Heretics at large
Mandy Gundry is a community matron leading an integrated care team and district nursing in Farnham. Despite decades of frontline experience her first reaction when encouraged to apply for a place on the 2020 Leadership Programme was: “Me? Am I good enough?”
Dispelling her initial misgivings, Mandy immersed herself in the programme, laughing as she reveals that her leadership group badged themselves the ‘heretics’.
“I wasn’t sure what I was going to get out of the programme but I thought: I am passionate about community health; I know it inside out. It’s all very well having people up above with a vision but we clinicians need to keep them grounded. We need to ask: is this going to work for patients?”
The 2020 Leadership Programme is led by Dr Peter Bibawy, Medical Director at North East Hampshire and Farnham vanguard, with the support of an Executive Board and system leaders across the Frimley Health and Care Transformation and Sustainability Partnership and Thames Valley and Wessex Leadership Academy.
“The programme is built on cross-organisational collaboration, portraying leadership across a pioneering health system and reaching out to other public sectors, for example the military,” says Peter. “Open to all clinicians and managers working in the FH STP, the programme breaks down organisational barriers and prides its richness on the diversity of seniority.
The changing face of the health, social and public sector needs a cadre of innovative and empowered leaders, leaders who work at the coal face of service delivery. The system needs influential individuals who understand the needs of their local population and who will work across traditional boundaries to make change happen.”
So we designed the programme to create an environment of collaboration, trust and freedom where leaders can step out of their normal setting, away from targets, processes and hierarchies.”
Programme events and residentials included public sector collaboration, for example with the military and private sector learning through corporations like Microsoft. They also developed new connections between communities, for instance by involving local hospices; and bridged gaps between policy makers, front line staff and communities.
Karen Hampton, NHS Surrey Heath’s Head of Quality, says: “I wanted to learn about different leadership styles - how to influence and challenge decisions, how to manage difficult conversations. When we went to Sandhurst, I had a kind of ‘eureka’ moment. I realised this wasn’t just about the NHS. We can be very blinkered; it’s about a sense of place and the impact we have on the community around us.”
It’s interesting that leaders on the programme talk about a visit to a drop-in homeless centre, and having breakfast in an office block where children came to read for an hour before each school day. This was redefining their idea of ‘community’.
The 24 Fellows on the programme each had to adopt a change challenge. Mandy and Karen came together with four others to locally launch the National ‘Red Bag’ scheme across six CCGs – improving the transfer of care home residents in and out of hospital.
“I have been in the NHS 26 years,” says Karen, “and this was a brilliant opportunity to get a better understanding of the wider Frimley Health and Care STP footprint, to learn from other vanguards about integrated care, and join other colleagues in mental health, social care, district nursing and secondary care.”
Mandy, who works for Virgin Care as one of the contracted community health providers in North East Hampshire and Farnham, says: “I learnt that if you’re not willing to make mistakes, you’ll never affect change. Be a heretic! Have the courage to think out of the box and have a go. The nursing profession sometimes doesn’t have a high opinion of itself but we do have ideas, we do have vision.”
The 2020 Leadership Programme set out some clear principles around having courage to innovate, involving the community as partners of change, being able to adapt and be resilient to change, with a focused bias on action. Theory and inspiration were key components but, ultimately, people have to take action to deliver lasting change.
Angela Murphy, Deputy Director for Hampshire CCG Partnership and Lead for Children & Maternity Collaborative working across the five Hampshire CCGs, says: “The beauty of this programme was leadership at every level. Everyone was on an equal footing – consultants, directors, nurses, GPs, physios. This is its Unique Selling Point.
“I work across a complex landscape and I wanted to work across the system without barriers, and learn from others with different skills and disciplines. It made me realise the power of people when hierarchies don’t matter - everyone had something unique to bring to the discussions.”
Angela’s Change Challenge, as lead for the Children and Maternity Collaborative across five Hampshire CCGs, was about improving care for children with Autistic Spectrum Disorder and Attention Deficit Hyperactivity Disorder.
“We were faced with a number of challenging circumstances around community services, affecting children and their families. The programme helped me with some techniques to use when meeting with parent groups. When I met those parents, my worries were turned completely on their head. Essentially, they wanted the chance to share brilliant ideas to resolve real-life issues that they and their children face – and we continue to work with them to co-design service change.
“What’s been brilliant is the parents were empowered to design a system that worked for them. They have launched their own website, which they developed with young people, turning a very negative position in to something rewarding and positive for parents.”
The New Care Models programme at NHS England has been supporting vanguards to adopt a systems leadership culture to integrate their delivery of services. Learning and development support has focused on communities of practice, sharing experiences and working collaboratively on solutions.
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