Leadership Listens 4 – Compassionate leadership as part of working in and across systems of health and care

This recording is a conversation between Michael and Fatima Khan-Shah, Programme Director, Unpaid Carers and Personalised Care Programmes, Convener of the Race Equality Network, West Yorkshire and Harrogate Health and Care Partnership. This conversation focusses on the importance of compassionate leadership as part of working in and across systems of health and care and its role in engaging with citizens and service users.


Paul O’Neil [00:00:02] Hello and welcome to Leadership Listens curated podcasts for leaders in health care. My name is Paul O’Neill, Head of Strategy, Research and Development at the NHS Leadership Academy, part of the People Directorate of NHS England and Improvement. This mini series of podcasts as part of Leadership Listens, is a series all about compassionate leadership, but it’s a collection of conversations between Professor Michael West and a leader from the health and care sector. This recording is a conversation between Michael and Fatima Khan-Shah, Programme Director, Unpaid Carers and personalised care programmes, convenor of the Race Equality Network in West Yorkshire, and Harrogate Health and Care Partnership. This conversation focuses on the importance of compassionate leadership as part of working in and across systems of health and care, and its role in engaging with citizens and service users.  

Michael West [00:01:04] So welcome everybody. My name is Michael West, I’m a senior visiting fellow at the King’s Fund and Professor of Organisational Psychology at Lancaster University, and this series of podcasts is just a huge pleasure and a privilege for me, particularly because I get to talk to some of the most inspiring people and lovely friends across our health and care sector. And today it’s an opportunity for me to be with and learn from Fatima Khan-Shah. Fatima a warm, welcome to you. You’re a multi award winning director known regionally and nationally for actively championing patient involvement, carer support, health inequalities, leadership and diversity and inclusion. And I suppose formally, you’re currently leading the West Yorkshire and Harrogate Health and Care Partnership programmes for long term conditions, personalised care, unpaid carers and you also convene the regional West Yorkshire Regional Equality Network. And I know you were recently recognised in the Health Service Journal’s top 50 influential Black, Asian and Minority Ethnic leaders, as well as being recognised in the British Muslim of the Year awards for your work nationally. So it’s a delight in an honor to be with you.  

Fatima Khan-Shah [00:02:26] What an introduction Michael I feel a bit fraudulent just sitting here with that description. But thank you, one of the conversations I often have with people is when I try and explain to people what my day job is. They don’t understand. And so I just say positive disruption, I just go cause trouble wherever I go for the greater good.  

Michael West [00:02:46] Well, it’s a trouble that comes out in wonderfully positive form, I must say, and I want to start by reflecting or acknowledging the context we are currently in, which is sadly far from positive. We’re still in the throes of this global shiver that is a pandemic, and it’s had a huge impact on health and care staff in terms of stress levels. And I know many of them have been under such protracted stress. They’re exhausted and tired of being exhausted that they’ve either quit or intending to quit. And I think it’s also had an effect on moral distress, people not being able to provide the care they want to provide. So it’s a really difficult time, I think, at the minute, and was difficult even before the pandemic with staff shortages. What’s your perception of the experience of staff and the experience of the health and care system at the minute?  

Fatima Khan-Shah [00:03:41] I mean, I think you summarised it very accurately. The pandemic has been something, I call it a nightmare, that just doesn’t seem to want to end. The moment you think you’re going to wake up, something else happens and you just back in the middle of the nightmare again. And I remember, sort of, at the beginning feeling absolutely helpless because I wanted to do something to help. And there was this really divisive language about frontline staff and frontline care and everyone, you know, in sort of battle formation and thinking, What can I do to help people who genuinely cares about our communities, our people, my loved ones? This genuine feeling well how can I contribute or make things better? Because there’s nothing in my control and people were going in at one hundred and ten thousand miles per hour, and I remember doing a video for the King’s Fund, where I just spoke really honestly and I said, I’m exhausted. I’m going 120 percent in the day job trying to deliver and support people as best we can. But because of the momentum and the longevity of what we’ve experienced, there’s been no let up when I can’t recharge and I feel really guilty for saying that out loud but it’s how I feel. And I think what video did was it gave people permission to acknowledge that. And I think one of the reasons why I admire you so greatly, Michael, is because you advocate a slightly different leadership, which is not the hero leadership that some people feel like they need to demonstrate in emergency situations like this. This is a marathon. It’s not a sprint. And if we’re going to continue to support people through what I call the nightmare but the pandemic, then we need to recognise that people are multidimensional, they’re multifaceted. We have different factors that impact the individual that you see within the workplace. One of the things I discovered, particularly talking to colleagues and providers of health and care, is that there are things going on at home as well, so when they’re coming into work, they may have a relative that is dealing with cancer, they may have caring responsibilities. They might have a child currently recovering from COVID, and they’re bringing that into the workplace, giving a hundred and twenty percent and then going back and dealing with that and there is no chance to recharge. And there was this culture and, because it was all hands on deck, not having the bandwidth to recharge and self-care. And my new mantra as a consequence of having those conversations was that self-care is not selfish. It is, it is essential in being a good leader. The ability to demonstrate and role model those behaviours, that actually I do need to look after myself in order to look after you because you would gives your car an MOT. Why wouldn’t you look after yourself? We’re not machines. I think the other thing I would say is we’ve seen some really amazing examples of people stepping in and dealing with uncertainty with real honesty. And I think some of the anxieties that come from people that I’ve spoken to has been, I don’t know what’s coming and I’m really scared. Some of the most inspirational leaders I’ve spoken to have responded by saying, Yeah, I don’t know what’s coming, but I’m going to deal with it when it comes and we’re going to work on it together. And I honestly don’t have the solutions. I will find the people that have the expertise. I will bring them to the table and we will resolve it together. And I remember sitting with you one time when we were talking about the captain, was it? A major of a submarine. And he came on the submarine and he didn’t understand the controls, but he didn’t need to because he was there to facilitate and enable the people with the expertise. And that, to me, was a real penny drop moment of, yeah, actually as a leader, I don’t want to have all the answers. I just need to have the skill set to support people to develop the answers together.  

Michael West [00:07:31] So there’s, I think, really powerful lessons, the importance of self-compassion, not as some sort of selfish, self-indulgent orientation in life, but is a fundamental way of being that enables us to connect more deeply with ourselves in order that we can connect more deeply with all of those that we provide care for. We lead, we interact with. And I think that second observation about leadership is, it’s not necessarily about having the answers, but it is about bringing the attention and the resources of everybody to bear on the most difficult things we face. And then there’s the learning as well I think that you’ve talked about from the pandemic about how compassion has been at the heart of this, the compassion that health and care staff have shown and the compassion they shown patients and service users and the compassion they shown each other. And I think also what’s really struck me is the huge compassion that people in the community have shown for each other. So my mother, who’s 95, going on 96, her neighbours have been dropping in regularly to check on her. And there has been this huge upwelling of compassion from the community as well as, as it were, from the professionals. And I suppose in thinking about the future, I’ve begun to think that we can’t go on with the paternalistic health care system that doles out health care to a so-called supplicant population that we have to move towards a situation more where the community genuinely co-owns and co-designs their health and care services. Is that just an idealistic kind of dream, or is that something that you’re seeing beginning to happen in reality?  

Fatima Khan-Shah [00:09:21] If it’s an idealistic dream, then I want to go wherever you are because I’m totally behind that vision. I think you’re absolutely right. If the pandemic has taught us anything, is that the walls are meaningless anymore. We’ve come together across sectors, across organisational silos and really transformed the way in which we design and deliver care at pace. And it’s just shown us what is possible. Actually, if we parked the usual, sort of, mantras and way working the old ideals are actually fantastic, change is possible. And we saw this during the vaccination particularly in West Yorkshire, where I work, where we were using grassroots community influencers, we were delivering caring venues that we wouldn’t have thought of or considered about delivering care in before that, we were trialing and doing different ways of having conversations with the public about the way in which they perceive and manage their own health and wellbeing, which is absolutely what personalisation is about, it’s what personalised care is about.  

Michael West [00:10:19] So can I just ask you the grassroots influencers and venues you wouldn’t have used? If you can just say a little. Give me a couple of examples.  

Fatima Khan-Shah [00:10:28] Yes, definitely. So one of the key things that we have found absolutely instrumental, particularly with the vaccinations, is using trusted influencers, people that are within the grassroots of our community that are connected like the mafia for want of a better phrase. Knowing loads of people in the shops, in the community centers, in their homes, articulating some really key and simple messages about certain elements of health and care. Whether it is about the debunking of the myths that people have regarding vaccination, whether it about addressing some of the systemic barriers when it comes to health inequalities and using those influences and using venues like mosques like community centres where people feel comfortable and safe to receive care, has actually really, sort of, ensured that people are accessing care in record numbers. Another thing that has worked particularly well for us was the work that we did with the vaccinations on the Unpaid Carers Programme, so it’s taking an opportunity to go okay. One of the biggest issues we’ve got at the moment as a system is there’s no consistent definition of how we define a carer and a carer is that provide some time and support to a loved one. They don’t have a formal title. They’re often not recorded in the Department of Work and Pensions that don’t receive benefit. I certainly don’t because of my working situation. But actually, I’m instrumental to the health and care system. I wouldn’t normally be seen as part of the workforce, but I am part of the workforce because I’m keeping my loved one out of hospital and God forbid, if they were in hospital, I’m instrumental in that effective discharge. So developing that consistent definition, developing a process, a way of working where the local authorities and the voluntary community sector and the health system all work together on a standard process to identify these individuals, to invite them in for vaccinations early and delivering care to them in the places they were comfortable, enable those in three months to identify fifty one thousand new carers. So these new ways of working are shown that, one innovation is possible, two when it’s done right can be absolutely astounding when it comes to impact. But three shows that actually we are redefining what we mean by our workforce. We don’t just mean the people in the scrubs in a hospital estate, we’re talking about people in our communities that can talk about social prescribing. We’re talking about individuals, that are in community centres that provide peer to peer support on things like diabetes. We’re talking about someone in a voluntary community sector organisation that can support a carer with the navigating of the health and social care. All these elements in this new world, this new exciting world, particularly with your vision, could enable people with the skills and expertise and knowledge to make informed decisions about the care they actually need, not care that they’re expected to need because of the old ways of working. And it may mean that they take a decision that the usual course of treatment is not for them, and that social prescribing is a better way. Just one example. 

Michael West [00:13:25] Can you say a bit about what sorts of things social prescribing involves? I mean, I always get confused a little bit by the term, but what little I know about it suggests it’s a really exciting way of thinking about how we care for people around us.  

Fatima Khan-Shah [00:13:40] I mean, social prescribers, I think, are instrumental within primary care networks and they work alongside our primary care colleagues, our colleagues in the community. Quite often somebody will be signposted from a primary care setting to go and see a social prescriber for possibly things on diabetes or another long term condition. And it may be that the social prescriber connects them into something related to physical activity or a peer support group to help that person manage their long term condition. Because quite often the cause of the manifestation of the individual in front of you is actually a little bit more complicated than just treating the condition before you. You may be that they’re in a situation where the housing isn’t supporting them to have the best health and wellbeing outcomes. It may be that the socioeconomic circumstances in which they’re living is having a negative impact. It may be that lack of social contact. I mean, we often start to medicalised things like unhappiness and loneliness. Where actually a social prescriber can be instrumental in connecting people back into their community to do things like gardening or befriending others, which has not only a positive impact on the person receiving those outcomes, but also the person doing that, volunteering or linking in with that group.  

Michael West [00:14:53] I guess it also recognises the fundamental importance of a feeling of belonging of relationships and how damaging loneliness and exclusion are and the sense of isolation for us as human beings, as a species. And that interconnectedness, which is so fundamental to who we are.  

Fatima Khan-Shah [00:15:13] And that’s why ICSs is so incredible me now our partnership, I think, and I’m biased because I work with it at have been really innovative on things like loneliness. We’ve had a campaign called “Look Out for your neighbours”. It’s been running for a couple of years now, and that is just a very simple concept, as you describe with your mother Michael, of just looking out for neighbours, just knocking on the door, making sure they’re okay, popping round for a cup of tea, dropping off a casserole or a curry. Whatever it is, those small things matter, and I always say that kindness is free, but its impact is priceless.  

Michael West [00:15:47] And its impact both ways. The love is at both ends, the being cared for and the caring. Both have really beneficial outcomes for us. I mean, my sense of what you’re doing in West Yorkshire, in Harrogate, in the integrated care system is, I have a sense that it’s a pretty enlightened system that you’re developing, that you’re making really good progress. And my sense is you’re involving lots of organisations, voluntary sector organisations, local authority, community groups, social care and health care. So I’ve got two questions. One is how is all of that going and seeking to interconnect all of these entities? How’s that going and what’s difficult? What’s really hard about that? Because I have an intuitive kind of expectation that trying to get organisations across boundaries to work together sounds good in principle, but it’s really hard when you try to do it in practice.  

Fatima Khan-Shah [00:16:40] I mean, you’re a very wise, man Michael, and you’re always on the money, particularly with that last point, that it is difficult. But going back to the first part of your question, I mean, I am extremely proud to live and work in West Yorkshire’s Health and Care Partnership. The reason why I am proud is because we have a leadership that’s led by Rob Webster, but others like Ian Holmes and other colleagues that very much are the paramount, and visible example of a values based leadership, and a values based leadership to me is somebody or individuals who collectively have a series of values that they’re very open about that are very accessible. People can connect with them, they can believe in it. We can get it. And they’re brave. You know, one of the things that I always remember about meeting Rob Webster in particular was his mantra of the distributed leadership model. So I started my journey as a patient public advocate champion working in the grassroots of West Yorkshire. And the first time I had a conversation where I felt empowered to act was so liberating because I was given the opportunity to lead a solution to a problem that I knew I could fix. I just needed someone to give me the platform the permission in inverted commas to go in and deliver the change. And he was one of the first leaders that I met that was like, Yes go and get on with it. So what are you waiting for? Type conversation, which I found absolutely refreshing and really empowering. The other thing I would say is, you know, we’ve always been really clear about what our shared vision is. We’ve got 10 system ambitions. The very easily accessible and, sort of, I always say, is if someone stops in the street and says, Well, what joke do you do? I tell them that I work for an organisation that’s committed to improving outcomes for people with cancer. We want to diagnose cancer earlier. We want to address the problem with people with a life expectancy that is lesser because they happen to live with a learning disability. We want to support the wider determinants of health and address things like climate change. All those examples are really simple and that most people can connect to and start to go, Yeah, I get that. I can buy into that. I want to join the West Yorkshire party, which creates this feeling of momentum and a social movement, rather than a bureaucratic organisation that’s got to deliver certain key objectives and which have to be measured in a very sort of nugget like way. And I think the other thing I would say is we’re not afraid to be ambitious. We always think really big because we’re thinking about the long term and a mantra we’ve always got is, you know, we don’t sit around and admire the problem. We want to do something about it. And, you know, we roll up our sleeves and get our hands dirty, which I think is really important. But that’s only worthwhile if you back it up with the action. So the other thing that we always try and do, I always try and do, but I emulated the leadership by their example. Is if we’re going to do something about it and we’ve got to back it up with the doing, haven’t we, because words are easy, doing the actual doing, as you just described, can be really difficult Michael, and I think it’s important then to share with people that we have done it. So one of the fantastic leaders in our system, a lady called Karen Coleman often portrays and develops case studies which demonstrate the impact of our partnership is making because it’s important to be able to tell that story to get people to connect into again the vision of what we’re trying to achieve in our system. And then the thing that I would always say is my which I find really inspiring is we’re not afraid to give power away. So one of the biggest challenges I give to leaders nationally in particular. And Michael, you’ve seen this with colleagues that I’ve been with is saying, OK, if you genuinely are committed to this and give the power to the people to go and make it happen. And that’s scary because it comes with risk and sometimes it might go wrong. But unless you give the power back, then the balance is unequal and you’re never going to get the change, the dynamic relationship that you need to make that change happen. And that very much is the case with the patients and the public and the carers that we engage with in our system. We advocate and have adopted patient leaders. I’m an example of that. We’ve also got voluntary community sector organisations that sit in our leadership forums as equals. They’re not there as a tokenistic thing they’re there with influence and power and the resources are shared equally as well, which I think is really important because we’re not just talking the talk, we’re walking the walk. And I think the final example of that I’d say about how amazing it can be, but also challenging is the work we’ve done on health inequalities and race equality. So we acknowledge that our leadership is not what it could be. It’s not reflecting our communities, and we took a long term approach to do some systemic action to make that happen. Some of those things were, well, let’s get people in the room. Let’s get some representation and let’s back it up with influence. You’re not just there as a token, we’re giving you an infrastructure resource to give you some influence and some teeth, dare I say it? But also, when it comes to health inequalities, we have addressed some of the more complex issues. So we’ve just given away, for example, a million pounds away to support people with fuel costs because of some of the fuel poverty that we’ve experienced in the region. And I think what this is showing is the power of an integrated commissioning system can go far beyond health and care. Actually, it’s a huge anchor within a region that works alongside West Yorkshire Combined Authority. Or likewise, organisations such as businesses to really address some of the complex issues affecting our health and care and the wider determinants of health because you might treat the condition that’s in the room. But some of the issues might be more complex, might be about racism, might be about adequate housing. It might be about the experience of people caught in the criminal justice system. It may be the economic recovery and all those elements and all those relationships are really crucial in the integrated commissioning system was instrumental in making sure that we’re working in collaboration towards the same goals.  

Michael West [00:22:42] You just gave me an amazingly rich feast, and there are so many morsels and so many dishes that I want to savor. And so it does seem to me, from what you’ve described, that this group of organisations formal and informal and group of communities that constitute West Yorkshire and Harrogate is in a sense bound together by a shared vision of creating a place or nurturing a culture in that area focused on enabling people to live, fulfilling happy lives, feeling safe, feeling loved, feeling as well as they can feel. And that binding together is also a consequence of an explicit commitment to core values to do with sharing responsibility, sharing power, caring for people, and that honesty and transparency and a recognition of the reality of what’s happening, there is inequality, there is racism, there is discrimination, there is abuse, there is poverty and values focussed on how we can address it. So the values and the vision in some sense, giving people a shared sense of purpose and a shared identity is what I’m hearing. And then there’s something around. This is about a focus on the long term. You know, it’s not just we’ve got objectives for the next three months or six months. We’re talking about how to change things over the next ten years. I was reading recently about some Native American communities where it’s traditionally been the case that you think about the future in terms of the next 70 years or the next 150 years and what we want to achieve. And that’s a very, very different perspective from what are we going to achieve in the next three months, this kind of obsessive, target driven culture? That’s what I hear you saying as well. Is this the sense of a long term commitment?  

Fatima Khan-Shah [00:24:41] Absolutely.  

Michael West [00:24:42] And then the idea of giving power away to people, you know, I’ve always thought that the co-design and co-ownership of health and care services must be what we aspire to. But that means this incredibly complex set of structures that is our health service and health service organisations and sectors that’s about them genuinely seeking to be owned by patients that I remember, particularly the NUKA system in south central Alaska, where Native American leaders now lead that system. Patients are called citizen owners, and all of the different agencies work together. And it’s not just, you know, this is a good idea. The outcomes in terms of reduced suicide, drug addiction, alcoholism and maternal health are extraordinary. And then your point about sharing the resources. This is a shared budget, as you’re doing in West Yorkshire and Harrogate, and I guess it was a hallmark as well of the Canterbury New Zealand Christchurch system, which responded so well to the earthquake because they were already sharing budgets and resources. But I’m aware that all of this is achieved by working really hard. What is there are hard yards to be ploughed. I’ve always thought that if you’re not having conflicts, you’re not innovating, you’re not changing anything if you’re not having conflict. So how do you manage conflict within West Yorkshire and Harrogate? Because they must arise continually.  

Fatima Khan-Shah [00:26:10] Oh, absolutely. And debate is a really important element of leadership. You need to be in a position in a system where people can tell you what you need to know and not what you want to hear. Because if you’ve got an echo chamber, that’s a very dangerous place to be. And we do operate on a principle of subsidiarity. So you are trying to deliver care as close to people as possible and supersedes the system. And all those elements are very important. But I totally agree with what you are alluding to Michael, which is the job is really difficult. I remember when I first started working in a system role that I really struggled with it, because it does create conflict. There are competing priorities. You’re very much delivering through others. And sometimes that can be really difficult, especially if they have not bought into the vision or they don’t agree with the new way of working. And I remember sitting with one of my most inspirational leaders and colleagues, and I remember him saying to me that. The job isn’t the work Fatima, it’s the people. You’ve got to work with the people, you’ve got to develop those relationships and invest in those opportunities as organisations and if they’re presenting conflict, you’ve got to explore it and explore and understand why, where they come from, they’ve got those challenges and also they’re the ones with the expertise and we need to tap in and utilise that. So I think debate is really healthy. I think it’s really important we have to always agree on stuff, and I don’t think there’s any way in the world where everyone always agrees on everything. But I think there’s a real positive element in our system where we feel safe to articulate our concerns and challenge back and we always assume the best of intent. So there isn’t an assumption that you’re out there for your own agenda or benefit. But if there is a challenge coming in and it’s coming from a good place and we need to explore and understand why that challenge is, and how we can work together to develop that solution. And I think going back to your point, everyone needs to feel invested and equally committed to what you’re trying to do, otherwise you won’t succeed. And I think there’s also something about really investing in developing those relationships. And I think one of the things I’ve learnt on this job particularly, and it is something that will take with me wherever I go, is it’s not always about the system, process and policy. It’s about the ability to pick up a phone to someone to go I need your help with this. Can you give me a hand? Just need to deliver this, and that person and yeah what do you need? Let’s sort it. That is far more instrumental than any standard operating procedure or policy practice that you were ever going to get. But it again, it comes from an ability, and belief for all structures within the organisations to have those uncomfortable conversations. And we did that on health inequalities. We did that on the race equality stuff. The reason why we commissioned the independent review was because we knew that we were doing enough on health inequalities. The faces of the people that we were passing away in front of us was showing us that something was wrong. And the fact that we got an independent chair to lead that review and the fact that we did it at pace showed that we were committed to having a cold, hard look at ourselves, answer an honest response about whether we were doing enough when we were told that, yes, we were doing some good stuff, but it was far more we could do and we took that bull by the horns and went with it and went with it at pace, which is why we delivered so much in the year after the review. And I think they are really important elements that I would encourage anybody to consider in regards to leadership. That ability to really be able to take that feedback to really welcome challenge and to explore the issues and rationale behind that challenge and not assume that it’s coming from a bad place and recognising that there will be situations where it might be right for elements of West Yorkshire, but it won’t for others. And to be able to have the relationships are mature enough to deal with those things. The same with sectors as well, and we’ve had many of those situations where we’ve worked through those issues. But you’re right, it’s never rosy everywhere.  

Michael West [00:30:01] So what I understand from what you’re saying is, firstly, there’s a kind of leaning into conflict. It’s almost like an orientation that says we’ll welcome disagreement and we’ll welcome different perspectives, because that’s going to enable us to have a more comprehensive understanding of the situation that people are facing here in West Yorkshire and Harrogate. So we’re going to lean into that, but also that leaning in is also about spending enough time together so that we really listen deeply. And I think one of the things that has struck me about the development of more integrated ways of working is that sometimes it seems it doesn’t really work very well because the key people just don’t spend enough time together. If they do spend time together, it’s a formal meeting with a long agenda that they’ve got no hope of getting through, so they never really connect. I guess what I’ve really been impressed by, and it’s what you were saying about relationships, I think, is that if the job is about relationship, that means that’s what you need to be spending your time on is having contact with key people across the system.  

Fatima Khan-Shah [00:31:10] What you were saying reminded me of an example, about two years ago now where we were facilitating a workshop very early on our journey to race equality. And I was working with a chief executive called Owen Williams incredible man, and we were organising the workshop together with a number of other leadership colleagues and colleagues from the core team. And we developed a range of videos with some really uncomfortable and provocative questions. And I remember saying to everybody that I was worried about this, and he said no it’ll be fine, it’ll be fine. And he was really challenging me in a coaching type of way to push the boundaries a bit more. And I was like, Wow, this guy’s either really a genius, or really dangerous territory. And I remember when we were doing the workshop, and I was sort if saying to him these conversations were incredible. But I need to nail some outcomes Owen, I want some one action that I can follow up afterwards to make sure they do. And he was like Fatima, that’s not why we’re here. What do you mean that’s not why we’re here. He goes, I just want them to leave the room thinking differently. And I’m like what, so we’ve got no takeaways, no actions. I’ve not got a plan. And he goes No, I don’t want any of those things. I just want them to leave the room thinking differently. And obviously, he’s a very wise man. Everyone who knows him knows he’s incredibly intelligent and wise on these kind of things. But it was one of the most important lessons I learnt on that agenda, which was plant the seeds let people go through on their own journey. Let them come back to you and have some more exploratory conversations. But give people the opportunity to get behind an agenda. I know I’ve always been a carrot, not a sick person. But I do think that some of the most successful ventures we’ve ever done, particularly in the programmes I’ve led in, the work I’ve done nationally has been by winning over the hearts and minds of people to get behind something rather than making them do it because it’s in an SOP or they’ve got a target, because you could hit the target, couldn’t you Michael and this wouldn’t?  

Michael West [00:33:08] Well, I certainly see in parts of the NHS and I certainly see this in some integrated care systems that we create, almost like artificial palaces in the sky. So I think sometimes our national bodies, they have a rationale and a discourse and policies and procedures. There was a book that I read in my youth called the Glass Bead Game by Hermann Hesse and it’s this elite group of people who play this elite game. But it’s somehow removed from reality. And I think sometimes some of the structures we create and some of the processes and some of the policies feel like they’re removed from reality, and that actually they don’t effect any real change on the ground. They become an end in themselves. But it sounds like we some of the principles you’re talking about in West Yorkshire and Harrogate, about relationships, about sharing resources, about power being distributed, not just given away but being distributed. I guess the other point I heard you say was this kind of underlying principle that all of the organisations, voluntary associations, community groups, are oriented to asking How can we help you so that together we deliver and that being in a way a cultural norm, I guess.  

Fatima Khan-Shah [00:34:27] I wouldn’t say that’s always true. So I think going back to your point about conflicts, one of the most insightful pieces of work I ever did with colleagues in our system was developing the Independent Voices Panel, which was the structure: now part of our governance processes that consists of people from voluntary community sector organisations from ethnic minorities. Who have a role in holding up a mirror to us on the delivery of our review into health inequalities. And they very much challenge the status quo and ask us some very hard questions about the distribution of wealth, particularly when it comes to not just the voluntary community sector as a whole, but certain grassroots communities. So you can have something right in principle, well we’re distributing the wealth and giving it to a group of individuals. But are they the right individuals with the right focus, with the right infrastructure? And they challenges us back and go, actually, you know what? You might need to think differently on this. Or you’ve started a really good journey, but you’re missing this. There’s a whole load of direction to go in. So I think that’s equally important and again, going back to the healthiness of that debate and the ability to constructively challenge and tell you what you need to know has been really instrumental to our success with the launch of these intersector organisations, but also that we need to work collaboratively as partners to make sure that we deliver the care and the vision that we want to get into. But I think the other thing I wanted to say was, a key element of our partnership model are our local authority colleagues. We’ve got amazing leaders like Robin Tuddenham and Kirsten England and Tom Ridge, and in that system who have amazingly large and complex jobs but are always deeply embedded in the work that we’re doing within our system. And again, if you go back to the work that we were doing in the vaccinations and dealing with the pandemic, some of the conversations we had about utilising resources both in care within the communities, freeing up resources, getting things like iPads to people in care homes and creating a digital infrastructure for people that are in poverty to be able to access health and care via the digital means, they would not have been possible without our local authority partners moving heaven and Earth to develop an infrastructure for us to make it happen. And I think it’s really, again, as I said before, changed the dynamic by which we can deliver care and where the boundaries and the walls used to be Michael, I now do not believe in assuming that there are any walls anymore or any boundaries. I’m kind of like, No, let’s just think outside the box and see whatever is possible. And that is really instrumental by making sure that we have got the right partners around the table who are equally brought into our values. Hold the mirror up when they think, Oh, actually know what? I’m not quite sure that’s the right call to make. You might need to think about this or actually you need to be supporting. So one of the things that we recently did was increase the living wage for social care colleagues you know our people working in our care homes. And that was very much led by our local authority colleagues who was saying, Look, we’ve got a situation where a number of our colleagues in this part of the system are going into health because the infrastructure in the renumeration isn’t there, we need to make sure we level up to create that parity of esteem. These are the kind of really difficult issues that we danced around prior to COVID, or prior to integrated commissioning systems. But we’re now moving towards dealing with those rooted issues, and that’s only possible with this new way of working.  

Michael West [00:37:49] So, rather than avoiding them you actually directly address them together. And I think the other message I hear from you is there’s a kind of humility in what you’re saying that in a way there isn’t some hubris or arrogance or power and control orientation from particular parts of the whole system. There’s a humility that says, we don’t know, but collectively we’ve got more chance of generating creative ideas about how we can respond to this. And I suppose there’s something about the pandemic enabled all of that because this was a don’t know situation writ large. And suddenly it did require a recognition that there were no walls. There could be no walls if we were to respond effectively. So that humility sounds really, hugely important. I think the other thing I want to say in response to what you’ve been saying, Fatima, is that I’m not sure how optimistic I feel sometimes about climate change and our health care system and our political system. I don’t feel naturally optimistic, but I do feel hope. I feel hope when I hear about, see witness people doing great things together in small ways, in big ways, and it does feel like what you’ve been describing is really hopeful because if West Yorkshire and Harrogate can make progress like this, then everywhere can do it. But it does take these lessons that you’ve been describing. I think that’s critical. One of the questions that feels kind of slightly unfair to ask you, but I’m going to ask it anyway, because I think a lot of people need help, and they need simple direction is, for people who are struggling with these issues to do with working across boundaries, to do with collectively caring for the people in our communities. What’s the one or two really important practical principles that you would advocate?  

Fatima Khan-Shah [00:39:46] I mean, I think the first thing would be to go about what you just described as our humility. So I started in this system as somebody who was a grassroots positive disruptor, really focused on empowering communities, empowering carers to work in a different way. I would email chief executives, accountable officers of organisations in our system. And I was never once made to feel, Who do you think you are emailing me asking me for a favour, do you know who I am? Never once. I’ve always had a response of. Absolutely, I really want to support this. What do you need? And I remember one time when we used to meet in the physical world before COVID going to one of the venues that we used to meet in, in Brighouse and accosting various leaders who I didn’t know very well and I was probably scared of and saying Oh, I’m just doing some videos for Carers Rights Day, and I really would like you to just do a quick thirty second video on your commitment to supporting carers. Would you mind doing a quick video on the phone for me? And bless them, they’d go into this little room or wait outside and do a quick video for me and then wrap it up and carry on. And it’s just those little human and humble ways of working and leadership that just empower anyone in your system to think, Oh, I can lead the change I want to see. I can do something slightly differently without feeling that, Oh, I’ve gone above my pay grade or actually I shouldn’t have spoken to you. Those kinds of values and behaviours I think are instrumental to success. The other thing that reminds me when you’re talking about climate change was, one of the aspirations towards our work on climate change was we were at the NHS assembly meeting Robyn and I were, and we saw Dame Jackie Daniels talking about climate change and some of the work she was doing and how exciting it was. And I remember sitting in the meeting going, Wow, this is incredible. We need to be doing this in our system and we’re going to I’m going to go and talk to some people before I even got home from the train, Rob had tweeted. Fatima says she sees something in climate change. We’re going to make it happen. It’s just that thing is there is no bureaucracy structures. Yes, we have governance processes. Yes, we have ways of providing assurance. And yes, we meet all our statutory legal obligations. But we also are nimble and innovative and pacey and exciting and creative and I think all those things are absolutely crucial for a successive system to work, and they don’t come out of nowhere Michael, they come from a development of time and thinking and system leadership and OD are things that we very much focus on in our system, developing relationships, developing ways of working, agreeing what we’re going to do together, really galvanising momentum behind things and being brave so that you know your point about how do we get people, communities to feel that bought into, and are part of what we’re trying to do. Our anti-racism movement is an absolutely incredible example of coproducing a piece of work which was sensitive, risky, emotive about people’s experience of racism. It was about us doing something quite provocative. So, you know, we use the juxtaposition of some really positive messages which could have been perceived as quite triggering for some people on the images of people from ethnic minorities. And we put them on buses and on billboards, etc, to stimulate an uncomfortable conversation within our communities. And it wasn’t just to deliver a work product, it was because we wanted to create a better place for people to live and we recognise our responsibilities anchor institutions in leading the way, in those things. But what it did as a consequence was create a belief in our communities that we’re committed to change and we mean it and we’ve got integrity and they can trust us. And just think of the transferability of those values into some of the wicked issues that we’re seeing in health and care today, which is why I think ICS’s are incredible. If we harness their potential appropriately, and we’ve got the right leadership behind them.  

Michael West [00:43:45] I agree. That’s what I’ve been thinking for some time now. It’s how we harness that potential and see that that’s a step along the way to the interconnectedness that is the vision for the integrated care system in West Yorkshire and Harrogate. So the themes that you’ve described about the shared vision, about the kind of interconnected communities we need about the values of openness and trust and courage. To make a difference, the wisdom to ensure that we distribute power and create a sense of autonomy and control for people and build that sense of belonging and interconnection. I mean, all those themes, I think, are really powerful and I suppose I just feel really humbled now. Listening to you because you’ve been inspirational and it just feels an absolute privilege for me to listen to you and to learn from you and not just want to say thank you for your courage and your wisdom and your compassion. It’s a model for us all. Thank you so much.  

Paul O’Neil [00:44:50] I hope you enjoyed this conversation. Please look out for others in this mini series and subscribe to the Leadership Listeners’ Collection for more content like this.  

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