Can the NHS be a truly flexible workplace?

Key:

HM: Helen McKenna
KJ: Kate Jarman

HM: Hello and welcome to The King’s Fund Podcast where we talk about the big issues and ideas in health and care. I'm Helen McKenna, Senior Fellow here at the Fund and your host for this episode. Like many people at the moment, we're working from home which means we're recording this episode remotely, so please excuse any background noises. I'm really excited to be joined on this episode by Kate Jarman, Director of Communications and Corporate Affairs at Milton Keynes University Hospital and also Co-Founder of Flex NHS which is a movement promoting flexible working in the NHS. Kate, welcome to The King’s Fund Podcast.

KJ: Thank you very much. Delighted to be here.

HM: So later in the episode we'll be talking about your career journey, some of your experiences during Covid-19 and also trying to find out a bit more about Flex HNS. But first, I know that in your work you place a lot of emphasis on the importance of maintaining wellbeing. So hopefully this is a nice, easy question to start off with: what do you do to look after yourself and keep yourself well?

KJ: That’s a terrible question. I think -

HM: It's not really one at all.

KJ: No, it's not. So I think I talk a lot about wellbeing and you're absolutely right, I place a huge amount of value on promoting health and wellbeing for staff and some of that is at the heart of Flex NHS particularly and the work we do here at Milton Keynes. So I think for me, I like to run. I'm really bad at it, but I try. I like to spend time with my kids and my family and I like to read. I like to write, so I try and build those things into my day, into my week, sometimes more successfully than others, and I think that’s probably one of the things that I've got a little better at is being a little bit easier on myself for those weeks when you can't do everything. So sometimes wellbeing is just about getting through the week in one piece and everyone is sort of fairly clean and tidy by the end of it.

HM: So let's spend a bit of time on your career journey and your current role. So you're currently Director of Communications and Corporate Affairs at Milton Keynes, but before that, you worked in the criminal justice system. So can you tell us a bit about your career journey and how you go to where you are today? What's the thread that links the different roles?

KJ: So I loved writing. I loved English at school and I went to university and studied communications and social policy and I suppose the thread that links my roles together is both those things really, a sort of love of writing and a passion for social issues and social justice. I did a few different jobs. I did a journalism qualification after university and then I started working for the police in Cambridgeshire and joined there in 2002/2003 and was very fortunate to work on lots of large, difficult enquiries. Everything from murders through to terrorist incidents. It was a challenging job, especially being pretty young. It was a very steep learning curve. I also got the opportunity while I was there to work across the criminal justice system. So I did lots of work for what was then the Criminal Justice Board, so Criminal Justice Boards and I also got to work with the Youth Offending Service and the Crown Prosecution Service and the court system. So I learnt a huge amount doing that and was really privileged actually to work with a very senior group of people really early in my career and they were, at that time, a group of chief officers, all of whom I think were men at that point and then worked for a really incredible chief constable, a lady called Julie Spence who took over as Chief Constable in Cambridgeshire Police and was also very closely involved in senior women in policing and a sort of movement around women and equality in policing and amplifying women's voices. She was a very inspiring person to be around and from there, that role moved into health. So I joined Bedford Hospital in 2007 I think and I've been in health ever since.

HM: Great, thank you. So as we speak, we're in the middle of a second wave of Covid-19 and right at the very start of the winter period. Can you tell me just a bit about your experience of the pandemic so far as an NHS leader and I guess first of all, just how are you and how is the team?

KJ: I suppose it's felt like a long year. In Milton Keynes we were involved in the running of a repatriation facility for people returning from Wuhan back in February. So I felt like we'd been immersed in the sort of world of Covid since that time. I think the organisation is going into winter and is tired and I think people generall… In life there's no kind of respite is there and none of your normal coping structures and mechanisms are in place because when you come home from work if you're in lockdown, you often can't do any of the things that you might normally do - seeing family, going out for a drink and all the things that you might do to sort of counterbalance the stress at work. So I think it's very tough. It's really challenging. I've found it tough and challenging at different points. Again, I'm very privileged. I haven't personally lost a family member to Covid and many, many people have and it's been absolutely terrible and heartbreaking, the experiences that people have endured over this period. So I recognise my own privilege in feeling a bit tired and fatigued. I think I see my job as trying to keep up staff morale over this period, understanding what will support staff, what will help, what will get people through the next few months? How do we communicate effectively? How do we ensure that people using our hospital get the right information, get it quickly, get it accurately? The logistics of the new few months in terms of asymptomatic staff testing and the vaccine and again, being able to balance all these other agendas as well, so we're not just looking at one thing all the time. So we're actually looking across a range of things that we do and provide for patients and for staff so services aren't forgotten and people aren't forgotten within this. So it's really tough and really challenging. I believe it's about organisational conversations, about public conversations and about being as open and transparent as possible.

HM: So you mentioned communicating during Covid and when it comes to communicating with NHS staff and with the public, what do you think the legacy of Covid-19 will be? How will it change the work that you do as a communications professional?

KJ: That is a fascinating question. I think at different times because challenges have been very different, I think one of the major pieces of learning is how do you take very, very rapidly changing situations and communicate them clearly and also, how do you keep it as simple as possible? I think one of the huge bits of learning for me as a communicator is that we took part in a documentary programme in the first wave of Covid that had some really difficult, oh my goodness why are you doing this feedback before it was broadcast. After it was broadcast, I think people understood why we'd done it, but actually what it did, it drove some different conversations around enabling visiting and visiting in different scenarios because there was a huge amount of sort of social media feedback and some quite difficult days of quite sustained personal abuse which was the first time I'd dealt with that, which was interesting.

HM: Was that the Ross Kemp?

KJ: That was the Ross Kemp documentary, yeah.

HM: And I think did the Chief Executive get death threats?

KJ: He did, yeah, the Chief Exec got a death threat as well. So it was a really, just odd time but obviously there's huge strength of feeling about what was happening at that time and lots of… Other places had done documentaries and allowed journalists into their ITUs and what we did with Ross Kemp was probably a fraction of what others had done, however, different type of programme, different type of presenter, different type of coverage. So I think that learning through that was around, again, around understanding the sort of strength of emotion and feeling and also particularly at that point around enabling visiting and end of life visiting during that first lockdown period. And again, about how do you have conversations with the people using your hospital at scale at a really difficult time? So I think yeah, huge amounts of learning throughout and it's been a tough and challenging time for comms' professionals too actually.

HM: Absolutely and actually just on the kind of role of government and national bodies, have you found that the approach you take to leadership and comms at a local level, have there been points where that felt in tension or conflict with the style or messages that are coming from national bodies and government?

KJ: Yeah, personally, absolutely yeah. So I think it's been really challenging, looking at just how that's worked in the NHS. I suppose it's sometimes really difficult when you're in an organisation to be able to see outside of that and to understand the perspective of people in national bodies and the job that they're trying to do and the balance that they're trying to strike etc. So it's easy to be furious about what someone else is doing or stopping you from doing. Just step back from that and try and understand different perspectives is important and quite often hard to do in the heat of the moment. So yeah, so I think lots of amazing working actually across comms' professionals and different tiers of the NHS at different times and lots of support, lots of stuff to be really proud of and inevitably, a lot of conflict and challenge too because it's been a really difficult period of time. I guess we're all used to operating, again with agency and ability to dictate our own terms as directors of communications. That’s tougher in times of national emergency when that’s being much more controlled by the centre. So for good reasons, it's been an interesting learning experience.

HM: So I wanted to ask you about Flex NHS as well which you're a co-founder of, and as I understand it, it aims to promote and enable flexible working in the NHS. Is that right?

KJ: That’s right. So Flex NHS was founded about 18 months ago by myself and someone who I'd never met before at that point, Asha Kari, and we met over Twitter and we met because we're both kind of good over-sharers of stuff on social media. We'd both been writing about being working parents I guess and the difficulties that can pose. I've got three young children and Asha's got a young daughter and we'd both been talking about how we balance work and life and actually I'd been really privileged in my career to be sort of surrounded by really incredible, sort of role models and advocates for work/life balance and people that had been vocal about the sort of juggle around, not necessarily just parenting, but wanting to do anything outside of work. But I was quite conscious that a lot of those forums were for quite senior people and actually as a senior person, as a director now, it's really easy now in lots of ways to be flexible because I have lots of agency over my own diary and my own time, and I was really interested in how we kind of brought that to staff at different grades in the NHS, different levels of their career, different professions. So how is it possible for a newly qualified nurse to work flexibly? How is it possible for a junior doctor to work flexibly? That was the sort of thinking behind Flex NHS. It was about how do we create a sort of social movement where people's voices can be heard at any level in the NHS and how can we really understand what the barriers are to working flexibly and helping people keep a good work/life balance because we know it's one of the reasons people leave their job in the NHS and anywhere else. We also know in the NHS that we want to keep people in those jobs because we spend a long time training them and they're really skilled and we want to keep them. We're facing a workforce crisis. We want those people to stay.

HM: I've seen that your own trust has implemented flexible working opportunities for staff. What does it mean in practice on the ground, certainly in your trust?

KJ: So we've done a huge amount of things I think. We've put in a huge amount of support quite quickly and I’ve worked with two directors of workforce here, Ogechi Emeadi who now works at Princess Alexandra in Harlow and Danielle Petchi is our current Director of Workforce, they've both been very generous and kind enabling someone like me bouncing around and the workforce going let's do this, let's try this. Pre-Covid we'd done a lot of work around trying to understand what support people needed at Milton Keynes Hospital. So everything from if your child is ill or if you need to take your elderly dad or mum to a hospital appointment, that actually there is huge variation between how people did that. So some people took annual leave, some people took flexi time, some people took carer's leave and we wanted to make that as generous as possible to enable people to take time to sort of meet those obligations outside of work without it eating into their annual leave all the time because we know that people give a huge amount back in hours that they never claim for that actually often, are largely invisible. So really it was about that give and take relationship. We can't take all the time as an organisation, as the NHS. It's about giving back. So we increased bereavement leave too to support people in a different way when they were bereaved and we also put in place a huge amount of kind of well-being and staff benefit offers. So everything from free tea and coffee to free parking and lots more besides. So we packaged all of that together as a sort of big offer and we did that in conversation with staff here. We do an event every year called Event In The Tent. This year it was a in a virtual tent, but we still did it. Normally it's in a real tent. We have these big conversations with our staff over the year about what it is that will make a difference to their working lives. The challenge now is to keep that conversation going in what will be the next set of interventions and things that will make a difference and I expect that Covid will have changed that very significantly for people and probably in ways that we're yet to understand.

HM: I guess when I think about the workforce challenges in the NHS at the minute, that there are huge staff shortages and as a result, staff are working under incredible pressure. The idea of introducing flexible working into that mix doesn’t seem intuitively compatible with the current situation, but it's obviously actually part of the solution, is that right?

KJ: I think that’s right. When we talk about flexibility, lots of people kind of default. Lots of managers that we talked to actually default into well, is it a four day week, is it a three day week? Is it working at home all the time? What is it? Actually it's a whole range of different things. So actually what we find more often than not is people want and need fairly marginal flexibility. Often it's I need to be here kind of 10 minutes later on this day or on this day can I leave a bit earlier? Can I do the school runs a couple of times a week? So you're right. In some ways it doesn’t seem intuitive. I think what we've got emerging at the moment is these two very distinct workforces, a workforce that’s able to work from home and a workforce that’s needed to be here on the hospital site, for example, or in a site delivering, care or supporting the delivery of services. I think we have to be really careful not to think we've done the job of flexible working by enabling people to work from home because working from home has all of its own sets of challenges around never being able to switch off from work and actually, ending up working a huge amount of hours more than you should be working, about your home life feeling fairly intruded upon. We've also got this group of staff at work, everybody's feeling fatigued and tired and we need to be able to do things to address that and some of that is about flexibility. Some of that is about saying it's okay not to be here. It's okay not to be at work. We don’t expect you to be working wherever you're working 24 hours a day, seven days a week. We need you to be healthy and well and that’s what we're saying to our workforce. We don’t want you to be heroic, we want you to be healthy and here and wherever here is actually, whether it's here, at home and present in the working day or the working hours that you have or here, on the hospital site for the time that you are. But also, we need to put lots in place to be able to support people to do that. So I think for me, the really critical thing about flexibility and about health and well-being at work is being able to have good conversations and being able to empower managers at every level to have good conversations with their staff, to be able to have difficult conversations that might feel uncomfortable but we need to equip our managers to be able to have those in a way that’s supportive and doesn’t feel invasive in terms of intruding into somebody's private life. So I guess that’s really hard actually. That’s both the sort of toolkit of skills, but also a kind of cultural development programme as well. I talk a lot about flexible working and about how emotionally loaded often a request for flexible working is. So we talk a lot about trying to take away the emotion and the need to justify a flexible working request and to sort of take away the moral judgement that surrounds it and actually place a legal value on people's time and people's time back, as well as people's time at work. So it's not easy. It's not a quick sort of fix in lots of ways, although the people plan has done some incredible things to further the flexible working agenda. They put in Flex from day one which is huge. I think it's kind of slipped in and the people kind of came on stream obviously at the same time as the pandemic really started to hit. So lots of those really significant things in there, I think have probably not got potentially the coverage across the NHS that they need to make sure that they're embedded. So flexible working from day one is six months better than the statute. It's six months better than what you're able to do in lots of other companies, and flexible working by default is also another huge policy change that the People Plan introduces. So there's lots and lots going on in that space. It's really exciting.

HM: Kate, did your work inform the interim People Plan?

KJ: Yeah. So we're part of a group, a community of practice. We work closely with NHS England and other groups like Time Wise and it was a very collaborative process. So we were able to contribute to the plan which was great. It was a great experience. It continues to be a great experience actually. It's a really good collaborative group with lots and lots of voices, diverse voices all contributing to that ongoing conversation and that ongoing policy change which is really powerful.

HM: And that must have been really exciting to achieve that momentum and really start to be landed across the system?

KJ: It's so exciting, it really is and it's such a privilege as well because Asha and I are just two regular people that decided that we wanted to open up a conversation about this and to really champion a cause, and it's been incredible to be able to do that.

HM: How much resistance did you face initially and did some people think of you as a trouble maker?

KJ: I don’t know, probably, maybe. I think ultimately we all want the same thing really. Championing people to have healthy, good, satisfying working lives and to make sure that people are able to work feels to me like it's a shared social endeavour. We certainly don’t actively go out to trouble cause. We are, as a movement, keen to highlight where practice should be better and that actually there's no excuse for it not to be better. So calling out poor practice, and we tried to do that in a sort of supportive way, rather than a finger pointing, look how terrible this individual trust or organisation is. That’s not helpful. But to call out general poor practice around flexibility and working lives and to champion where it's actually really good and some places do it really well. So I think for me, there is a real place for activism within the NHS. There's a place for people to be activists in their approach to change and I suppose we all have to be careful that that doesn’t wear out individuals and that’s probably the same across a whole range of issues at the moment around all sorts of issues, particularly around equality. The flexible working conversation is a really interesting one to have in the context of gender equality as well and we often sort of end up talking about both of those things quite a lot because a lot of the… There's probably a natural part of being part of a movement that represents a workforce that’s 77% women, but there's lots of experiences that are particular to women that cross the divide between gender issues and issues of gender inequality and issues around flexible working and health at work.

HM: So you mentioned activism and also gender equality and I know those are things that you care a lot about. So earlier this year you wrote an incredibly powerful article which everyone should read. It's on the NHS Confederation website and that was in response to the findings of the Cumberlege Patient Safety Review that was published in July and for people not familiar with that review, it was called First Do No Harm. It was led by Baroness Cumberlege and it looks into the harm caused by pelvic mesh implants and a couple of drugs prescribed to women in pregnancy, and Kate, in that article, you describe the review as skewering the NHS on its treatment of women and then another sentence that really struck me and stuck with me, you said that the Cumberlege Report itself deals in the shame felt by women and the currency of silence and it deals in misogyny and paternalism in arrogance and the imbalances of power, both individual and systemic. Can you expand a bit on that and do you think the NHS has a systemic problem in its treatment of women?

KJ: So the Cumberlege Report for me, I felt furious reading it on behalf of the women who'd shared their stories and who'd talking about their experiences, and obviously they represent a huge number of other women whose stories aren't told individually, but who share those experiences. There's a few things I think from the report that stuck with me and one of them was the phrase ‘those blood women. You listen to those bloody women’. I just thought wow, that’s just absolutely astonishing that women are dismissed in such a way, and I think there is a gender imbalance in senior leadership in the NHS, we know that. Do I think the NHS has a problem with misogyny? I think that’s a very difficult, nuanced question and I don’t think that there is a single answer. Do I think that there are parts of the NHS where misogyny is a problem? Yeah actually I think the report reflects that and actually that these were women who were able to be dismissed. There were issues that I expect it took a huge amount of courage for women to go forward, to seek help in the first place, and then to be sort of treated and dismissed, in particular about pelvic mesh in that, but also the sort of paternal notion that I think probably does still exist in medicine. The report demonstrated that. But you have to be passive in your receipt of healthcare and you should be passive and grateful and that’s really dangerous in healthcare actually, really dangerous. I can probably draw parallels between that notion of being passive and accepting, with all sorts of other reports around the institution versus the individual and the impact that that has when people are forced into the position of being a sort of passive recipient of healthcare or of reports into their care or in incidents, or if you've been harmed by healthcare in some way. So I think that the Cumberlege Review really exposed the sort of gendered issues that other reports haven't done, but actually they're all around harm and they're all around the power of institutions versus the power or lack of power of individuals. But I thought that actually, the Cumberlege Review really did centre that on the experience of women in a very powerful way and for me, yeah, it absolutely brought together lots of different areas where we need to do better and we need to engage in different conversations and change how we operate as the NHS, as an institution. I guess we need these honest reports and these difficult conversations to make that change and again, I think that the report came out at a time where lots of other, so much stuff has gone on this year, I hope it doesn’t get lost because the experiences of those women absolutely deserves to manifest change in the health service.

HM: And I think we're still waiting for the government response on that?

KJ: Absolutely, yes, and I know that that was called out recently by Julia Cumberlege who said herself, yeah, how frustrating to have shared your experience and to again, be met with silence. So utterly disempowering and we must do better than that.

HM: And so I see you very much, particularly on Twitter, but obviously in lots of your work with Flex NHS too, you use your position and your ability to have a voice to amplify the voices of others, and call for rights to improve. Do you think leaders have a duty to use their position in that way?

KJ: Yeah, I absolutely do. I'm still kind of astonished to find myself in this position really and so I think it absolutely is beholden on leaders to listen, to actively listen, to go and seek out voices other than they're own. It's really easy to surround yourself with people that agree with you or just be sort of blinded by your own privilege in life generally, and I think probably in lots of ways I absolutely am. I think leaders should be able to be challenges. We should be able to be made to feel uncomfortable because that’s where change happens. It's not we don’t address those difficult issues in the NHS, they will never be anything different. So yeah, absolutely, I think it's beholden on leaders to amplify the voices of others, to further the causes that might not be something that is their cause, but is something that's important for equality and we won't always get it right, absolutely. We won't on a sort of personal or organisational level, but the more you listen, the less likely you are to get it wrong, the more able you are to drive change in different ways for different communities.

HM: So I wanted to ask you, because Milton Keynes has done quite a few interesting things on the digital tech side, so I think just in the past couple of years, you've introduced a patient facing app for booking outpatient appointments, and you've worked with Apple to provide patients with the ability to access their health records. So what's behind that push for progress?

KJ: So I think this, from respect to being able to empower patients and again, about addressing that sort of inbuilt imbalance of power between institutions and individuals and access for information in healthcare is transformative for you, as a patient. So the sort of tech agenda here is very much about that. So our chief exec really promotes this agenda and is really passionate about this agenda and it is rooted in being able to be empowered as a patient, to be able to take control of your own healthcare in a way that you've not been able to do before. So the My Care Patient Portal was the first part of that. It meant you could do things like change and cancel your appointments and the Apple Health app which we are one of two hospitals in the country to have that partnership with Apple where you can access your results and information on your iPhone, and we will continue to innovate I think in the tech space on the basis it improves the experience for patients, and it puts them in more control of their healthcare.

HM: And I did just want to ask, I mean obviously when you're introducing something like that, it's not going to be a walk in the park and there must be, I assume difficult conversations in terms of bringing people along on the journey with you. How do you bring people on board?

KJ: So I think it's happened over a period of time. So a lot of the tech, I think, has been iterative. So people have a chance to get used to it. So we've also done some really big changes like introducing e-care, so the electronic patient record which was a huge change for the organisation when it was introduced a couple of years ago, so switching to digital healthcare records. So I think actually the organisation has also become quite quickly very digitally enabled and for me, at least, it's felt that it's really responded very agilely to that and people have embraced it, and I think probably because we use tech so much in our personal lives generally, so I guess it's probably fairly easy to do that tech innovation when the product is intuitive and easy to use. I think people see the benefit of it as well. So by being really clear that the benefit is for patients and for patient experience and being clear what the sort of vision and the kind of road map is around wanting to innovate to empower patients and to improve service delivery, then I think people feel it's the right thing to do. But that’s not to say there hasn't been challenges. There's always challenges in digital programmes and I think you have to be prepared for stuff not to work and to be honest and upfront and say we won't get this right all the time. I think we're good at doing that here. We talk openly about wanting to do things, try things, innovate, but that sometimes we won't get that right and you know, we're prepared to sort of take the risk of something not going as well as it might have done so that we can learn and do it better when we try again.

HM: Thank you. Kate, thank you so much for joining us today. So that’s it from us. You can find the show next, for this episode and all our previous episodes at www.kingsfund.org.uk/kspodcast and we'd love you to subscribe, rate and review us on Apple podcasts or wherever you get your podcasts as it helps others to find us and it also helps us to improve the show. And you can also get in touch with us via Twitter either @thekingsfund account or my account @helenamacarena. Thanks as always to you for listening, but also to our podcast team for this episode, producer Sarah Murphy, researcher Jonathan Holmes and a special thanks to my colleagues Pritesh Mistry and Tricia Boyle for their input. We hope you can join us next time.