Weeknotes s01e03

TL:DR; Exciting news, better governance, better service design.

[week ending 22/01/2021]

The good

Important inaugeration news! I can finally announce that I was formally made Lead Governor of Gloucestershire Health and Care NHS Foundation Trust this week. This is quite a daunting role to take on, having only become a Governor at the start of September, but it is great that people have so much confidence in me after only a few months. I really am grateful for all of the support I’ve received from Chair, Ingrid Barker and Assistant Trust Secretary, Anna Hilditch along with the NEDs and my fellow Governors. I’m really enjoying both my national NHS work and getting to grips with local providers too, there is a great deal of experience we can share across the two.

And so we lift our gazes not to what stands between us, but what stands before us.

Amanda Gorman, The Hill We Climb

There may have been some other important inaugeration news this week. Whatever our politics, I hope it was clear to all, that there is great beauty in the arts and they deserve to be prioritised in our society.

We had an excellent GovernWell training session this week on ‘Effective challenge and holding to account’. Two things are standing out for me so far about how we can be effective as governors; ‘dialogue’ and ‘what’s the exam question’. Dialogue, how do we effectively connect and create dialogue both from our communities into the Trust and back out from the Trust into our communities. We need to ensure truth and experiences are heard and understood on both sides while fostering unity and a shared purpose of healthy communities. What’s the exam question, what are the questions that truly matter, that ensure citizens receive the care they deserve. How are we clear about the answers we’re looking for that provide the right assurance. I often think a challenge when talking about public services is that people think about the gold standard and then get disenfranchised when what they see fails short of the mark. I’m still processing how we ask good questions and would really value feedback on this. But one thing I have clarity on is that the exam question should never focus on ‘what would this look like with unlimited time and a blank chequebook’ but how we ensure service is appropriate given the budget, environment and other constraints. would I be happy for my loved ones to receive this care, are services safe, and is the tax payer getting good value for money?

On the topic of good value for the tax payer, I filed my tax return. The HMRC Self Assment service continues, in my mind, to be one of the biggest successes of the Government Digital Service. The commitment to doing the hard work to make things simple is really paying off. All of us who build services should follow this great example. I remember when I first started filing self assessments, and the HMRC website was a weird green colour and fixed width, it would take me longer to log in and setup my return that it does to fully complete it these days. Despite my tax return getting more complicated over the years.

Great work and a huge thank you to everyone who has worked so hard across Gloucestershire with the vaccinations!

The bad

Three things this week follow the theme of ‘really positive, but could be better’. I don’t want to criticise here, behind these pieces of work are stressed people working at pace. But I offer these reflections as a way to ask myself, what could be my role in helping to improve these things.

1. Vaccination publications

Public Health England have published some excellent resources about covid and the vaccination programme. There are also translations in 11 different languages. All very impressive. As we were thinking about how we get the messages out to everyone and help people to feel comfortable about recieving the vaccine, I realised resources aren’t readidly available in Romanian or Bulgarian, two languages that are quite common in Trust’s catchment area.

With the help of my team, I had a play with Amazon Polly last year. An AWS service for creating audio from text that also offers translation. I was quickly able to create an audio version of the People Plan. We also trialled it in a few languages spoken in my team. On the whole, the translations were reasonable and the audio quality is stageringly good. But I wouldn’t want to trust a service like this with medical information unless there was someone who could check it before publishing. Leave a comment if you’ve solved this problem before.

2. Fake vaccination websites?

I’ve had a slew of freinds and family members contacting me about vaccination booking websites this week. It’s so great that people are being offered the vaccination, that they’re accepting and that digital is playing a role in the delivery, but there is a lot of nervousness out there. I’m regularly trying to educate people about cyber security so it’s good that people are checking stuff, but as a system, we need to get better at producing services that people trust.

I’ve seen many booking systems on .co.uk domains that don’t look anything like a trustworthy NHS website. Usually, a quick google of the local CCG finds a somewhat hidden information page that links to said suspecious booking service and gives a little credibility.

My team have built and support an Open Source WordPress theme that makes it really easy for NHS organisations to setup a professional website that meets brand and accessibility guidelines without technical know how. It is build on the excellent work of NHS Digital’s NHS frontend library and adds in form and event booking styling for good measure. It’s already used by 1000 GP practices and I’m keen to help other organisation adopt this solution.

3. Emergency planning

Unfortunately, our town, much like other parts of the country, has recently been hit by flooding. As a town councillor, I’ve been some what shocked at how disjointed and disconnected services are for responding to emergencies like flooding. As Chair of the Council, I’m now leading a full review of our local emergency plan and trying to build networks with all the relevant organisations who should be able to respond.

Cuts to services have led to work being trimmed back, teams no longer existing and confusion in who is responsible for what. Where a local authority or Forestry England aren’t responsible for maintaining a water course, it falls to land owners. Many are unaware of their responsibilites and even if they are, often lack the means or will to do anything about it, especially when there is no enforcement. I assumed the Environment Agency were responsible for flooding, but only if it is a river, and that seems open to interpretation.

Another area where we need clear services to help citizens make good plans and have easy access to the right support when it is needed.

The ugly

I’m definitely a supporter of helping people to have a voice when they don’t necessarily feel able to speak up. In a way, moving staff briefings on to Teams due to lockdown and working from home, has enabled many more people to have a voice. However, I’m seeing a growing trend of people not asking questions, but making digs or wrong assumptions anonymously in the chat. This week, a national project I’ve been working on received some particularly pointed comments from anonymous authors. Thankfully, a director on the call was very well briefed and quickly corrected the comments and showed excellent support for our programme. However, there was a definite negative impact on a number of colleagues watching the briefing.

I don’t want to close down criticism or stiefle debate. But we need to work harder at creating a culture where people can bring forward challenges and enter into a conversation. I don’t pretend our work has been perfect, we have already published an interim lessons learned document and constantly look to improve. As more of us work longer and longer into this pandemic response, we need to focus on our impact on others and practice kindness. “What’s it like to be on the receiving end of me?”

Notable conversations

• I had a fabulous conversation with one of our regional leads earlier this week. Despite the huge pressures involved in the covid response, it was brilliant to enjoy 40 minutes where we not only talk about work but about how we’re doing, model cars and how we can share experiences and support each other’s work.
• I remotely met with my fellow Deanery Lay Chairs this week from across Gloucestershire Diocese. Finance and Deanery Strategic Reviews were high on the agenda but there was a good amount of time for checking in and seeing how our parishes are coping the ever changing rules and lockdowns. It’s great to hear how technology is enabling our churches to remain open, even while our buildings are closed.

Things I’m reading and watching

• WandaVision – not at all what I was expecting, but seemed just the right mix of light hearted fun to wind down in an evening.
• Spider-Man: Far From Home – I’d missed this in the cinema so it was good to catchup. Not my favourite Marvel film by any measure but it was lovely to spend an evening with Rachel.
• Emotional Agility – I’m continuing to enjoy this on Audible. I was particularly struck this week how we can incrementally shift our behaviours by changing the language of “I have to” to “I want to”. Something to practice over the coming weeks.