Thursday, 1 October 2015

National Association of Voluntary Services Managers speech (volunteering in the NHS)

Many thanks for inviting me to your conference.

I want to start by sharing a very vivid memory from 2012. I got tickets for the 2012 Olympics and attended with my family, in particular my Dad who had also attended the 1948 London Olympics. So it was a very special family occasion, but he is not as young as he was.  The day was always going to be special, but it was made so much more enjoyable – and in fact, manageable – by the help and guidance we received from the Olympics 2012 gamesmakers, the volunteers who were everywhere and added a real joy and vibrancy to the event.

Getting to and around the Olympic Park was a bit nerve-wracking, but nothing like the anxiety that people obviously feel when they arrive at hospital for an appointment – or even to visit a loved one. If you’ve been lucky enough to visit or to see our hospital at the QE, you will know that it is a stunning and imposing building. It’s a fantastic place to work – a real monument to the NHS – but it’s also a big, scary place to arrive at. When you do, some of the first people who will greet you are our blue-shirted volunteer greeters. I have witnessed people visibly relaxing as they are greeted, reassured and pointed in the right direction by those volunteers. They may then be going on to receive some of the most advanced care in the country, from some of the most skilled doctors with the latest techniques and technology, but that first impression of being met and supported is invaluable in setting the scene for our aim to provide the best in care to all who come to the QE.

In a target driven, cash strapped, enormously busy NHS it is wrong, but not surprising, if staff sometimes struggle to think of patients as the anxious people they often are. Patient experience can feel like a secondary task if it isn’t made an absolute priority by the leadership of the organisation.

We certainly aim to make it a central part of our work at the QE – we prioritise it on the Board and in the way we deliver our services, but we are helped enormously in doing this by our 600 volunteers. They really do play a crucial role in enhancing a patient's experience of their time and treatment at Queen Elizabeth Hospital Birmingham.

I’ve mentioned the role they play in meeting and guiding patients, but, of course, their roles go so much further than this – as I’m sure they do in your organisations.

Volunteers are currently placed in approximately 75 departments throughout QEHB. The number of volunteers continuously grows as more roles and ways of helping patients and staff are identified.

A small sample of areas worked and roles held by volunteers at QEHB is listed below:

  • Ward helpers
  • Outpatients department
  • Cardiac rehabilitation classes
  • Patient and Carer Council
  • Peer support groups
  • Chaplaincy
  • Patients' library
  • Buggy drivers

So in almost every part of the hospital, there are volunteers supporting patients, their families and the staff in their work. As the Chair of the Trust, I have no doubt that this is enormously important for enabling us to achieve our objective to provide the Best in Care. However, unlike in our achievement of our targets or in our financial planning, it has sometimes proved difficult to quantify the impact of volunteering. You will know as managers of volunteers, that there are a whole range of competing priorities in hospitals – it is important that volunteering maintains the profile and support of senior managers. I don’t know if there are clever ways to quantify the impact of volunteering on patient outcomes, but I certainly hope it’s an issue that people are considering.

When research has been done, it has shown a clear financial benefit from volunteering – The King’s Fund in their research into NHS volunteering in 2013 suggested that the NHS gets £11 of value for every £1 invested in volunteering. Adding this together with the impact on patient experience convinces me that volunteering has a crucial role to play – we must all ensure that the case is made in our own trusts and to those at the most senior levels of the NHS.

The other fallacy which often needs to be challenged by those managing and promoting volunteers and volunteering is that because volunteers are unpaid, they are, therefore, cost-free. This is wrong – and a real threat to the development and most effective use of our volunteers. 

Just thinking about the range of areas where volunteers are working in our hospital demonstrates the enormous management and administrative task involved in allocating those volunteers. This is without considering the issues of recruitment, ongoing supervision and working with staff to ensure that volunteers are used as effectively as possible and that new opportunities for volunteering are identified. You have a big job to do.

And, of course, if volunteers are to be used to best effect, they also need to be managed by the staff they work with. I have tried to support our excellent volunteer managers at the QE by making the case to ward staff and others that they need to incorporate the volunteers fully into their teams. We expect a proper role description for volunteers so that everybody understands how they are to work and what they are to contribute. However, it is not surprising that staff sometimes worry about whether volunteers are there to take their jobs, especially when money is tight. We must be clear that volunteers add value to the work of our permanent paid staff – they do not substitute for them. Wherever possible we need to support staff to manage volunteers and engage them in designing the roles we offer to volunteers and evaluating their impact.

Of course, managing volunteers is also an added pressure for very busy ward managers – and I’m sure it’s something which it is easy for them to let slip, but it is a mistake in the long term. The contribution that volunteers can play directly supports those running the wards to deliver their objectives. A volunteer who can encourage and challenge visitors and others to wash their hands plays a vital role in infection control. A volunteer who acts as a dining companion to a patient helps to ensure that nutrition and hydration standards are upheld. This is not about replacing mainstream staff, but it is about delivering mainstream targets. That is worth investing management time and effort into.

As well as thinking about the volunteering that takes place directly in our organisations, we should also consider whether we can help to support volunteering more widely in other organisations and the community. This can also bring benefits for our patients.

At UHB, we have memorandums of understanding with volunteer providers such as the hospital radio provider and Home from Hospital. We support the organisations with their employment checks to ensure that the volunteers meet NHS standards. This can open the way to some even more innovative services for patients – we have developed a project proposal with Home from Hospital to support patients on discharge giving some continuity to patients, enabling HFH volunteers to meet them before discharge or UHB volunteers to visit the patient after discharge. This has real potential to reduce readmissions for patients – good for the patient, good for the trust.

The other commonly held misconception is that all volunteers come with the same motivation. Of course they don’t. In any form of volunteering, there will be as many different motivations, skills and experiences as there are volunteers. I suspect one of the things which does bind many of them together is their commitment to the NHS. A recent IPSOS MORI poll asked people what made them most proud to be British. The NHS came top – even above the armed forces and the Royal Family. We are lucky to be working in an internationally unique system which, for many, forms part of what it means to be British.

This is stirring stuff, but for you, it doesn’t solve the problems of how you manage the enormously varied range of people who come to offer their services as volunteers.

The first difficult challenge for some is the recognition that offering yourself as a volunteer cannot guarantee you a position. It is very important that people are clear about what they are being expected to do and what we will expect of them.

Of course we are enormously grateful for the time and effort dedicated by our volunteers, but that doesn’t mean that everyone and anyone is acceptable. This is sometimes a difficult message to convey to people who want to volunteer, but it is crucial. We cannot argue that the role of the volunteer is vital to the hospital and our patients and then not put them through a rigorous recruitment and induction process.

At the QE, we hold an introductory session before we even allow volunteers to apply. It is important to make clear to people what is in store for them and what is expected. Hospitals can be very challenging environments. They are busy places that care for sick and critically ill patients and their families, which can be distressing.

To be a volunteer you need to be able to commit to the role fully and ensure you are the right type of person to volunteer in a hospital environment.

Volunteers need to be:

  • approachable
  • good listeners
  • comfortable approaching people to offer help
  • able to work independently and to show initiative
  • emotionally mature and able to stay calm; adaptable
  • and of course available enough to offer a regular commitment over a period of time

Once people become volunteers, it’s important to ensure that they have a clear and defined role with a specific list of duties in addition to upholding the values of the trust and fulfilling basic requirements in terms of behaviour, appearance and duties.

These are the common responsibilities, but the strength of volunteering in the NHS partly rests in the range of roles available. Many will want to work directly with patients and their families, but others will be less keen, but nevertheless have important skills to offer. We need to encourage staff and managers to be imaginative in the way that they think about possible roles for volunteers – to go beyond the obvious.

At UHB, assuming the volunteer wants to go ahead with the application after the information session, they will be interviewed, asked for two referees and subject to a DBS check. I know that you are discussing the implications of the reviews into what went wrong with Jimmy Saville’s access to hospitals and patients later in the conference. This is so important.

Whilst the vast majority of people will volunteer with the best of motives, the nature of those who wish to find opportunities to abuse is that they are often extremely clever and devious, and succeed in getting themselves into positions of trust with vulnerable people. We must take the necessary precautions to protect our patients, the reputation of volunteering and our organisations from such individuals.

The fact that someone is a volunteer does not relieve them of the responsibility to understand how the hospital works and what is expected of them. A good induction programme is really important for ensuring that volunteers can slot in in a way which makes the most of them and maximises their value added for the organisation.

Many people feel that the reward for volunteering is the experience of the volunteering itself. They don’t necessarily expect reward or recognition. However, I am strongly of the view that they deserve it – and in fact that the organisation as a whole needs to know what is being contributed by those volunteering alongside them.

One of my favourite events as Chair at UHB is to attend our certificate awarding lunch with volunteers. Volunteers get certificates for time served as a volunteer – next year, I’m looking forward to presenting a certificate to someone who’s been volunteering with us for 45 years. I’m accompanied by the Chief Executive and the Chief Nurse – I think it’s important that the most senior people in the organisation recognise the contribution being made.

As I’ve suggested, there are many things which draw people to volunteer in the NHS and many people wanting to take on the role. That does not mean that we should rest on our laurels in attracting in new volunteers. Like many we are reducing our age to 16 for volunteers – as the mother of teenagers, I gulped at the thought of that, but in fact I know that there are many with the energy and enthusiasm to add a real sparkle to our work with patients. And giving them real experience of the NHS may well help to grow our workforce in the future.  Most young people, luckily, have very little contact with hospitals as patients – giving them the chance to see the whole range of roles and work will at the least lead to a generation who understand the challenges and achievements of the NHS – and even provide us with the workforce of the future.

We also need to think about how we can offer a range of experiences to volunteers of all ages – we are looking to develop a joint programme with the Birmingham Women’s and Birmingham Children’s hospitals to widen our offer.

We must also ensure that we are opening more opportunities to volunteer to people with disabilities. Research suggests that one of the most important attributes of volunteers is that patients often feel that the volunteer will be better able to empathise and understand than staff will. Someone living successfully with a disability is both a source of information and of encouragement to those thinking about the impact of their illness on their future lives. We need to see these volunteers as an enormous asset to our volunteering force rather than focus on the issues involved in enabling them to access and play a full part. These can be overcome and the benefits will be significant.

In conclusion, thank you again for the invitation. And thank you for the enormously important work that you are doing for the NHS and for patients and their families. I hope my attendance has demonstrated the significance with which I know senior leaders in the NHS view your work. You are making our organisations more effective, you are supporting our hard-working staff and whilst you may not be making our services quite as enjoyable as the 2012 Olympics, in my experience you are making that trip to or stay in hospital a far better experience for anxious patients than it could be without you. That is vital work – thank you for leading it.


UHB Annual General Meeting speech

I am immensely proud to be part of a hospital which is clearly providing a fantastic service to patients, carers and their families. UHB is a regional leader, and increasingly a national and international leader, in delivering the very highest quality healthcare for our patients.

And it’s not just us saying that – the inspector of hospitals, the Care Quality Commission, visited us this year.  60 people spent four days exploring every part of the hospital and our services. They reported that we are Good overall with Outstanding leadership throughout the organisation. They highlighted examples of excellent practice in almost every part of the hospital. Our staff deserve enormous credit for that conclusion.

It is, therefore, hardly surprising that the numbers we treat continue to rise. This year, for the first time, we will treat over 1 million patients. I’m proud to say, in most cases, the quality of care these patients experienced was exceptional. We know that because we ask them. We have some of the highest levels of patient feedback of any similar trust in the country – and at Board meetings, we always look at the results of the patient surveys and feedback to see where we can improve. Our governors too make it their job to get out and about to listen to staff and patients.  Much of what we hear is complimentary. which is great, but we don’t always get it right.

Some of the most useful comments are those where people have highlighted problems. Knowing where things haven’t gone right is a vital way of getting an idea of what needs to change and what actions need to be taken.
I am pleased that so many people choose to be treated here and that their GPs want to refer them. But this is not without its problems. We want to treat as many people as possible, but there is a limit to what we can do. In the last year, we have tried to protect the specialist work that only we can do for people, by asking some of those with more routine needs to go to hospitals nearer their homes which also are able to provide the secondary care.

Unsurprisingly this proved controversial with those turned away. National bodies have now changed the rules to prevent us taking control in this way. And we now have GPs in Worcestershire being told to send their patients here rather than to Worcestershire hospitals to give those hospitals a breathing space.

We understand that we operate in a system, not as an island. We’ve been willing to share our expertise with a range of hospitals in the region and more widely – in Nuneaton, in Hereford and even in Medway, Kent – to help them to overcome their problems. But that’s the key. Where hospitals are having difficulties, surely the priority should be on making them better, not shifting their patients somewhere else.
We remain willing to step in to help other organisations so that we can spread the good care our patients receive as widely as possible.

We take our responsibility to our local community seriously, too. There is too much to outline in a short speech, but for example:

  • A key priority for the Trust has been to broaden access to the jobs and training healthcare have to offer to unemployed people, particularly those living in the most disadvantaged parts of the city. The training projects, now in the Learning Hub, have enabled nearly 1,900 people to gain a job – with 210 trainees gaining employment in 2014/15. A further 35 have been offered jobs
  • We are using our "connections" to join up third sector organisations so that we can all work better together, e.g. Thrive Birmingham (elderly isolated) and Guide Dogs to work with Harborne Food School to address nutrition, isolation and socialisation whilst at the same time working with us to grow the food they cook. This gives us and them "further reach"
  • With all the work and activity happening in our grounds too, we are not just a hospital; we are a place to find work, a place to learn, a place to take exercise, a place to buy your "7 a day" and a place to simply have a coffee and a chat!

Whilst we welcome everyone coming here, I’m also very aware of the traffic and parking issues we face. In the last year, we have also been designated as the first Green Travel District by Birmingham City Council and I am now chairing a group covering the campus with the aim of supporting people out of their cars and freeing up the area from traffic.

One of UHB’s other great assets is our volunteers – all 650 of them. We owe a debt of gratitude to those willing to give up their time to support patients and staff here. They’re a key part of the UHB team and we’ll continue to work hard to make sure  that they are being supported properly and used most effectively to show how much we value the time that they are willing to give freely.

As you will hear from Mike Sexton [at the AGM], our financial situation is extremely difficult. It is no consolation to know that the majority of hospital trusts will also find themselves in deficit this year. We are very clear, as a Board, that when money is tight we need to be sure it’s being spent to best effect. This is something we look carefully at in our Board meetings and Mike Sexton will give you more detail about that in a moment [at the AGM].

But that also means we can only continue to provide world class care by supporting the enormously talented people here to look to the future through research. Finding the new drugs, the new techniques; by learning, for example, how to use information from genes to target drugs where they’ll have the best effect – we’ve got a real chance in Birmingham to grow this work.

Last year I talked about the planning for the new Institute of Translational Medicine by Birmingham Health Partners, a collaboration which brings together the clinical, scientific and academic excellence of UHB, University of Birmingham and Birmingham Children’s Hospital. This year, the Institute has moved from plan to reality and has started work in the original QE hospital, now known as the Heritage Building.

The centre will help turn the very latest scientific research findings from the University into better treatments for patients across a range of major health issues including cancer and liver disease.
This is a very difficult time for the NHS, but I have enormous confidence in our staff, volunteers and managers to do their utmost not only to continue providing the best in care for our patients, but to continually look for further ways to grow and improve our work.

I look forward to working with you all in the 12 months to come and once again thank you for the support and commitment you give to our patients, their carers and our organisation.

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Monday, 3 November 2014

Turning research into jobs

Our biggest impact is on the patients we care for. However with more than 8500 employees and a budget larger than many local authorities, we also have a big role to play in the local and regional economy. Last week we hosted a conference focussing on how healthcare can help provide good quality jobs and boost economic growth.

We make this a reality at the Learning Hub where people who’ve lost their jobs can get training and a confidence boost alongside work experience. Many of these people then get jobs working with us and other healthcare providers – it’s a win win. We get enthusiastic members of staff and there’s one fewer person on the unemployment register.

It’s not just employing people directly that can make an impact on the local economy. Research is very important for us at the QE, but it’s fundamental to the future of the NHS and to growth and jobs too. With greater needs, but less money we can only continue to provide world class care by finding the new drugs, the new medical technology and devices; by learning, for example, how to use information from genes to target drugs where they’ll have the best effect.

We’re already literally building on our research expertise with the development of the Institute of Translational Medicine in the old QE building. You may well have seen the work underway to convert part of that iconic building into something which will point the way to the future for bringing together science, research and clinical practice aimed at converting science to patient care as quickly as possible. It will also contribute towards 2000 new high value jobs in life sciences and related areas.

But we’re not stopping there. The Battery Park site between us and Selly Oak may look like a mass of mud, but it is actually the start of another exciting development. With the City Council and the University, we have plans to develop this site to build on the research and life sciences work we’re already doing.

The NHS is facing a tough time at the moment in terms of our finances and the demands on our staff. There is a strong temptation to just focus on our day to day work – to see this employment and research work as an unnecessary distraction and cost. I think this would be a mistake. There is real potential in developments like the ITM and Battery Park to give people even better healthcare; to provide high quality jobs in the region and to maximise the impact of research for patients, jobs and economic development. In the end, that’s the only reliable, long term way to make sure the money is there for the NHS and that we’re able to do the best possible job for our patients.

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