00:00:00:00 - 00:00:03:22

Unknown

do we actually work together to get better health care outcomes

00:00:03:22 - 00:00:06:10

Unknown

this is not an experiment, which is an unknown,

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Unknown

biggest opportunity around virtual wards is the on the prevention of admission,

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Unknown

underestimated at our peril

00:00:13:20 - 00:00:16:11

Unknown

can't suddenly turn this on. You've really got to think through

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Unknown

Some of that can be done at small scale.

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Unknown

the system had become far more digitised within that period,

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Unknown

enlightening, scary, invigorating, fun.

00:00:25:04 - 00:00:26:22

Unknown

We know how to do this.

00:00:26:22 - 00:00:32:07

Unknown

we had over 400,000 people nationally going through a virtual

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Unknown

Hur som helst, helt klart ganska.

00:00:38:05 - 00:00:55:06

Unknown

James, welcome to voice of. It's really good to meet you in person. It's lovely to meet you. Thank you. Well, it's a transformational time. The NHS ten year plan, NHS England changes. Also anniversary time. I think 15 years since culture formally got together is so exciting for you.

00:00:55:07 - 00:01:14:17

Unknown

Very exciting, very exciting. And I've been chasing now for almost three and a half years. Really, really good times. And in terms of culture, if we can just get a broader picture because, I'm very familiar with the organisation and for personal and professional reasons, as you know, it's spread in such a big geographies in Ealing, Hertfordshire.

00:01:14:17 - 00:01:43:13

Unknown

Can you give us a little bit of a snapshot? 14 London boroughs, something like that. London boroughs and all of Hertfordshire, we provide 105 service lines across those areas all the way from, sexual health service and integrated family planning through children's development to universal services, working age adult services, frailty, end of life care and posted back with support and very much community based provision, community based provision.

00:01:43:13 - 00:02:16:24

Unknown

So we see around anywhere between 10,500 people a day, across a variety of different sites and in their own homes and their own homes. And obviously this is a place where throughout your tenure and actually prior to that, it's been renowned for being quite innovative. I think you were one of the very first, organisations to trailblazer with nursing associates, if I remember, we are so we have a really strong academy and really thinking through how do we support, local populations to join, the National Health Service?

00:02:17:05 - 00:02:34:14

Unknown

How do we support that? Through both, clinical training, non-clinical training and becoming an anchor institution? I think that's important, especially if we think about where the ten year plan might be heading around really developing networks. Yeah. And also that you are also pioneers. And we're going to talk about that later. But hospital at home and virtual wards.

00:02:34:18 - 00:02:58:03

Unknown

Yeah. So to really support people at home and keep that home, in a safe way, we've been doing an awful lot of work with partners over many years, thinking through what that model of care looks like and how we, integrate care across the primary care to acute, the NHS confirmed recently, produced a piece of sprint around neighbourhood based care.

00:02:58:03 - 00:03:18:08

Unknown

Place based care. I think we should probably stay there for a second, because you've been extraordinary busy with your team, in producing a new strategy. Can you tell us a little bit about that? So I think it's really fresh off the printing press. If that's not a, a very analogue way of describing it. Well, now there is definitely going to be a paper, and digital as well.

00:03:18:10 - 00:03:48:04

Unknown

The strategy recognises the importance of lights. And when we talk about place from a London and hospital context, we're talking about, boroughs or districts in the county. And that's important because people live in the places in which they live. And the way we therefore develop integrated neighbourhoods is going to be based in those geographies. They're going to be, real teams working with partners in support of our residents.

00:03:48:06 - 00:03:59:23

Unknown

There will be some service lines that are going to, of across maybe more than one place, from a skill point of view or resourcing point of view. Yeah. But the direct focus is going to be about how

00:03:59:23 - 00:04:03:20

Unknown

do we actually work together to get better health care outcomes

00:04:03:20 - 00:04:14:02

Unknown

for our, our children, families and adults. And the emphasis is very much on also tackling health inequality, but also boosting the broader mission of economic growth.

00:04:14:04 - 00:04:31:12

Unknown

Yeah. So if you really want to think about, health inequality and, economic growth, a really good example of that. Our, our Ms. case, a little we've got an awful lot of people in society who are not working. It wasn't that

00:04:31:12 - 00:04:34:06

Unknown

how do we actually support people to get back to work

00:04:34:06 - 00:04:35:23

Unknown

and remain healthy?

00:04:36:00 - 00:04:56:21

Unknown

How do we, especially for people with long term conditions, support them to retain, their ability to work and be economically viable in our communities? And I think one of the things that struck me from looking at, the plans that you've got, and we can focus on them a little bit is the idea of a three layered approach.

00:04:56:21 - 00:05:19:01

Unknown

Can you unpack that for me? Because it's not looking for what you're going to do right now. It's a much more longer term vision and being accountable. I think that's a big word that's come through. There is quite a big accountability piece, but it's based on the three types of changes and change methodologies, doing things well, doing things better, and doing better things.

00:05:19:03 - 00:05:59:02

Unknown

And if we sort of unpack that, doing things well is how do we make sure that we, actually just delivering good to everyone that we are working with? Doing things better is really starting to push the boundaries of, well, what more could we do to get better outcomes, for our residents and our society and doing better things is really starting to, think through how might we organise this in a fundamentally different way, that meets the government's ambition around prevention, around digital health care, around delivering more services in the community.

00:05:59:02 - 00:06:32:00

Unknown

And a lot of that is going to be both as a leader and as a partner. But also maximising the skills of an engaged population to really think through how did they support themselves into the real, a social health care contract. And that's going to require not putting words in your mouth. It's going to require a shift, not just the left shift that we've talked about, to community, but a rethink perhaps, or rebalancing in the way power and financial flows work.

00:06:32:00 - 00:06:52:12

Unknown

Because the stats show over the recent years, despite many policy documents for five years, Forward view 11 years ago talked about this shift. But the the percentage of the NHS budget going to acute care has actually been drifting up, whereas the budget going, I'm sure you're painfully aware of this community care, it's been going the other way.

00:06:52:16 - 00:07:20:06

Unknown

So there's going to be some tension in how that works. There is. So yes, we've had a proportional reduction in in that spend, although recognising that the NHS we have spent more in the NHS over years. So it's not a, oh I necessarily need more money disproportionality what that looks like which would result in more spending caring in, in communities services, any primary care services as well in mental health.

00:07:20:08 - 00:07:43:11

Unknown

A part of that is us really thinking, through not just the, the PowerPoint you went to. I think accountability looks very very different in the non-hospital space. And part of that is how do you therefore work with partners specifically local government, in ensuring that we get the best for our residents.

00:07:43:11 - 00:07:45:14

Unknown

Some of that can be done at small scale.

00:07:45:14 - 00:08:11:18

Unknown

Yeah. Neighbourhoods and some of it, we really think through some of the digital transformation that might need to occur. That's more than just me as an organisation has me work with other partners in in our sector to think through what does that digital that look like, for work, for organisations and that will cut across not just local authority but dare I say, the integrated way of delivering social change.

00:08:11:20 - 00:08:52:14

Unknown

Voluntary organisations, and social care. Yeah. So I have absolute regard for the voluntary and community sector and we do an awful lot of work, with the sector to promote better health care and better health care outcomes and a different way of engaging with our populations. And I think this is a real opportunity to strengthen that relationship, hence why the relationship with local government is important in that space, because they have a really strong commitment to that in all the places in which we work, but also the relationship then circling back to our GP or other primary care providers that dentists cell phones in the community, really thinking through, how do

00:08:52:14 - 00:09:18:06

Unknown

we create a clearer health care model? Part of that is, I think, being much clearer around what is the offer to residents so that all of us fundamentally know when we break this postcode lottery or the types of services people get. That doesn't mean that we won't be offering specific services in different communities, because some communities have very different needs, but

00:09:18:06 - 00:09:21:04

Unknown

we should all be getting the same outcomes

00:09:21:04 - 00:09:22:02

Unknown

in terms of our health care.

00:09:22:02 - 00:09:47:14

Unknown

And unfortunately, that's not historically been the case. And the final point, just look, wrapping around the context of it, we've obviously had the spring statement, etc.. Mr. McKee has, set a financial reset, £7 billion overspend. So there's going to be some little bit of alchemy that you're going to need to do in terms of meeting the budgetary requirements while delivering these aspirational, services.

00:09:47:15 - 00:10:11:03

Unknown

Yes. So I think, the community sector is really interesting because the vast proportion of our contracts are on block. So, I'm sure, your listeners will understand it, but we get an annual, settlement. Yeah. Within those means, which is very different to payment by results. So the sector is being very used to cost reduction, and actually taking costs out of the system and maximising productivity.

00:10:11:03 - 00:10:49:07

Unknown

So I'm, acutely aware of the cost per unit case of every single service line in my organisation or 105. There are some improvements that we are making continue to make in their other service lines that I actually think are probably, as cost effective as anyone could possibly imagine. And that's where I think the, the conversation tension and positive engagement coming together and this potentially there, if I may say so some hope because if that shift to community where they you are used to doing these annual settlements, perhaps offer some I wouldn't say the solution to productivity, but probably some, positive views around that.

00:10:49:07 - 00:11:13:06

Unknown

Well, part of the solution to productivity. But also the solution to ensuring that, the financial settlement is not overspent, absolute, a really important thing for all of us as taxpayers right now. I wanted to delve into, one particular aspect, and that's the virtual wards. You're a national lead advisor, for national, for virtual, wards.

00:11:13:11 - 00:11:42:02

Unknown

But the context for this is the move, into digitally enabled care at home. Set the scene about I think everyone's heard the phrase, but if you look at different policy documents, the varied definitions, I would like you to unpack that. But the concept of hospital level type of care globally has been around since the 60s. But I think 2021 and 2022, the government here put the formal policy behind that.

00:11:42:04 - 00:11:57:22

Unknown

So 2122 we were in the middle of I absolutely needed to provide as much care to people in their homes to prevent people going to hospital and save those beds. What was required at the time? We were fortunate that I think then

00:11:57:22 - 00:12:01:03

Unknown

the system had become far more digitised within that period,

00:12:01:03 - 00:12:03:20

Unknown

and we would now in a very different place.

00:12:03:22 - 00:12:29:13

Unknown

Some of us have been doing this for quite a while. So this is not, as you flagged, a new concept. But it was about putting resources. Where. Resources. Yeah. Yeah. All of a sudden you had people at home and there are really two distinct differences in virtual wards. The first of those virtual wards, wards that are on discharge, how do we get someone to be discharged safely home?

00:12:29:15 - 00:12:49:03

Unknown

To be cared for at home with technology where they may not need care, they may need remote monitoring and so like to give confidence to our acute colleagues. Patients are going to be a great medicine, but more importantly, to give confidence to our residents, patients, families that they are set to be at home. That's I think that's really, really good.

00:12:49:03 - 00:13:09:04

Unknown

Yeah. Advanced proportion of people are actually wearing wearable technology all the time. Our phones, our watches. Absolutely. With that said that those virtual wards were aimed to reduce the length of stay, in my house with you. 1 or 2 days. And that's really important. In terms of elective recovery. But the

00:13:09:04 - 00:13:13:20

Unknown

biggest opportunity around virtual wards is the on the prevention of admission,

00:13:13:20 - 00:13:17:19

Unknown

for largely people with complex, and frailty.

00:13:17:21 - 00:13:44:03

Unknown

Yep, yep. And, this is something is really, a core plank of what we do in the community. We don't we support an awful lot of people to not fail. And this reducing statistics that an a frail, largely older person who goes into hospital will take 30 steps a day in a hospital right when they're at home, when they're just as frail and unwell, they'll take 300 steps.

00:13:44:05 - 00:14:01:01

Unknown

That's a dramatic difference. Massive dramatic difference. And, you know, if you know any physios, you know, that is a that is a big difference in our frail older population and going into hospital. We do need to support people in hospitals are the right places for some people.

00:14:01:01 - 00:14:05:09

Unknown

But the longer someone who's frail stays in hospital, the more likely it is that they will die.

00:14:05:09 - 00:14:06:05

Unknown

Condition

00:14:06:05 - 00:14:29:21

Unknown

and a lot of it is that they will need increased care. And that's something we need to prevent, not from just a financial point of view, but from an actual personal health care plan. So if we can support people at home. They won't deconditioned as much. Yeah. And they're more likely to remain. Well there's some really interesting work that we've been doing.

00:14:29:23 - 00:14:52:02

Unknown

With some our when you're just about to launch a piece of research that looks at, patient satisfaction, quite specific amount back towards, the, but one of our, service users, made a comment, which was, well, of course, if you're in a hospital bed, in a shared ward, portion of them up close, in the middle of the night when all the lights are on and the bells are ringing.

00:14:52:02 - 00:14:59:04

Unknown

Thank you very much. Sleep. And it was. That brings it down to earth. Really wanted to it to a core. Yeah.

00:14:59:04 - 00:15:01:06

Unknown

Not everyone can be supported.

00:15:01:06 - 00:15:18:21

Unknown

Sometimes you do need to admit patients, but you also need to support that person to get back home as quickly as possible. And this is where putting the right resources in the right nursing, therapeutic pharmacy, medical support to support people at home, becomes really important, enabled by technology.

00:15:18:23 - 00:15:45:02

Unknown

Yeah. So that we can monitor that person, robustly, but also bringing in care support. Throughout local government partners and care agencies. And I think that all starts to alter the role of carers in, in, in society as well. That's a very vital part of that offer. No. Thank you for setting that out, because I think there's some confusion for people who are not absolutely experts.

00:15:45:04 - 00:16:05:24

Unknown

You've talked about it's part of the goal of the policy, clearly, was it was financial, budgetary, reducing the pressure, of course, in hospitals. But it's also about patient choice. And there's a lot of stats and surveys done, approaches. There's quite a lot of public buy in to the concept of virtual mode. Yeah. So this if you've been on a virtual ward, you've had a fair number of friends on a virtual what?

00:16:05:24 - 00:16:32:16

Unknown

You can completely understand it. You think it makes absolute sense. I do understand the reticence of, people who have never been in a virtual because it, it could be quite, scary. But, the vast portion of our patients enjoy it. And, you know, from a national point of view, delivered more than 12,800 virtual wards on, virtual beds on that on a daily basis.

00:16:32:18 - 00:16:36:06

Unknown

And last year were so if we look at the 25 years,

00:16:36:06 - 00:16:41:16

Unknown

we had over 400,000 people nationally going through a virtual

00:16:41:16 - 00:17:08:22

Unknown

these are here. Then you just say we are going to need to consistently improve them, think through their occupancy, check the way into living the right sorts of candidates, and very important plank of the way we are going to deliver neighbourhood care moving forward and looking at the impact of virtual wards, drawing on your own experience, perhaps we'll come into that a bit more details, I think some really interesting work, I think led by Doctor Rochford at CLC.

00:17:08:24 - 00:17:27:13

Unknown

But looking at the national picture with your national hat on, looking at the impact, are we able to see is it too early in terms of the data? Because some of the research says that certain groups are underrepresented in virtual wards, whereas others say, actually, it has begun to make an impact in terms of the pressures on the system at an acute level.

00:17:27:15 - 00:17:48:10

Unknown

So, this is definitely a piece of development and live research. If you do anything, I'm sure your listeners will recognise this. Do something in 20 2122 is that we're going to we're going to start this. We believe it to be the right thing by operating clinically. To deliver, that means you do need to allow people to experiment.

00:17:48:14 - 00:18:13:16

Unknown

Yeah. That being virtual wards where I would say probably we haven't had the impact that we would have wanted right. There's been some virtual wards where the return on investment, they, the perception of service users is really quite significant. And it does go to that, that frailty of, if you think through the other impacts around skill development, green technology community,

00:18:13:16 - 00:18:17:09

Unknown

I don't think we would have progressed anywhere near as quickly as we have,

00:18:17:09 - 00:18:24:14

Unknown

in terms of bringing new types of digital technology into the, non-hospital space.

00:18:24:16 - 00:18:49:06

Unknown

Well, you know, a piece of work with partners in Hertfordshire around how do we start to use the same type of digital technology across the totality of the health care sector, which I think is a really, interest and novel, place to be. But it's also about how do we start to really think through what point of care testing would look like.

00:18:49:08 - 00:19:22:22

Unknown

And part of that is, you know, pre 2021, my community nurses, when not able to analyse bloods right through point of care testing. If you think through that productivity and community nurse would go into someone's home, take plants, hopefully get them to the lab in time for them to be read correctly, turn around, turn around, and then the GP or the advanced nurse practitioner or or therapist would then make a decision.

00:19:22:24 - 00:19:46:16

Unknown

How long will that take? A day? Yep. Right. The likelihood is of that for a lot of those who would already be in hospital. Right okay. Because they had actually deteriorated now through point of care testing for some some tests, we can actually determine whether or not the patient is unwell. What we might actually do to inform your care.

00:19:46:18 - 00:19:54:01

Unknown

And there's been an important debate about whether or not that point of care testing is as accurate as it could be. And it's

00:19:54:01 - 00:19:55:20

Unknown

it's not 100%. You're right.

00:19:55:20 - 00:20:10:23

Unknown

I did challenge some, some colleagues about this. And similar to what's not 100% accurate is what we've already go. Okay. And us thinking through life change methodologies in in the NHS is a really important fact.

00:20:11:00 - 00:20:33:07

Unknown

In terms of delivering care, because we do need to make sure that we are constantly testing. And this this goes back to the three pillars in our strategy, doing things well, we should know what those things are doing things better. And we really start to think through how can we make this better? Okay. Doing better things becomes really important.

00:20:33:07 - 00:20:55:03

Unknown

Really thinking through how are we going to transform the way, delivered and received. And it's interesting you talked about, an experiment, and some of the numbers I've seen, I think some analysis, of the southeast region did point to savings, significant savings, over £10 million in the south east. There was, I think, an outlier research.

00:20:55:03 - 00:21:18:19

Unknown

I think it was Reddington, said it was twice the level of inpatient care, but actually, that's been been revised. But I wanted to centre in on the feedback that we've had from the users. The patients? Have we beginning to see data where people are actually really embracing the opportunity to to co-produce plans? We've got and we've got evidence 97, 98% of service users valuing virtual wards.

00:21:18:19 - 00:21:38:05

Unknown

And I think that is really, really important. Absolutely. That you tend to see that sort of level of, recommendation. From, from being in a bid. And, and why would you, if you're unwell, becoming more and more, you're not really feeling like you've got you're getting better. But if we can keep people as well as possible, they're more likely to be happy.

00:21:38:05 - 00:21:43:15

Unknown

And that's a huge thing. I just want to circle back to one thing about the experiment. Yeah,

00:21:43:15 - 00:21:46:03

Unknown

this is not an experiment, which is an unknown,

00:21:46:03 - 00:22:11:22

Unknown

position. I think that's we've got to be really clear with both our clinicians and our residents and positive patients, and this is based on clear historic evidence and actual worked live examples that over significant periods of time, you know, I, I was running this with partners as a model in Barnet with colleagues at the Royal Free many years ago.

00:22:11:22 - 00:22:44:13

Unknown

So it's a trailblazer. Well, no, I mean, no, I, I didn't come up with the great colleagues. Liverpool came up with me. But it works and it it gives confidence to clinicians and leaders across the whole health and care spectrum, because as we start to build neighbourhood health care, what we've got to do is make sure that we are all collectively confident in a social health care model, that we are getting the best outcomes that we can, for our residents.

00:22:44:19 - 00:23:09:20

Unknown

No, absolutely. And I want it. You've mentioned them several times, quite rightly, of course. And I think that's quite a big piece for listeners and viewers. Is the implications some of the lessons for workforce now we're at NHS ten Year plan, a revisiting of the long term workforce plan. There's quite, an inflection point for the NHS workforce.

00:23:09:22 - 00:23:29:09

Unknown

Can you just show some of the observations you've had. And then I'm going to look at some of the couple of your case studies. But, the way that this has impacted the way multidisciplinary teams work and across the usual boundaries of health and social care, and so our workforce is by far our biggest asset. And we,

00:23:29:09 - 00:23:32:03

Unknown

underestimated at our peril

00:23:32:03 - 00:23:35:15

Unknown

in society.

00:23:35:17 - 00:24:06:08

Unknown

I, have the fortune of leading an organisation, where, 82% of my workforce are women. The average age is 14. And, she is, more likely to be from the global majority. So, 58% of the workforce is from the government, from the global. My my biggest hope for my workforce is that they are proud of what they do and what they achieve, working together for our patients.

00:24:06:10 - 00:24:42:11

Unknown

But that is about skill development. Yep. And really thinking through how do we support, people who have been fortunate to, to be trained through university to, to develop their careers? More importantly, how do we, support people through, and through an anchor institution coming from communities to develop a career in, in social healthcare? How do we therefore engage with our workforce to work with partners, and particularly not just the statutory policy and not just at social care or about the voluntary sector?

00:24:42:12 - 00:25:07:11

Unknown

Yep. And really thinking through what is that relationship with them. And then we go to three points. It's about skill development. Yep. And that you know those are teachable things. It's about confidence and us giving confidence to society to our healthcare workers that they are valued and are able to deliver. And the third part is really around

00:25:07:11 - 00:25:10:04

Unknown

how do we teach new types of skills?

00:25:10:07 - 00:25:34:12

Unknown

Yeah, that's where I think it be digital. Absolutely. Yes. You know, I'm not using digital. Okay. I have a twin brother and he's very much better than, you know, at digital things. And we are going to need to teach people and that becomes important because if if our healthcare workforce are more competent in digital society, he's probably more competent to do so as well, I'm sure.

00:25:34:13 - 00:26:01:05

Unknown

And there's been an embracing, I guess, from your feedback. With your very early work in Hertfordshire, etc.. I think the cohorts you work with, frailty and also people with heart condition, I think the virtual so respiratory. Yep. Heart, heart conditions. I think we're going to be extending into end of life care more fully because that's on the background of frailty, very topical at the moment, you know, very topical.

00:26:01:07 - 00:26:15:06

Unknown

And part of this and this is why not over towards, across the country or in this same space? Because a lot of this has been about what resources do we already have that we might be able to shift, change, and develop? You

00:26:15:06 - 00:26:17:22

Unknown

can't suddenly turn this on. You've really got to think through

00:26:17:22 - 00:26:19:10

Unknown

what are the skills that I've got?

00:26:19:12 - 00:26:47:03

Unknown

How do we give confidence? What is the level of resource and capacity that we would have to be able to admit patients into those virtual wards and care for them? It's the last thing you want is to do harm. Absolutely. There has been some coverage going back to the point around the financial, budget says I think the survey from NHS providers came out in May, showing that 47% of trust leaders, I'm sure you saw it, are going to potentially pare back some services.

00:26:47:03 - 00:27:11:00

Unknown

There was a hint that virtual wards may suffer. So I guess the the evidence is going to be really important that this produces great return on investment. Agreed. A great I think we are in we're in a very challenging time. So, you know, I applied before I'm, I'm very aware of the cost per unit case of every single service line in the organisation.

00:27:11:02 - 00:27:23:14

Unknown

We have plans for further productivity measures as, as your listeners would expect, but they does get a bit where a conversation is going to be had about what resources do we collectively had at the time?

00:27:23:14 - 00:27:27:10

Unknown

Where are we going to spend our money to get the best results that we can?

00:27:27:10 - 00:27:31:24

Unknown

I'm sorry, I'd like to end, if I may, to take a slightly bigger picture.

00:27:32:01 - 00:27:57:07

Unknown

This whole shift to community based provision, prevention, and the role of leadership, because this comes up regularly. We've had messenger reviews that you it review paint the picture of how important the role of integrated systems is going to be and the role of the leaders within them, because to make this transformation real is going to require a big step change.

00:27:57:09 - 00:28:42:11

Unknown

I mean, it's very different to, an organisation that works out of 750 signs and an organisation that runs that are 1 or 2, and that's based upon ensuring you've got good processes in place to, to, to identify where there are risks or there is nothing delivered in a way, that one would expect very different processes, and risk appetite around how I and my team developed not only the leaders in my organisation today, but give them accountability to ensure that they also don't trip up and think about, well, he's he's going to be the next leader.

00:28:42:13 - 00:29:07:00

Unknown

And that we spend quite a lot of time really thinking through how do we actually support those, those leadership teams to understand that and make sure that they understand their operating performance? And then the third part is about how do we work consistently to to rather than, than just describe the Kim, delivering a way, delivering, what that actually means for our residents.

00:29:07:00 - 00:29:35:03

Unknown

So through the lens of I don't need to describe, to my board about the care that we deliver and that's, that's that's the day job we need to move into a space of actually starting to to describe more fully to our residents how they can be assured about, the, the care that is being provided. And the resource uses, that would be, needed to, to drive care forward.

00:29:35:05 - 00:30:08:07

Unknown

But in that, what that does mean is that we need to recognise that leading services across a partnership, is very different to a command and control type of leadership, you know, a completely different skill set. And logistically running an organisation over so many sites with so many patients on a daily basis, is is a completely different, different way of leading.

00:30:08:10 - 00:30:24:13

Unknown

And I sometimes say to, to colleagues or friends, you know, I, you know, the chief executive centred on the Community Health Care Trust. It's probably an organisation you've never heard of before. And on some level,

00:30:24:13 - 00:30:32:21

Unknown

I'm both disappointed that people don't recognise that the historic value of community service design immensely proud of, what we're able to deliver.

00:30:33:20 - 00:31:01:21

Unknown

But it's a good news story that no one needs to know because it just kicks off in a usual, in a usual way on a on a daily basis. And that, I think is is something to be really, really proud of, you know. Absolutely. One very final point, if I may, James, if we look at the big picture of the Health Foundation, I'm sure you're aware has done a lot of work around where the health landscape will be in 2040 9.1 million people with major, at least one major health condition.

00:31:01:21 - 00:31:27:12

Unknown

That's a 37% increase. The shift to community. I guess there's some positivity around the anyone now Mr. Storm on the government have talked about increasing the attractiveness of health and social care. I guess, the final point to use is this could be a really fabulous time for those considering a career in community. Community based care to deal with and support these changes that the society is facing.

00:31:27:16 - 00:31:41:19

Unknown

So I am I historically worked in hospital. My first jobs, were in hospitals as a speech language therapist. My first senior management job was in the community, and it was both

00:31:41:19 - 00:31:45:03

Unknown

enlightening, scary, invigorating, fun.

00:31:45:03 - 00:32:02:07

Unknown

It's a really, really different way of working. And if I was to ask any of my staff, I suspect that the vast proportion of them would say it's tough, but you have so much more accountability.

00:32:02:09 - 00:32:30:19

Unknown

And at the end of the day, we have been doing community care for a very, very long time. I had the, you know, and I'm being with some colleagues in, the Queen's Nursing Institute, and, you know, Queen's nurses. So our, our district nurses, our health visitors have been delivering public health nursing for years since the reign of Queen Victoria.

00:32:30:19 - 00:32:32:12

Unknown

We know how to do this.

00:32:32:12 - 00:33:15:04

Unknown

This is new in someone, but it's based upon a proper public health response to improving the life of our residents. And the the original, contract that the NHS had with the population in this country was about delivering services that were free and care that were close to home. And you can't get much closer when your district nurse is walking in, or your community physio or speech therapist or your pharmacist, or you can call again when they're in your own home, helping you to remain well.

00:33:15:06 - 00:33:39:08

Unknown

I think on that hopeful, historical and forward looking note. I think there's a lot of excitement ahead and a lot of transition. James Spence, and thank you for your time and for your insights. Thank you. It's been a pleasure. Thank you. If you've enjoyed this episode, please like, follow or subscribe wherever you receive your podcasts. And if you want to learn more about how it really turning the dial on the health and social care debate, please visit New Cross healthcare.com/voices of care.

00:33:39:10 - 00:33:45:24

Unknown

In the meantime, I'm Suhail Mirza. Thank you very much for joining us today, and I look forward to seeing you on the next episode. Thank you.

00:33:45:24 - 00:33:57:11

Unknown

Hur som helst, helt klart ganska.