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The People’s Summit with NHS Sussex

Louise Patmore, our Systems Change Lead, reflects on the People’s Summit with NHS Sussex held in April

It is always a privilege being at the Amex stadium in Brighton on a sunny spring day with views of the downs and my old campus at Brighton University where I started this journey of systems change back in the early noughties. Today is the people’s summit for the Sussex Health and Care ICB (Integrated Care Board) the people’s summit is all about the people that work in all of our services but also all of the people that use our services.

Sometimes it might feel like we aren’t getting anywhere with systems change. What does it mean? It can often feel very nebulous. Lately there has been pressure about performance, “what are you (me) doing? What is it? I cannot see it. I might not like it. But here is a real victory for us in Changing Futures to get invited to, but also to be very much thought of as part of, the Violence Reduction and Prevention Team as the experts in Trauma Informed Care.

Celia Lesquerre and I sat overlooking a bright stadium basked in sunshine and as the grounds people mow the lawn below. The presentation is given by three key people who are dedicated to improving quality for the workforce, Maria Roberts, Jason Hathaway and Stephen Rowley. They shared aspirations about working together, building in more strategic ways of creating more flexible ways of working.

A third of people who work in our services have experienced violence, feel ill, or are thinking of leaving. It was also highlighted that those of an ethnic minority and those with long term conditions, many of whom are working very valuable night jobs, are often worse off. One of the ways of altering this landscape is to implement trauma informed care and part of the work Changing Futures are undertaking is seeking to ensure that services are working in a trauma informed way.

What this group are doing and how Changing Futures are helping

Changing Futures, in Partnership with NHS Sussex are delivering bespoke and leadership focused training in trauma informed care. “We have deliberately not gone outside the system to find this, we are the first to deliver in the country a violence prevention strategy across an ICB and Changing Futures is co-leading the trauma informed element in that. We are using the expertise that is already in the system.

This is a testament to how well the trauma informed programme’s community of practice has worked. The fact that we have had lived experience in the programme from the start and the fact that we have partnered with a great many organisations has led to the beginnings of an adoption of a trauma informed culture. It also goes against a bit of a trend I have noticed in Sussex where it appears harder for East, West and Brighton to share knowledge and understanding across Sussex. Instead, good practice outside of Sussex is favoured. This often leads to good practice not getting embedded in the intended way. This was highlighted in the group discussion we had later on, where siting on a table were people from across the system who were able to comment on the historical narrative and bring to light the DNA of why Sussex is as it is.

A director and a senior university member described the history of the South Thames Health Groups, one east and on

e west. East and West Sussex were members of the respective areas. They had very different ways of working. Both had good elements to them. I think that if both were able to fully integrate the strength of the diverse knowledge would really galvanise what potential we have across the piste to work in a more integrated way. However, good practice in other areas seems to land in the Sussex landscape without proper context or thought on ‘how did we get where we are’.

There is an objective in systems change called “the flow of value” – this is broadcasting good practice so that it gets noticed by the relevant people. It is a cumulative process that builds impetus, urgency and momentum for change. Sometimes I forget the name of things and what I am doing then remember when it is pointed out, an earlier conversation reminded me of that label and what we are doing. We are currently mapping our flow of value and I am really proud of our journey so far, its huge. Sometimes, it is difficult to see, sometimes the fruits of this mode of working take a long time. But here, today, I see a really tangible living win.

Changing Futures are deeply embedded now in the workforce delivery of the ICB, informing, being consulted in decision making and providing training in trauma informed care. This will have a positive effect on people interacting with the system who have multiple complex needs, for example, more listening, empathy and kindness and understanding from staff on the front line, fewer restraints, fewer security guards on front desks and staff trained in de-escalation techniques.

All of this will make for better work practices. Moving away from zero tolerance to a more understanding empathetic landscape for service users and staff.

The People’s Summit will enable more relationships, increase visibility and create a stronger flow of our value connecting with others who have similar goals. I think our work and networking will produce long term dividends. There is more and more a sense of need to look at things and do things differently. Changing Futures need to be at the table advocating for the people not usually heard and promoting new, progressive ways of working.

In the opening speech Adam Doyle, the CEO of NHS Sussex and director of systems change for NHSE said, “This might annoy some, but this is quite simple. It is about getting services closer to people, in their communities, closer to their homes.”

Systems change is also simpler than we think it is. We must simplify things and make the permission giving by senior leaders to undertake new ways of working a priority. We need to underpin the system with a safe and trusted space. New models emerge, lots of diagrams appear, influencing ideas and calls for action. We can get swamped with new models and ideas and this will in some ways stall our progress. It could be thought that this is a way of avoiding the complicated which is the doing the action itself! The outcome rather than the output. Outputs might be thought of in this context as gathering the set of intentions into a project plan, setting up a steering group, employing staff. The tricker bits are measuring what have we done and establishing how we know we have done something positive.

Our contribution to the People’s Summit was to input into the overall people’s strategy that will include workforce and development, ensuring that the Changing Futures work on trauma informed care in collaboration with NHS Sussex, SPFT and Co-Production is front and foremost in the VPR strategy.

These initiatives will create new outputs, new policies, new training, etc. We need to hold on to what those outcomes are going to be, asking what will this mean to the person interacting with our services? Will there be palpable reductions in violence? If we can achieve this and increase collaboration and participation, this will impact, for the better, the lives of those using services, especially those experiencing multiple complex needs.

Overall, we were left with a sense of optimism. All the words are right and there is definitely a momentum and loud calls to action. However, as with all large systems, the question remains of

how does this make its way down into the day to day, the teams that are burnt-out. This is where Changing Futures can and definitely will help, ensuring that trauma informed care is not just a tick box, not the latest buzz-word but a living breathing entity in our system that informs practice and improves lives. It is also very encouraging to see people I have known in this space championing the cause, supporting us and knowing what we do.

Sitting in, and contributing to, the leadership training on trauma informed care this morning highlights how Changing Futures are actively challenging, coming up with new ideas, trying out approaches and thinking about barriers to change in issues that are live and living for the whole system.

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