might affect our rating.”

Is fear about the consequences of standing up to bullying, confronting discrimination and protecting people from violence in the workplace a reason not to act? The answer is: we must act. However, the reality is that many of us will find reasons not to.

We might do this by pretending the bullying doesn’t really hurt. Being relieved when the bully moves on to someone else. Convincing ourselves that the person being discriminated against is just being over-sensitive. Unconsciously deciding that a certain level of violence at work is to be expected. Eventually, that might mean going and finding another job, leaving the bullying, discrimination and violence for others to cope with.

If I think more widely about bullying, discrimination and violence at work, I also see a direct link to the productiveness (or lack of it) of the workforce. Bullying, discrimination and violence damage the quality of people’s care and support, and ability of workers to do a good job.

Bullying can make people frightened of challenging poor practice. Discrimination can create a narrow workplace culture where anyone that doesn't conform is marginalised and the knowledge they bring is not taken seriously. Violence can increase absenteeism, burn-out and turnover. 

Standing up to bullies, challenging discrimination, not tolerating violence at work is hard. But, in my experience of each of those things, the key to success is to not face any of this alone. A bully will usually be bullying more than one person. Discrimination will impact on everyone in different ways. Violence at work will lead to people getting badly hurt.

Open and transparent conversations with your colleagues and managers is key. Everyone will be frightened about changing things, but fear can be lessened if you act together. You are never on your own.

Like any other sector, bullying can be an issue for people who work in adult social care. In this blog, I reflect on my own experiences and what can be done to tackle the problem.

I think the subject of bullying in the workplace is complicated. I have worked in social care for many years and the truth of it is, over this time I was once accused of bullying and have also felt bullied myself.

When accused of bullying by a colleague I had a responsibility to line-manage, I felt quite desperate that this word was used to describe how I made someone feel. I read the Acas definition over and over: “bullying may be characterised as offensive, malicious or insulting behaviour, an abuse or misuse of power through means intended to undermine, humiliate, or denigrate or injure the recipient.”

I didn’t recognise these words as a description of anything I intended to be when managing my colleague’s performance issues at work. The matter was resolved following an investigation, yet the feelings I was left with felt unresolved for some time afterwards. I imagine the feelings my colleague felt were unresolved for some time too. I watched her distress in investigatory meetings and I’m sure she observed mine.

When I felt bullied I felt distressed too, out of control and a great sense of injustice about the way I felt treated by a colleague. 

Looking back and looking forward, the lasting thoughts for me are about how we make people feel working with them when we go about doing our job, and also the feelings of people with care and support needs we work with in our social care job roles. I always conclude that how we make people feel can be more important and more lasting than what we actually do, with the memories of how we felt about something being more lasting than our actual experiences. 

As a social care practitioner, I believe the best protection we can adopt to look after people – whether our colleagues or people we provide care and support to – as we go about meeting our job responsibilities, is to be continually reflective on the values that inform how we think and behave.

Checking out with ourselves: are we doing what we need to do in a caring way, giving due consideration to how we might make someone else feel and are we doing it in a way that treats people fairly and with respect? Sounds simple – just always think about the impact of how we behave on others and ourselves – like I said, it’s complicated.

This blog is an update on the "Assault on emergency workers bill"

Matt Hancock on emergency workers

Last week the Ministry of Justice announced it will be doubling the maximum jail term for anyone convicted of assaulting an emergency worker

The move was welcomed by Health and Social Care Secretary Matt Hancock, who recognised emergency workers have some of the most important and challenging jobs in our society.

More than 17,000 NHS staff were deliberately assaulted in 2015 to 2016. Since then, the annual NHS staff survey reported that 15.2% of the staff who responded say they have been physically assaulted or abused – this is a 5-year high. 

The Royal Assent Bill is a big step towards reducing violence against staff, and helping people feel safe to go to work.   

The Department of Health and Social Care’s Simon Goodwin has first-hand experience of the hostility staff can face on the frontline, through his role as an Emergency Responder for the London Ambulance Service.

Simon Goodwin

“Sadly, assaults on emergency staff will never be completely eradicated, and spending so much time interacting with patients and families puts those in the 999 family at far greater risk than most jobs,” said Simon.

“Having experienced violent and threatening behaviour first-hand, I believe those who make a reasoned decision to attack staff deserve to have the book thrown at them.

“It’s good to know myself and my blue light colleagues have a more protected status when it comes to the sentencing of assaults. I hope the publicity around this new Bill will make potential attackers think twice.”

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Keep your ideas coming

Posted by Matt Hancock 9 months ago

 

Last week we launched #TalkHealthAndCare in Bristol and one week in, I’m so pleased that thousands of you have already visited the site and given specific ideas about how we can support you at work.

I’m really grateful to all of you who have taken the time to tell us what you think, and I have already read with interest many of your suggestions, including how we better learn from serious incidents, to ideas about empowering staff to bring their compassion to the fore when dealing with patients.

Kieran’s post, ONE healthcare record system to rule them all…, was the first idea I commented on and there are many more that I have read and hope to respond to soon. I completely agree that IT systems need to talk to each other and in the future we will publish robust standards that IT systems must meet if they’re going to be bought by the NHS.

We’ve also been asked, when we have a gap in a rota, why not offer more money to NHS staff instead of relying on external agency staff? And I completely agree – we’re encouraging trusts in the NHS to move more and more work over to staff banks instead. This is the in-house solution to temporary staffing, where NHS staff are paid to fill gaps in rotas, saving money on agencies, and ensuring better continuity of care. For the staff members, working through a bank can provide much needed flexibility and we’re working with several trusts to pilot new ways to make these banks work even better for you, and for patients.

Another area that has come up is working without fear of bullying, discrimination or violence. It’s one of the toughest areas to talk about but I have been impressed with those who have shared their experiences of how it has been handled in the workplace. We have a lot to do but are already making progress, with the introduction last week of new laws to better protect NHS staff by increasing maximum prison sentences for those who assault our hardworking emergency services colleagues.

There is so much to do, please keep contributing.

 

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