Season 1: Episode 3 The Handover - How we're building better community care

In this episode we catch up on the key projects at NCH&C:

• Project Manager, Jayne Rose, takes us on a tour of the Willow Therapy Unit as the state-of-the-art centre nears completion
• CEO Matthew Winn is interviewed by colleagues Sam Hobdell from NCH&C, and Ash Sumbhoolaul from Cambridgeshire Community Trust (CCS) about our two trusts forming a group
• Kate Pontin, Operational Director of Transformation and Delivery, updates us about the progress made so far on the Better for All community nursing and therapy design programme
• We join Community Physio, Katy Turner, on her patient visits in Norwich to find out more about the importance of treating people in their homes

Transcript

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Hello, I'm Vicky from the communications, Marketing and Engagement team, and welcome to The Handover, the podcast for all staff at NCH&C.

The Handover is all about handing over updates and information, that's both us to you and you to us.

This podcast is created with the aim of being an excellent two-way platform for having a conversation with all of our colleagues.

This time on The Handover, colleagues talk to our chief executive Matthew Winn about the recent announcement that we will be creating an NHS group with Cambridgeshire Community Services.

We have an update on the Better For All programme and I spent the day with one of our brilliant community physios to see the difference they make in providing care and support in patients' own homes.

First though, to Norwich Community Hospital, where last week I got to have a tour of part of the new Willow Therapy Unit.

Last time on The Handover, we talked to staff at Birch about the work they're doing in preparation for moving into the Willow Therapy Unit later this year.

Joining us on the tour and seeing the interior for the first time was Luciano Patese, who will be the Willow Unit lead, and Katie Turner, who will be the clinical lead for physio at Willow.

Building work at Willow has been going on since early summer, with huge pods that will make up the building arriving bit by bit over the last couple of months.

Jayne Rose, project manager, led the tour and gave us all an update on the progress made and what will be happening next at the site.

This is the left hand side of Willow and Zone A.

So the entrance to Willow will be up there, where you see, just beyond the blue piece of equipment there, there is a pad, and that will be Zone C, which will be the entrance to it.

So the ambulance bay will be in front of there, and that will be the main entrance with the corridor that connects you to the main patient residential area, shall we say.

So Zone A will connect with Zone B, and that will be your main patient area.

So, let's go and have a look at Willow, then.

Go and see your new unit.

So this is a four bed day.

Wow, four beds?

Yeah.

Huge.

They are bigger than any other four bed days that we have for the podcast.

obviously, not finished.

We'll have a series of LED skylights that simulate daylight.

So some of these panels, and they looked lovely the other day, two or three of these actually are just blue with clouds, and then further down, clouds with balloons.

So they look like this, and they light up.

And obviously, we switched them off at night.

This is a single, honestly.

Yes, there will be blinds, and the blinds are pale gray that match that, because there's so many colors.

Once you get the yellow in for the toilet, which is the standard, and it's slightly luminescent, so at night, they can find, oh, patients will always find a way to the toilet.

Luciano, what would you say your single occupancy rooms will be used for?

Mainly for patients that require infection control, mainly, I would say, or patients that may require a little bit of a calmer environment and no less interaction with other patients, but that will be the main use for the side rooms.

Cool, and of course, we've got the specific bariatric rooms that will allow us to take patients up to 40 stone.

That is the length of zone A.

Wow.

So you have as much again.

This is just garden.

This is just forest.

Just forest, sorry.

So you've got two four bed bays there, and down there you've got a further three four bed bays.

So you have even more for the rest of zone A than you have here.

Almost as much again.

So there are 12 pods this side, 13 is the connector pod, and then there will be a further 10 pods that make up zone B.

Can I ask you two to tell me what your thoughts are, being in here?

He's amazing.

He's bright, he's open space, and just, I can already imagine seeing our patient have been fully active, fully operational, our staff running up and down, get our patient active.

But this is a really long corridor, a bit perfect for gait assessment and exercise, but yeah.

Yeah, I agree, lots and lots of space to work with, which is excellent.

To see how this new technology will make our day to day easier, and how we're gonna adapt to this new technology, and how we're gonna make it our best advantage to, and for the best care for the patients.

Very exciting, very exciting, right?

Thank you, Jayne.

You're very welcome.

More information about Willow Therapy Unit can be found on The Loop or on our Trust website.

An interview now with our CEO, Matthew Winn, and colleagues from NCH&C and CCS, about the announcement that we will become a group with CCS next year.

Over to Tom.

Hi everyone, my name is Tom, and I'm part of the NCH&C communications Team.

I'm here with Matthew Winn, CCS and NCH&C Joint CEO, as well as Sam and Ash from NCH&C and CCS respectively.

My name is Ash, I'm one of the physiotherapists here at CCS.

I'm also Network Advocate, previously Network Chair to the Cultural Diversity Network here at CCS.

I'm Sam, I'm an MSK physio as well, FCP Clinical Lead, and also the Joint Staff Side Secretary for NCH&C.

So we're here to talk about the plan announced six weeks ago, or thereabouts, to bring NCHC and CCS together, initially under the NHS group model as independent organisations, but with a single board and executive team who will lead the organisations into alignment from April 2025.

Today is an opportunity to dive a little bit deeper with Matthew and give Sam and Ash a chance to ask him their questions, having had a bit of time now to reflect on the announcement and speak with colleagues about how they're feeling about the upcoming change.

So to start us off, Sam, if I could come to you first for your general reflections, thoughts.

So I think thinking of the announcement, it kind of probably quite a few people came out of the blue of then.

I think when looking back, they've also thought Matthew was the joint chief exec.

It kind of made sense that we might be going down this model.

I think a lot of potential thoughts and concerns are, is it a merger?

What is a group model?

I don't know what those two things mean, so I think that would be really nice to chat to Matthew about.

I think also a lot of people will be going, what does that mean for me and what does that mean for my job?

I know the statements have been very much clinical, won't be affected, but a lot of our support services will now be working closely alongside our colleagues at CCS, and that becoming a bit of a challenge.

So it would be really nice to hear Matthew's thoughts on those.

Thanks.

Matthew, did you want to pick up on any of those points?

Sometimes these things appear to come out of the blue.

They clearly haven't.

We've done lots of thought behind this.

Both boards have been working quite hard since about March, April.

So it's been relatively quick and focused.

And the purpose, which I hope people have had a chance to look at the case for change, is to say we want fabulous community health services.

We need fabulous community health services.

I mean, Ash, you and Sam both work in musculoskeletal elements, and those should be done as close to where people live, GP surgeries as you do, Sam, and expert help allowing people to get into hospitals as quickly as possible for orthopaedic care without going through loads of outpatient work.

All of those things revolve around great community health services.

And today we were recording this on a day that someone called Lord Darcy has reported a date of care.

And again, it's reiterated, we need to invest in non-acute services.

That was our real driver to say, well, if that's the prize, how do we do it?

Both organizations are actually relatively small in NHS terms.

Bringing it together, bringing our joint expertise, the good things that we both do into a more sustainable size, single board oversight, I think was the real imperative, so we can support frontline staff even better than happens at the moment.

And on the specific, Sam, a group model is just an interim step to us becoming one organization.

And then we would really bring everything together.

Everybody would be paid from the same bank account.

Everybody would be one electronic system.

We would all work for one organization.

The group model then is a kind of hybrid.

It says, well, both organizations need to continue and be continued to be managed well.

And we're keeping that in place until we get to the endpoint.

A group is just two organizations existing, but with one guide in mind in terms of executive and board approach.

It's as simple as that, really.

That makes sense.

Thank you.

Thanks, Matthew.

Ash, from your perspective at CCS, initial thoughts and feelings?

question around those on the staff on the shop floor.

Can they expect any changes?

And if so, what are those changes?

I think over time, and I think it will be different for different parts of the organization, Ash.

I mean, again, let's pick your expertise areas, both of you, which kind of helps because you're both in your musculoskeletal world.

I am not, and we will not be, then saying, well, Sam, I know you don't, but if you're in North Walsham suddenly, actually, we want you to be in Huntingdon tomorrow to do a clinic.

That's just daft and is not going to happen.

Here's the but though, if you're working in King's Lynn or some of those down a market or some of those GP surgeries on the west side, and Ash, we have a very good MSK center in Whizbeach, and the line between Cambridge and Norfolk is, as we know, right through the edge of Whizbeach.

Where can we then maybe say, well, that team can operate in a bit more flexible way?

If there's space in the MSK center in Whizbeach, why can't Norfolk residents who live very close to there go to there and cut down some of those barriers?

That's just a practical thing.

I think the second thing service-orientated is that we can really begin to look at standardizing protocols, practice, training, research, potentially, and saying, wow, we now have a double the workforce across the organizations in MSK.

So what can we do together to really push forward clinical leadership?

That's the sensible way to do integrated across both organizations, how we learn from each other and develop a service together.

Well, that's kind of exciting and gives opportunities, doesn't it?

Absolutely.

Thank you.

I suppose it's around kind of sharing resources, isn't it?

So as you say, and I know we're taking it on a bit of a clinical level, but if we have two clinics that are quite nearby, but because of a county line, actually can we use that shared resources?

And both being community trusts where CCS, you guys have people all the way down Luton Dunstable, all the way up to Whist Beach, we're the same.

And actually could we use estates more effectively?

I presume that's one of the thoughts that has gone into this idea.

And CCS already have children's services in Norfolk and Waveney, sexual health and HIV.

And there are premises which are a stone's throw from the HCHC site.

Well, when those leases come up, actually, why don't we have a conversation about have we got spare estates?

What can we do?

How can we co-locate all children's services together?

Because NCHC run a set of children's services and bring them together.

I think the other aspect which we've already started to do, Sam, is I was out visiting both CCS and NCHC start up in Kingslyn a few weeks ago.

And the CCS world is recruiting a new team of mental health support teams into schools.

They're extending the service as is planned.

And they were thinking of having to buy space in premises for holiday time when schools aren't open to see children.

And five minutes down the road is St.

James' where we have got space that we could use in NCHC.

We'll still pay NCHC for the time being to actually use that space.

But and actually, if you can start doing those things, we can start doing the hard things as well.

Okay, when would you expect that colleagues at both trusts could begin to start working together on coming into closer alignment?

I think we take things tactically.

There are already staff from NCHC doing things in CCS and people in CCS doing things in NCHC, both in a full time or a part time or a kind of subject matter expert role.

We'll see more of that where we have gaps, because we'll look to each other to say, have you got the support?

I think then from January, as directors are in post and then formally take up post between January and April, people will start looking at their portfolios and say, right, this is where we can easily bring things together.

So, Sam, you co-chair StarSide.

I imagine you'll be working with Heather Bennett, the StarSide chair in CCS, and say, at what point with Anita and Liz do we start saying, well, let's have one meeting or let's have an alternate meeting.

Let's have them separate and then we do them together so we can share and learn.

Ash, you chair one of our great networks in CCS.

There is another network in NCH&C.

When do we start doing those things as well?

When do we become, Tom, I think a judgment call about what's right.

Then I guess it's also, and Sam, this goes to your StarSide responsibilities, we won't change harmonizing things to where in one trust.

But in advance of that, let's take the opportunity if we're developing things together, or we're reviewing things to say, actually, let's make sure they are harmonized.

But actually, there will be a formal process of harmonizing things that will involve StarSide.

But if policies are coming up, or there's new policies, let's take the opportunity to do the same things together, and just imagine those will start happening.

So actually, terms and conditions, pay, your management arrangements, those are really important.

Those are the things that really inflect your employment, and we need to keep those really solid.

And Ash, you and Sam, I'm sure, will be advocating, you know, some solidity and sense, rather than just kind of going off.

I think we've already started to have those conversations in Staffsiders, how could we work alongside our colleagues in CCS, and what might that look like?

So I think it's a really good opportunity to start to have those conversations probably now about how things might work.

I think also probably the underlying question is, are we going to suddenly be merging one HR team?

Are we suddenly merging one staff experience, one EDI team?

And they're now up for grabs of their job as a competition with potentially a colleague that they might be working alongside at the moment.

So there won't be any, suddenly, it will be planned and it will be through an engaged process.

And the answer will be, yes, we will have one workforce team, one finance team, one clinical governance team.

Does that mean I am looking, well, we will just apply a rule and have less headcount?

Well, no, it's got to be planned and it's got to be understood.

Because if there's work today in both organisations, there will be work tomorrow, even though we're one organisation.

If we got six people and there's complete duplication and we need four going forward and we're OK with that, then there will have to be a process to look at that.

But, and here's the big but, we don't want to lose talent and people are talented, and can put their eyes and ears and approaches to other things.

And we already have a change management process, don't we, in both organisations where we will go through it.

It is not in our psyche in either organisations to move to try and make redundancy.

That's the very, very last thing we want to do.

We want to make sure we can redeploy, use people into other talents.

So we will take that approach, but it won't be a sudden and it won't be a surprise.

It'll be a working through and what makes sense.

Ash, you want to comment on that, maybe?

Is there any other suggestions that you can suggest to aid in our transition?

Yeah, I mean, it's good points.

The best thing people can do is to keep talking and talk about when they're worried about something, because the worst thing to happen is for people to make decisions about their future based on a misapprehension or a myth.

And actually, Sam, your point of will there be changes?

Well, yeah, there will be changes, but I don't honestly know what they might be.

There is not some great master plan sitting somewhere with everything plotted out.

I mean, we'd have to be really McLevellian and bizarre if we had that done.

And that's just not the way things were.

So I think people need to talk.

I'd love also people to be thinking about what they want to change.

So the good thing about coming together is it gives a chance to reset things.

If we do things that just are really annoying or they're custom on practice.

And you know that point where everybody goes, why do we do it?

And everybody goes, oh, well, we've always done it that way.

That's always a bad reason to carry on doing it.

I think, Ash and Sam, we need to get conversations.

And we will do this in a purposeful way next financial year, is start saying, actually, if we want to create something new together, that allows us to stop and start and refresh and do things together.

And Ash, I think that's about engaging with everybody to give their views around that.

Because, again, that's not corporate gobbledygook.

That's about how we support people to be great employees and be good and support in their teams.

And challenges.

So you talked about how stuff comes up.

Are there any challenges that we can expect?

So, look, I think things that I worry about as your leader is that this stuff takes us off course on delivering great care.

And we have enough pressure just to deliver great care as it stands and also continue improving care.

And in both organizations, there's loads of work going on to make sure what we do can improve and improve and change.

The challenge is making sure we do that all the time.

The second challenge is that therefore we make all of these changes proportionate.

And the third challenge I think we have is to ensure that this culturally is a helpful process.

It doesn't become divisive.

It doesn't become them and us.

And it doesn't become about creating something good.

And it just gets wrapped into worry and tribalism.

That challenge, it always is the challenge of bringing things together.

And we've all got to do our part to make sure that doesn't happen, I think.

So, Eva, if you have any of the burning questions that you wanted to put to Matthew today?

I had a light-hearted question as well as asking if everyone has to be seen.

What was the name?

It's not going to be called, I imagine, NCHCCS.

No, I do not think that's a light-hearted question.

I think that let's use that as an opportunity to get views and talk to people.

I think geography is really important, but also what we do as an organization.

So the name to me is not important.

It's what our services do day by day.

Sam, have you got anything else?

The only thing for me is just because I suppose looking at the board level, because I think we talk a lot about just our staff, but we forget the board and the boards are still our staff.

Would you see potential in the future deputies and stuff like that, quite similar to what you have at the moment with a deputy in CCS and a deputy in NCH&C?

I think that's a really important aspect.

So the answer is yes.

And thank you for thinking about the board that's coming.

It is chuff.

And I'm having one-to-one conversations that are now getting into the nitty gritty of how things change.

And that really is tough for people.

This is their livelihood.

For our non-executives, their appointments, and this is very much part time for them.

But even so, they put a lot of effort into our organisation.

I think the exciting thing, if I can finish on this, and maybe this can be a future kind of addition, is we need to formalise clinical leadership better across both organisations.

I mean, how we really get operational clinical directors probably working hand in glove with our senior leaders to drive things together.

We've got elements of that right in both organisations, but there are big gaps, and we need to develop that.

What I would say is, we're not going to be able to do that straight away as we make this initial change on board, but nothing stays the same, and we need to plan that together for the future.

But Tom, maybe we can come back to that as a future discussion.

I think we can.

That sounds like an excellent idea.

For now, thank you, Matthew, and thank you both for your time today.

It's been a fascinating discussion, and I hope colleagues will find it useful as we continue on this journey.

A quick reminder to everyone listening that you can find all the information about Building Trust, The Case For Change, frequently asked questions and contact information on the dedicated website, which is www.nhsbuildingtrust.info.

Do check that out if you haven't already, and keep an eye out for more engagement sessions coming soon.

But for now, thank you all again.

Until next time, bye-bye.

Thank you to Matthew, Sam, and Ash for talking to us.

This Building Trust interview is available in full on the Building Trust website.

For more details, see the webpage for this podcast.

You may remember on the very first episode of The Handover, we talked to Rob and Carolyn about the Better For All project.

Better For All is a design programme aimed at improving clarity on core pathways and priorities and reducing pressure on our community nursing and therapy teams with the goal of ensuring we can consistently deliver brilliant community care that counts.

We know colleagues in the community teams continue to experience real pressure.

We've recently heard powerful and personal accounts from both staff and patients about the effect this pressure has on our people and the people we treat.

We spoke to Kate Pontin, operational Director of transformation and Delivery, to find out about the progress made so far with the plans to address some of these issues and what will be happening next in the Better For All programme.

Better For All is a programme of work to better understand the pressures across our community of nursing and therapeutic teams, using data to support the decisions we make.

Part of the challenge is that each place is different and we don't have consistency across key areas like end of life and palliative care, wound care, diabetes, triage and allocation.

One of the important things that will come out of Better For All is that we'll have a single, consistent operating model for our community nursing and therapy teams.

Two things that we have moved forward with is to have a single system one unit across all of our community, nursing and therapy teams.

Also, we're going to be bringing in AutoPlan, which is an auto scheduling tool, which will allocate patients for us.

This will still need clinical oversight and input.

So our allocators will still have a vital role as we roll AutoPlanner out.

The next steps are a series of small pilots, starting in North Place.

To implement AutoPlanner, the community nursing and therapy teams will need smaller caseloads.

And North is going to be piloting this for us to ensure we have everything in place to implement AutoPlanner, which is planned for April 2025.

Thank you to Kate for updating us on Better For All.

There's a page on The Loop for NCH&C staff to find out more about the project.

Remember to check in to that page for more updates.

I'm just going to raise the chair up so you're closer.

Closer now.

Once it's up, we can actually get a nice bit closer.

Is that high enough to reach the bar?

Yeah?

Ready when you are.

So I'm shadowing one of our Community physiotherapists, Katie Turner, on her visits to patients in their homes in the north of Norwich.

In the background, you can hear Katie advising her patient on how to get in and out of her bed.

The patient is very elderly and has just come home from a long stay in hospital.

physiotherapy helps restore movement and function when someone is affected by injury, illness or disability.

As a Community physio, Katie provides treatment to her patients in their home or care home.

The patients she sees may have had a fall or injury and be in too much pain to travel to an outpatient department or clinic.

They may be having difficulty moving around safely at home or need mobility re-education following surgery.

Being in their home helps physios like Katie see how treatments and exercises can be incorporated into patients lives and provide help in navigating any issues they may be having getting around their homes.

I want to say, well, it's between you and the carers, basically.

If you feel well enough just to sit in the chair for a short period of time, five minutes, work up to 10 minutes.

I think that will just give you that little bit of extra tolerance and movement that you might need to get to the chair.

How many patients do you typically see in a day?

Typically four.

You can kind of arrange your day how it suits you or how it suits the day geographically.

I normally prefer to see three in the morning and one in the afternoon, but that's just a personal preference.

What sort of things are you treating?

What sort of patients are you seeing in their homes?

So technically we see anybody that's 18 years old.

We get a real mixture really.

It can be younger patients with chronic long-term conditions, neurological conditions, and then you get the other end of the spectrum which is frail elderly or orthopedics.

So it can be a little bit of everything.

I come up with a good leg first, I come down with a bad leg first.

But it's because it's a bit of like a bit of an illusion really.

Because when you're coming down, if you were to put this leg down first, then all of your weight is on this leg.

The patients that we've seen today have all been really varied in age and injury.

Each were having to adapt to a life following surgery or a stay in hospital.

Katie had in-depth knowledge of each of the patients and they responded really well to her advice and the bespoke exercises and activity she had given them.

She worked with some of them on requests for adaptations to their homes to help with their mobility and accessibility.

Enormous thanks to Katie for letting me join her on her visits.

If you want to find out more about community physiotherapy, then please visit the website for this episode of the podcast.

If you'd like one of the teams to come and shadow you or your team to find out more about what you do, do get in touch via the website for this podcast too.

Well, that was a very packed episode of The Handover.

We really appreciate everyone who has provided input, and we hope you've all found what we've talked about today interesting.

Further information about everything we've featured on this episode can be found on the webpage for this podcast.

Don't forget to send us your ideas and thoughts about The Handover.

If you have an idea for a feature or would like to host a segment, then get in touch.

We hope you can join us again soon for The Handover.

Bye for now.