Guest Blog: Dr Natalie Silvey on NHS Change Day

Natalie Silvey is one of the many fantastic people I have met through volunteering for NHS Change Day.  Her passion and commitment always inspires me and we help to keep each other resilient.  

Dr Natalie Silvey
@silv24

“What’s different about Change Day and the reason I was inspired to become involved is that it uses the passion and drive of NHS staff to make a difference. We all see things every single day that frustrate us or affect the care our patients get and so often people think they can’t have an impact on this. Change Day is the amazing momentum so many staff need. It shows the passion, drive, commitment and innovation that I see every single day and gives everyone that boost to challenge the status quo and to try something different. This is why I am involved. And at the heart of this has to be the reason the NHS exists – the patients who rely on us all for their care. We are doing this to improve things for them.”

I wrote those words before last year's NHS Change Day. The volunteers had been talking about what Change Day was and why we had been inspired to be involved.

I have been a doctor in the NHS for five years. My mum has been a nurse in the NHS for over 30 years. We both love our jobs and are passionate about caring for our patients. But the NHS isn't perfect, mistakes have been made - one only needs to read the Francis and Kirkup reports to see just how bad things have been at times and I would defy anyone not to feel ashamed at the lack of care given after reading those. However uncomfortable it may both should be mandatory reading for every single person in the NHS, from the chief executives to the porters. We all have a responsibility to ensure such situations never happen again and that a blind eye is never turned to such horrors.

Daily I go to work and see the flip side, the wonderful care given in our NHS. I see patients who could never afford care in other countries receive life saving treatment. I see surgeons up at all hours working incredibly hard to perform complex surgery. I see nurses flat out on the wards trying to give each and every patient the care they need. I see porters joking with a patient as they push them to a ward. I see a mental health liaison nurse give a patient some money so he can get the bus home. I see a cleaner in the emergency department bring in a bottle of pop each night shift to make sure that the staff working flat out have a drink during their shift. I see so much good and I am humbled by the staff I work with daily. I am humbled by my patients and I am humbled by our NHS and I am proud to be an NHS doctor.

NHS Change Day is probably slightly misnamed. I see it more as NHS “trying different things to improve patient care and enabling every single member of staff and every single patient to contribute to improving our NHS” Day but that really isn’t as catchy. Just like Earth Hour isn’t about that hour, NHS Change Day isn’t about the one day. It is a focal point. For me it is a little ray of positivity in a time where staff are under increasing pressure, where media coverage is nearly almost always negative and where patients often get forgotten in the political point scoring between our politicians.

Criticism can be a good thing, it can focus our attention on the things that don’t work, it can highlight things we had never thought of and it can also act as a catalyst to improve things. NHS Change Day isn’t perfect just as our NHS isn’t perfect. It will annoy some people, some people may think it is irrelevant or even self indulgent. Some people may think that the actions people take are insignificant or won’t help. And that is their right and, as someone who often gets on my own soap box, I have to respect them for speaking out.

My counter to that is this. The volunteers, known as the hubbies, who are increasingly taking over the running of NHS Change Day are all doing this in their spare time. They are a group of the most inspiring people who I have ever met and they genuinely want to make a difference. Every single person who makes an action is doing something positive, whether others feel it is relevant or important honestly doesn’t matter to me; I love the fact that so many people want to commit to something that matters to them. You don’t have to log an action; you don’t have to take part. But please, don’t dismiss those who do. They are doing it for their own good reason and often when we knock down and dismiss such efforts all it does it lead people to stop trying. That is a culture I don’t want to see.

It may be that NHS Change Day never leads to the sorts of improvements and progress that people think it should to have validity. It may be that in five or ten years, or even next year, there isn’t an NHS Change Day and we have all moved on. But one thing I am certain of is this. That I am a better person and a better doctor for having learnt so much from working as part of such a wonderful team and those are lessons I will never forget.

I never wanted to be a doctor

Science doesn't really interest me, and I was never very good at it anyway. 

When I was shadowing a surgical fellow as part of paired learning, I spent an afternoon in theatres observing eye surgery performed by the fellow, under the supervision of the consultant.  I was so envious of how much learning was going on. How the surgeon was challenged but also supported, and how much investment there was in his learning. This is someone who was really advanced in his career, who had done a long degree, years and years of training and was applying for consultant posts, but still was learning all the time.

I left theatres wishing that I had that opportunity, wishing that I still had a teacher and that I was still learning so much. All of a sudden I panicked I was in the wrong job, that I should be in a job where I'm not "doing" all the time, but in a job where i'm learning continuously.  

A few months later, I read this fantastic blog describing a shift in expectations of junior doctors, how some people think they can only learn in a lecture theatre, and they can't learn rewriting a drug chart or re-doing a task they've done thousands of times before.

This made me think of everything I've learnt by doing. I'm lucky to be in a role where all day I'm being challenged to try new things and given the opportunities to develop myself whilst being supported, but perhaps not in a traditional "teaching" style or environment.

Whilst I was thinking about this, I got this tweet:

@LydiaBenedetta @ian_wac @MaryHobin day you stop learning, time to a) stop lying to yourself or b) get another job
— Alex Borg (@AlexanderDBorg) July 14, 2014

I am developing my skills and knowledge all the time, but I'm not thinking about it or even acknowledging it. 

So much so that when I went into theatres with my colleague, I thought he was the only one learning.

not that bad

I thought about the blog that I was going to write after the event; about the NHS, equality and the workplace, the intelligent and insightful comments that came from both the panel and the audience.

I told my friend I had a taxi booked in ten minutes; “did you let them know about my guide dog?” It hadn’t occurred to me to tell them, but I thought, you never know, the driver could be allergic, their child could be allergic, so I rung back and explained.  

OK, the operator said, no problem.  Ten minutes later a phone call from the driver: “what do you mean there is a dog? how big is the dog?  you can only get in if the dog sits on your lap.”

I could hear my friend in the background: I’m not going to get let into that car, they never like it, I really struggle to find a taxi.

It’s illegal- she reminded me to tell the driver on the phone. When we got out to the taxi it was the same: “I’m scared of the dog, where does it sit, I don’t want the dog near me.  Don’t get me wrong, I like drivingyou people around but I don’t want the dog in the car”

After some negotiation and reminders that it was illegal to refuse us we got in the taxi and drove to the station while the taxi driver made small talk and my blood boiled.

When we got out my friend said- that wasn’t too bad, we got in the taxi.  I always have problems with things like this.   Not that bad?  We were not only made to feel unwelcome but also unwanted because of something that gives you independence and enables you to lead a full life- in a service which we arepaying for.  Not that bad?

So this isn’t a blog about quotas on boards, or the equalities act, or the lack of representation in Birmingham City Council.  This is just my account of one small moment in my friend’s everyday life; a single event in a long series of similar situations that make up her reality.  How ironic that it was on the way back from an event on equality and diversity in the workplace.  How can we have equality in the workplace if we don’t have equality in society?

Art and Hospitals

It took me a while to understand the photographs.  Close ups of faces with scribbles on them, some drawings, some with the whole face covered in writing.  It was right next to the revolving door at the exit of the NHS Expo conference, far away from the corporate sponsors and the stands of branded freebies and glossy brochures.  A simple stand of photographs and a small table with a few flyers.  It looked so lost in the corner so I wondered over.  Mike Papesch, an ENT surgeon, came and explained the project to me, which he worked on with the artist Emma Barnard.  Immediately after their consultation, patients were invited to have their portrait taken. They then drew or wrote on their portraits, expressing their thoughts and feelings.  The portraits show what patients are going through emotionally, through a snapshot of their hopes and fears.

The images are so powerful and so honest.  Mike explained how he had felt the consultations had gone, how surprised he was at some of images, and the insight he got into both his patients as people, and his own practice.   We discussed the reactions to the project from colleagues, which ranged from love or hate, to indifference.  I learnt more in the 10 minutes I spent looking at these photos and talking to Mike than I have done at any NHS conference.  Why wasn't this in the main conference site, where everyone had been for the last two days? They had been invited to exhibit at Expo but were only given this spot near the exit.  Unfortunately, this is the reality of an innovative idea with little funding and no corporate sponsorship, but it did make me reflect on the true purpose of the conference.  

These photos give an idea of what it feels like for that person at that moment in hospital.  It shows patients as people, with lives, loves, dreams, hopes, fears.  This is what it means to put patients at the centre, to give patients a voice.  These images encourage us to ask, listen, reflect, share and learn.  

 

Earlier in the day Helen Bevan described how true innovation happens at the edges of organisations.  How fitting that at the very edge of NHS Expo, there was the most innovative idea, the most though provoking, inspiring and uplifting project.  Instead of telling healthcare professionals and patients what to do and think, it calmly and humbly showed people's emotions when they are at their most vulnerable, and made me think.

Sorry about the poor quality of these photographs, they do not do it justice.  You can see more about the project here

Cake and Chocolate

My new job in strategy at Birmingham Children’s Hospital means I spend a lot of time in the office, but for a day I shadowed Mary Hobin, Head of Nursing in Medicine, to get to know the hospital a bit better.


As I expected, the day involved lots of discussions around staffing, current pressures in the hospital, and visiting the wards. However I definitely wasn’t expecting to have a massive cake in the conservatory to celebrate reaching 75% of frontline staff having the flu jab! The good news vibe didn’t stop there, as the management team meeting ended with good news stories and whilst there was a strong message about reaching financial targets this year and in the future, the atmosphere was positive.


The language we use is something that really fascinates me especially when there are two languages within the NHS- clinical and managerial. There was a good discussion on whether CIPs (cost improvement plans) is the right phrase to use with clinicians and whether it should be called something different in order to focus on the benefit to the patient rather than the bottom line. However it was also acknowledged that finding savings is going to get harder and we need to be honest about the financial situation and the reality of having to do more with less.


The day ended with a tour of Ocean Ward, the newly opened complex care unit, with a visitor from Alder Hey hospital. It is great that at a time where more and more competition is introduced into healthcare, colleagues are still welcomed to the hospital to learn from each other. The sister showed us around with pride and her passion for the service shone through. But it was a shame to hear about housing problems and cuts in social care across the country, that mean discharges are getting delayed and these children are in hospital rather than being cared for at home.


As we got back to the sister’s desk, we saw that the chief exec had been round to the ward to drop off a box of chocolates for each member of staff for Christmas. Working here definitely isn't all cake and chocolate... but it is a place where passion and commitment is celebrated, and isn't cake a great way to do it! 

How are you?

“Busy... I’ve had back to back meetings all morning, a long list of 18 week breaches to get in ASAP, there is a delay in outpatients and I need to sort it out now, AND the ward is really short staffed due to sickness AND It’s 3pm and I haven’t had lunch”

“Don’t get me started... My to-do list is never ending. I haven’t had lunch all week, in fact, I can’t remember the last time I had a lunch break....” etc etc...

How many of these conversations have you heard?  How many have you been a part of? The relentless re-shuffling of priorities, the crisis management, the to-do list as long as your arm...  But doesn’t it make you feel important? Being in demand is so validating; being busy shows that you are doing a good job; never eating lunch shows you are committed.  And my favourite: If you have time for twitter you clearly don’t have enough to do.

I have just finished two months working at the King’s Fund, and it has shown me a completely different way of working.

I spent the first week settling in to the new office environment, enjoying delicious lunches every day and going to events and conferences that interested me.  The next week, I started some research, but also carried on meeting inspiring and thought-provoking people, going to events and reading any blogs or articles I was curious about.  At this point I started seriously questioning whether I was actually doing anything and what the point was of me being there.  All I seemed to be doing was chatting to people and reading, and I had produced a list of women’s networks in the UK… hardly a productive two weeks.  So I started organising the new West Midlands management trainee induction session.  Luckily, this involved lots of emails, a conference call with an agenda and a load of actions for me and others involved.  Suddenly, I felt right again.  I was back on track producing something!  This is what I have been taught is valuable.  But what about reflection?  When I wasn’t asked to focus on outcomes and performance, I felt lost.  I didn’t need to be stressed to prove that I was working hard.  This attitude has been conditioned in me from a young age, through a relentless schedule of exams, applications and CVs.  I knew taking time to reflect was important in theory, I just didn’t really believe it; because I had been taken in by the myth that output is more important. 

Having said this, I hope I contributed something tangible of value to the King’s Fund team.   But the main thing I will take away from this placement is the value of reflection.  It was a luxury to have two months to step away from my general management role and I know that the reality of the job and the culture means that it is going to be difficult to prioritise reflection.  I hope that in the future when I question myself, or others question me, on the value of putting time aside to reflect and forward plan I will remember what I learnt at the King’s Fund.  Working on being reflective will lead to a better quality of outcome, help me to understand my personal impact, and to be genuine as a person; an authentic leader rather than a pace-setter.   After all, the best part of my job is connecting with others to make a difference to patient care.  Thanks to the King’s Fund team for showing me something that will enable me to do this better.

Goodbye to BMEC

My last two weeks at the Birmingham and Midland Eye Centre coincided with the first two for the new matron, who asked me what the best moment of my placement was.  My first thought was that I couldn’t possibly pick; the year went by in a blur of hard work and a never ending to-do list. But I soon realised that what all the best moments had in common. These were exceptional people.

The moments that stick out the most are when people from all staff groups came together as a team to make an immediate difference to a patient. Getting patients home after heavy snow when no taxis were available, ensuring a psychiatric patient had the multidisciplinary team around him to carry out a sight-saving operation, and developing a centre of excellence for the rare Behçet’s disease.

These are exceptional circumstances, but I also remember the daily team efforts; fast tracking patients through imaging as they had already had a long wait in A&E, sorting out early discharges so there were enough beds for new admissions, and dealing with patient complaints on the spot so they didn’t escalate.

This is not to say it is easy.  For every success there were many moments of despair, tears, anger and frustration.

I learnt so much this year from the people that were tenacious when faced with obstacles and weren’t afraid to challenge the status quo, were true to their values and never lost sight of the patient’s needs.  Everyday I learnt about courage, kindness and compassion from the little acts that come together to make up the NHS.  The health care assistant whose smile never wavered when dealing with a clinic of 50 patients that was running 2 hours late.  The secretary who calmed an anxious patient over the phone.  The junior doctor who saw a few extra patients in A&E because it was busy.  The manager who spent time on the front line finding out what the problems were and then did something about it.  The consultant who embraced clinical leadership and inspired the team to improve a service.  The allied health professional who calmed a patient too scared to ask the consultant that last question.

I didn’t see these things all the time. And that is the challenge facing the NHS.  But it shouldn’t be forgotten that I saw this and more every single day and it was done with little recognition or praise.  We should be thanking these people and fostering a positive culture in the NHS.This team inspired me to be the best that I can be and to never lose sight of why we are all really there: the patient.

Thank you to everyone at the Birmingham and Midland Eye Centre.