Speaker1: [00:00:00] Hello, I'm Suhail Mirza and welcome to this episode of Voices of Care. My guest today is Mark Cubbon, chief executive officer of Manchester University NHS Foundation Trust.

Speaker2: [00:00:11] Voices of Care, the healthcare podcast.

Speaker1: [00:00:14] Mark, thanks for making the trip down and joining us here on Voices of Care.

Speaker3: [00:00:18] Thank you Suhail. I'm delighted to be here.

Speaker1: [00:00:20] Well, it's really good to speak to you. I think it's been about a year or so since you took the helm at Manchester, and just wanted to dive in on a few of the initiatives that you're doing. But before that, Manchester is one of the largest trusts in the country. Can you just give us some idea of the scale? I don't want you to go back to 1752, because I think that's where it all began.

Speaker3: [00:00:40] Yes.

Speaker1: [00:00:41] At the Manchester Royal Infirmary. But just to give a feel for the scale of the task that you've taken on.

Speaker3: [00:00:46] People when they talk about MFT, as we call ourselves, they talk a lot about our scale and the size, how much money we spend, how many people we employ. But it's really important to us to talk about the things that the services we provide to the different populations that our services cater for, whether that's local population. We serve a population of about a million people directly, but we also provide, you know, for some of our specialist services populations of like four, six, 8 million, depending on the nature of the service and the specialisation of those particular services. So that's really important to us. A bit more about the scale though. So we employ 30,000 people. Big responsibility. One of the largest employers in the region. And I see, you know, you might want to touch on this a bit later, but some real opportunities for us to play a big role in supporting people in our community to come and be the future workforce, the NHS. So there's with the size, there's big responsibilities and opportunities for us to work on. We have ten hospitals within the trust, a combination of tertiary centres, with Endure and the MRI. We have some community hospitals. We have the largest children's hospital in the country, some say in Europe, and the oldest children's hospital. Not many people know that. But the oldest children's hospital in the country is the Royal Manchester Children's Hospital. So one of the things that goes with scale is the nature of the services that we provide and how we provide them across our group. But with that scale comes a responsibility to make best use of the scale and the opportunities it brings as well. So we recognise that. And that is a challenge for organisations the size of ours. But I think it's one of the things that drives me, drives the whole team to work out how we can use that to an advantage, not just talk about size, but talk about the value that we bring to our local population.

Speaker1: [00:02:45] And talking about the population. If we've got my numbers right, it's a growing population, very fast growing population, 36%, I think in the last decade or so, and an increasingly diverse one.

Speaker3: [00:02:56] Yeah, it is. I mean, the population growth is enormous. I mean, across Greater Manchester, there's been huge population growth over the years. But in Manchester specifically, the growth is phenomenal. I mean, you know you go around Manchester now and the development buildings, housing infrastructure has been growing for years. It has been one of the fastest growing cities in Europe for a number of years as well. And with that obviously brings more diversity. But what it also brings is, I think, a continual challenge about actually how we as the NHS, working with partners and social care, make sure that what we have is the infrastructure in place to deal with that population growth. So just, you know, in the next eight years it's going to go up by another 20, 21%. So really big numbers, different age group for that growth. But we have to be there thinking ahead of time, thinking actually what kind of needs, what kind of support, what kind of provision need to be in place for the population, not just when it happens and then work out what we need to do now.

Speaker1: [00:03:59] Absolutely. And it's just to step back in terms of your own journey. It's the prodigal returns. I think you began your career as a nurse if my memory is right.

Speaker3: [00:04:08] Yeah.

Speaker1: [00:04:08] I hate to remind you, I think when you began there in 1992 across three hospitals, I think Wes Streeting was nine years old. 

Speaker3: [00:04:15] Right, okay.

Speaker1: [00:04:15] But I think your journey began here. 

Speaker3: [00:04:18] It did. So, yeah, it is a bit strange actually coming back because I trained yeah, I trained as a nurse and I worked at Trafford. Trafford was a general hospital at that point in time, and I worked my first two jobs when I qualified was at the MRI and at Whittington Hospital. Whittington Hospital now is a community hospital with us. MRI has continued to be growing its specialist services. And Trafford, now we have a small inpatient bed base, but it's a really big surgical hub for us as well. We do quite a lot of elective activity in Trafford, the birthplace of the NHS, of course, so. Yeah, it's changed quite a bit. As you would imagine, it's 25 years since I left. Well, between the time I left and I came back. But I've obviously watched how the organisation has developed over the years and grown, innovated, adapted to the changing environment. And that's what we need to continue to do for the future. So it is brilliant to come home, really personal to me as well. And it drives me day to day to actually do some of the things that, you know, I could do, not just for the time I'm the chief executive, but to think about the services we provide way beyond what my retirement age, you know, in terms of how we're doing, what we need to do for our local people.

Speaker1: [00:05:36] And I think looking at your career, you've been very busy in those 25 years. Chief executive, a highly respected chief executive, I think all across the UK, I think from the South Coast, including a little spell at Whipps Cross. I say that personally because I'm actually from northeast London, and you also found your way into the NHS upper echelons in terms of chief delivery officer. Is that right? 

Speaker3: [00:06:01] Well, yeah, over the years, I've been, well, I think I've worked hard. Right? I've worked hard. Lots of people work hard, but I've also had the opportunity where people have seen something, you know, in you and believe in you and give you a steer in terms of where some opportunities maybe don't give you jobs. What they do is they, you know, spend some time talking about their career. 

Speaker1: [00:06:28] Some great mentors.

Speaker3: [00:06:30] And I've been fortunate that I've had people like that right throughout my career. And I think that's, you know, as leaders in the NHS, this is, I think we have a responsibility to do that for people who follow us because we have to spend time talking about some of the challenges, some of our things about our journey, not just for ourselves, but is to really try and show that despite some of the challenges in the service, it is a phenomenal kind of entity. And what we need to do is make sure we've got future leaders we've got to follow in our footsteps. So I have benefited from that in the past. And yeah, I've enjoyed different jobs. You know, I think I do well, I've enjoyed all my jobs and I have and I've been in some really, you know, tough jobs. 

Speaker3: [00:07:15] I think throughout my career I've gone to where things are going to stretch me. Opportunities are going to stretch me, where I can still learn and still develop. And it's important to me that I feel as though I'm making a contribution. I know that's for all of us. We all have that in us. But, whilst I'm doing the learning and developing, I want to make sure that I'm having the impact30-plus where we need to make it most. So I've done some national. I spent some time with the national team. I've worked in regional roles as well for a few years. And you learn a lot about people, a lot about the NHS, a lot about the different services we provide and a lot about the different communities we provide services for as well. So I think I've had a rounded kind of career to date, but I think my heart is definitely with where you provide services closer to the action, closer to patients is what I like, and it's the kind of thing that drives me to do what I do day to day.

Speaker1: [00:08:11] And on that note, before we go into the detail around what's happening at MFT, if I can use that shorthand with that national perspective and those 30 plus years of experience, I just wanted to get your sense, not in great detail around what you feel in terms of for the future of the NHS. We've had, of course, a seminal election back in July. New government, new review, ten year plan, potentially. You've sat across these national bodies. What's your perspective around the NHS? There's of course, waiting lists, workforce shortages. But your feeling in terms of this new landscape, particularly an integrated one.

Speaker3: [00:08:46] Yeah. And look I say this as, you know, the chief executive of trust not because I know anything else other than what I see here on the news and pick up in various kind of meetings, etc. but look, I just think the NHS is going through quite a bit of challenge at the moment. You know, I know that's stating the obvious, I know that but I think it's really important that we don't ignore the things that we need to do better and where we need to be more effective, but we just recognise some of the fantastic stuff that we actually do as well, and then work out how we can do more of the fantastic stuff, while still applying our efforts to do the things that we need to do better. So I think that and I don't think I'm alone in that. I think that's something that I hear a lot of my colleagues talking about. And it's really important, I think, that our people, in all the years I've worked in the NHS, which is what, 32 years now, I've never met many people, to be honest with you, who don't want to come to work in the morning and do a good job right. And I think there's something about us staying really connected to our teams who are, you know, providing some response to some really tough challenges. And did right through Covid. Before Covid, right through Covid, coming out of Covid, some different challenges, working flat out, trying to respond to those, the change in nature of patient needs and the changing environment that they're providing care in and trying to do the best they can.

Speaker3: [00:10:18] So there's more about now, I think trying to stay connected to make sure that we're trying to help our teams out. So we don't want them burnt out. We want them to be at their best to provide the best care for every single patient that walks through our doors. That's what we need. And I just think at the moment there's an opportunity, an opportunity for change. Now it's not this is not a political thing. This is just an opportunity. I think, that we have where there's an opportunity to set a direction and to talk about actually what we're trying to collectively do across the whole of the NHS. And that's, I think that's one of the biggest opportunities we have right now. We know the money is extraordinarily tight across all government departments. We know that. And we know there are still going to be things that are going to be tough to deliver. But I think having that collective buy-in about what those priorities are that we need to work on together is something I hope we can get the whole of the NHS, whatever kind of job you do in the NHS, but know your role in delivering that future, I think that's the biggest opportunity that we have.

Speaker1: [00:11:25] No, thank you for that. That's a very positive outlook for change. Let's talk about MFT. You came in April '23, an organisation that has itself gone through mergers and changes. Let's talk about this strategy that you've released, 24 to 29. Just very briefly, I'm going to dive in a couple of topics, particularly around data and technology and also genomics and research. But I wanted just to briefly, the genesis around the new strategy, because it's not an easy thing across such a large organisation to create a new strategy. You don't like taking on easy jobs, obviously.

Speaker3: [00:11:59] Look, we've had the benefit of MFT, you know, up until the point I took over, my predecessor was there for 21 years as the chief executive. Right. So we've benefited from longevity of the team in MFT. And we've also had, you know, we've had lots of different strategies. We've had a really good clinical service strategy for a number of years, which was born out of the merger between UHSM. So South Manchester, University Hospital South Manchester and what was the Central Manchester Foundation Trust. So that has done as well I think, in terms of developing our clinical services. But a lot of things have changed over the past years. So I think some of the challenges that we face in organisation are different to the ones that we've ever faced before. So some examples, we have mostly due to our response through Covid, which wasn't just peaks. It was a sustained period. And there were other parts of the country, you know, Birmingham, Leicester also similar positions where sustained periods where they had to stand down a lot of work to step up, a lot of critical care capacity because big organisations can do that, because the critical care facilities they had, you know, that knocked the organisation actually, and exactly the right thing to do.

Speaker3: [00:13:19] And we would do it again, I think we might learn from doing it again and work out how we can continue to sustain some elective services more effectively than perhaps we were able to at the time, but we had not been. I don't think we'd been used to actually dealing with some big challenges like that. We dealt with so many big challenges over the years, but we've had to adapt to work, actually. How are we going to tackle this? Because our patients need us to make the improvements, and our clinicians want us to make the improvements as well. So I think we're doing a good job on that. But there are some examples about the change in nature of how we work and what we need to do. The money has changed, you know, so the way that money flows into the NHS, you'll know, is different since the emergence of ICBs, and we've been used to doing well financially. As an organisation, you know, through all the different financial regimes, I think we've done well and we've had more money to put aside in terms of investments for certain things.

Speaker3: [00:14:17] And now, we have less money, but obviously we spend quite a bit a year and what we're trying to do is make sure we're as efficient and productive as we need to be, but we need to make sure that we have a plan so we can deliver our finances more sustainably going forward. So we thought actually, given the breadth of things, I was new into the organisation. It was an opportunity for me to generate a lot of conversations inside the organisation with our clinicians and teams, conversations with our Stakeholders outside and start to say, look, with the organisation being the size that it is at the minute, how do we create this wraparound strategy which talks about everything that we do. So it talks about the environment we operate in, some of the challenges we're wrestling with today, our strengths as an organisation, how do we maximise them, and some areas that we need to do more work on. So that's essentially how we've come up with the strategy, and that's what we've published. And we're working hard to deploy and deliver.

Speaker1: [00:15:13] Absolutely. Now let's zero in on one of the aspects. They're delivering high quality care. Of course that's a top priority for you. And I wanted to focus on technological transformation, the prospect of data. And there's so much you're doing. But I was really interested. At the end of the day, this is about patient outcomes always. And I wonder if you can walk me through because the hive, the electronic patient record, because that's been a national topic for a long time. And it's not just a matter of technology, it's a clinical transformation, isn't it? 

Speaker3: [00:15:47] It is. You know, sometimes people talk about EPRs and they want one and they need one, right? And of course. But it's more than just a system. It changes how we work and provide services. And the insight we have in terms of how those services are delivered to patients and actually the depending on the nature of the EPR itself, the way the system works with patients, you know, the transformation works for and with patients is different. So what it allowed us to do. Well, the organisation went live six months before I started, and I think it's fair to say that it was one of the safest deployments of an EPR. It was the largest deployment, one of the largest globally for the provider that we work with. As a single instance, given the scale, I think more recently there's been a single instance deployed in London between Guy's and Thomas's and King's. And I also think it's fair to say that each of the big deployments, there's been some learning taken into the next deployment. So it landed well without a doubt. Look, we've got 30,000 people using a new system. And you know, we had hundreds of different systems, literally hundreds and hundreds of systems that our colleagues were using in different parts and different systems that we were using. So we had to make sense of the data that we had centrally in order to report out, and then to make sense of it internally, to know that we're doing the things that we want and need to do for our patients. So it has taken a lid off that, and you've got enormous data set that we have for the work that we do from our front door right through to those patients that need very specialist care. It's great for research, great for the innovation data that we know we need for driving innovation. But importantly, it's important for the bedside care that our nurses, our therapists, our doctors provide to patients every single day.

Speaker1: [00:17:49] And in addition to that, using data is going to be fundamental. And I think you've made the conscious strategic choice to have that responsibility at executive and board level.

Speaker3: [00:18:01] Yeah, absolutely. So it's one thing having, you know, all the data we need to know what we're doing with it, right? And make sure that we're using it to drive many different opportunities that we have. And importantly, we're using it to provide the insight in terms of how impactful our care is to drive the outcomes that our patients and communities need which is not just about systems like, for instance, one of the things we're doing at the minute is we're just developing a data strategy to and that is working with all of our clinicians, working with our operational teams to look at whatever job they're doing, what information do they actually need rather than just getting, you know, giving information because that's what's available. It's starting to look..

Speaker1: [00:18:42] It's tailored, tailoring information.

Speaker3: [00:18:43] The data that's going to be necessary for the different types of roles, different tiers of leaders across the organisation and clinicians. So that's really powerful, I think. And, you know, a few organisations have gone down this route as well. But, you know, we've got to continually look at not just having a good data set. It's making the best use of it and having the effect that we need, and also using it to monitor the impact that, you know, some of the interventions we do, some of the treatments we provide and just how successful that is. So I'm really excited about that. I think I've not met a single person in the organization so far who is not excited about it, because it's not going to be fixed overnight, but it supports the transformation and care that we're all after delivering.

Speaker1: [00:19:25] And this is as you said, I think you've been on record as saying this is a 5 to 10-year legacy project, and I guess it does play a part in terms of productivity, because that's an important part of the long-term workforce plan and use of resources, which is a key strategic objective.

Speaker3: [00:19:40] Completely. And, I'm a great believer, right? We can't just, you know, use selective data to inform conversations that we have about, you know, this mantra, necessary mantra about being, you know, more productive, right. And you've got to give people the tools and the information. And then we have conversations together about what all of our roles in terms of driving, you know, better use of some of the resources that we have. That's how I think it should work. And I think we've got a bit more to do to make sure that some of our clinicians and some of our teams have got the right data to drive the improvements we want to see. It doesn't mean anyone's off the hook with it. You know, we're all on the hook trying to make sure we're driving better use of some of the facilities that we have, but we've got to make sure people have got the insight and the tools to do that. And that's part of my job and the team I have.

Speaker1: [00:20:30] And obviously, at the end of the day, this is about human beings using that data, having the data used for the benefit of patients. And just briefly wanted to touch on because it's often overlooked is the importance of making sure any data or AI or technology is inclusive. Because it's a very diverse community. 

Speaker3: [00:20:49] It is.

Speaker1: [00:20:49] You're serving, I think, Professor Habib Naqvi's work at the Race and Health Observatory. You'll be very familiar with it. So I think that's quite an important part of your evaluation and implementation. 

Speaker3: [00:21:00] Completely agree. Right. So if you look at, we host a number of NIHR services and centres in MFT. So we have both centres that coordinate activities and research across Greater Manchester, across the North West and in some cases the North. And the rigour now that goes through both the scientific advisory boards for, you know, we have the BMRC as well. The rigour that's applied now about equality, diversity, inclusion, and the effort that we go to, entirely appropriately, to make sure that we don't just have a data set and research insight about one part of the population, it has to be about all of it. There are 192 different languages spoken in our local area, and we have to find ways and we are doing we're finding really innovative ways because we know what's worked. Well, we, I don't know if you know, have done some great work over the years with targeted lung health checks, because we know we've had one of the worst outcomes regionally for people in our community, directly in our community served around, not limited to, but pockets of Greater Manchester where their health outcomes have been appalling because they've had late stage development presenting way too late for lung cancers.

Speaker3: [00:22:26] And we now have light trucks that go into the community to do targeted lung health checks, because in the communities that we know, we have the poorest outcomes and late presentations, fantastic results. It's now part of a program that's been going out across Greater Manchester and it's going out across the country. So we're using those kind of insights to think through how do we work with local communities, how do we make sure we've got researchers who are from those communities as well and talk to the communities. And I think it's fair to say there is some distrust about some types of research because of history and the way some research has been conducted in the past. So we want to make best use of all of that insight and build the confidence to show that we, of course, we need this a broader population to do our research, but it's safe to do. And why it's important for future generations from each of the communities that we serve.

Speaker1: [00:23:18] Now, thank you because I think that puts the technology into a very human, diverse context. One of your other priorities on the strategy I want to touch upon, and I think when you took up the post back in April '23, one of the things you were very proud of was to join, I think you called it, a unique clinical care provider with research and innovation at its heart, I think was the phrase that you used and just expand that for me, because precision medicine genomics, the MFT is renowned nationally for the services you provide. Just expand a little bit about that because there's been some really interesting. The National Institute of Health and Care Research, you've been doing some interesting work with them and been awarded, I think, a significant £3 million of investment. 

Speaker3: [00:24:01] Yeah. So we're very proud. Can I come back to the precision medicine genomics and the HRC in just in a minute. But talk to you about the reason why I say we're a unique service provider. So again, people talk often talk about our size and everything. Right. But we have it goes from whether we're working with our primary care colleagues or working with social care. You know, we've got two big. Well, one bigger than the other, obviously, because the nature of the population size. But we have local care organisations which essentially are health and care integrated teams working with primary care, working with our hospital teams, working with social care in all of its facets to look at how we're driving health. Better health. Better outcomes for our local populations. So we have that's what we have day to day working with our teams. We have big secondary care provision given the nature of our hospitals and the catchment we provide services for the million people. And then we also have the largest composition of specialist services that any other provider in the country. So what that does, it provides, you know, access pathways for patients locally as well as patients who are not so local but need to access them for a very super regional basis. When you put all of the nature of the services, we also provide children's mental health services. So not many people know that as well. So we provide a CAMH service for three boroughs. And not a lot of people recognise the breadth of different things that we do. So it's almost like it's a mini system in itself that we provide services for without primary care.

Speaker1: [00:25:31] And children's health is and the link with poverty has been highlighted by organisations such as the Centre for Mental Health. There's a huge societal problem.

Speaker3: [00:25:40] So then I'll come back to your point. Right. So genomics, precision medicine. So we're one of the organisations. There are a number of us across the country that are and I'd say, you know, respectable players in the continued emergence of genomic medicine, whether that's about making sure we've got the right tests to do the sequencing and then not just do the technical sequencing, but to think, well, okay, we've got this result and it's telling us, what does this mean? And what does it mean for the patient. What does it mean for potentially for their families? And what kind of treatment do we have? Do we have a treatment? And if we do have a treatment, then what kind of treatment can we deploy to those particular patients? And that's where, you know, with the research and innovation, you start to identify with clinicians and academics working together and actually some industry partners where you can start to think about how you can change the life course for individuals or the individuals in their family or with others who have those similar genetic traits.

Speaker3: [00:26:37] So some really amazing things going on because it allows you to tailor make some of the treatments that's going to prevent, you know, provide some new tests that are not laboratory based, you know, some point of care tests that can influence how you provide care. So, for instance, there was a treatment developed with industry, but with one of our clinicians, because for newborn babies having a particular type of antibiotic, there's for some patients, some babies who have this genetic trait, and if they had this particular type of antibiotic can cause hearing loss. But we developed a test that was deployed locally within the unit the baby was born and looked after, so that we could identify whether there was this genetic trait for this particular baby. And if there was, we would give them a different antibiotic if they had it, they would have a different antibiotic. And for those that didn't they would be fine to have it. So it's having that reassurance. So you obviously pick up small numbers because small numbers have the traits.

Speaker1: [00:27:39] But it has a national significance.

Speaker3: [00:27:40] The national significance, international significance. And for that particular patient, life changing because, you know, to be at that age and to, you know, to then to grow and develop and have a life, but with the difficulties with hearing loss. And then there's also, you know, from the health economic perspective, the health economic impact for every single patient that has hearing loss as well. So there are things like that. You know, this translation, it's translational, isn't it? What do you do? What kind of tests are available, what insight does it bring? And then what opportunities does it have to develop new things that's going to influence for that patient and their family. 

Speaker1: [00:28:17] And there's so many things you're doing and we can't cover them all unfortunately. But the other one that struck me, which I thought was really interesting, was some innovation around lung cancer screening. Is that right? I think that was it. 

Speaker3: [00:28:29] It was the targeted lung health checks I was talking about.

Speaker1: [00:28:31] And that's made a major difference. And tell us a little bit about the funding from the National Institute for Health and Care around the healthtech research centres because that's in emergency and urgent medicine. And you're one of the pioneers, I think, in that.

Speaker3: [00:28:46] Yeah. Well, we were delighted to be one of the organisations that spread across the country to be a healthtech research centre. So, in short, what does that do? First of all, we provide, it's joining up what each healthtech research centre does across the country so that everyone in the country can benefit from any findings, innovation that emerges through the centres. And what we aim to do is to be a gateway through which you can have industry partners, small medium enterprises, you know, businesses, startups coming with a product that there's some early evidence, product where we think it's going to have impact. And in our case, we're interested, our designation is for urgent and emergency care, whether that's emergency care and urgent care outside before hospital in the community to prevent the need to come into hospital or whilst they're in hospital as well. And it's looking for devices, it's looking for any kind of technological advancement that will support improvements to our patients, whether that's about support and prevention or supporting monitoring or some other type of intervention. So it's a very structured way of working with, you know, because you get some of these smaller businesses. And they don't have much money. They've got a short window. They've managed to get hold of some resource to support very critical period to work out whether that product is going to be viable or not.

Speaker1: [00:30:13] Which could potentially have a significant impact if they had the scale. 

Speaker3: [00:30:16] Exactly. And one of the difficulties that I think lots of small medium enterprises have, and some other bigger companies is that there are so many doors into the NHS and you never know which one is the right one. And sometimes those doors, when they open, can take an extraordinarily long period of time for that evaluation of the product, and sometimes those SMEs are running out of money at the same time. So as long as we provide some structure to what an evaluation looks like and some support, you know, to get through the regulatory processes, and at the same time, we're using that learning to be deployed across the whole country through this network of health tech research centres. I think that's a really exciting kind of development. So we're proud to be part of it, and hopefully we start to see some real innovations coming across the whole network. 

Speaker1: [00:31:00] Yeah, that's come on stream I think this year in 2024. So we'll have to get you back to give us some great success that you've done. So thank you for taking us through those two points around the data around the genomics. I wanted to end, if I may, because there's so much we could cover. But one of your key strategic priorities and one of your own personal, I think, comments when you took the post was the shared responsibility that you have to tackle health inequalities across the local population. I think something like 48, 49,000 people, children live in poverty in the local demography and generally speaking you've alluded to earlier, people do have generally shorter lives, although you've got quite a wide variety of outcomes across some of the most affluent, some of the least affluent. Talk us through about the health inequalities, working with local partnerships, some of the initiatives, because I think it's central in your whole strategy.

Speaker3: [00:31:52] It is. And, you know, one of the things when I came into Greater Manchester, a lot to talk about the devolution arrangements, which we, I know we haven't got time to go into. I was and I'm saying this from me coming in from doing this national role where I'd been doing quite a bit of work with systems, where they were looking at how plans were developed for addressing health inequalities, looking at how to improve population health. 

Speaker1: [00:32:19] That was central to the ICB, and the Health and Care Act.

Speaker3: [00:32:22] National thankfully, national policy and national expectation and some fantastic work going on in different parts of the country. But I have to say I was really taken aback positively in Greater Manchester, how it is such a core part of how Greater Manchester thinks, works, behaves and locally in the trust. The really, honestly some really amazing work going on. And it's not because people have said there's a policy that's come from the NHS, so we need to do it. It's because people know how important and how impactful, how necessary this work is. And it's not just started just recently. It's been going on for years. Now you might say to me, well, okay, well what are your outcomes like? Well, our outcomes have got to be better because it never finishes this, to address the health inequalities. But I think the starting point is making sure that people know that where the disparity is they understand what's driving it.

Speaker1: [00:33:18] The data that you're gathering. 

Speaker3: [00:33:19] They understand what's driving it. And then there's a plan to actually, you know, working with people to understand actually how we can make collectively make a difference. So, I mean, I'll give you a couple of examples of things that we're doing because, you know, whether it's about supporting, you know, citizens' health. So we have Citizens Advice Bureaus going in to some of our hospitals, working with patients, relatives can drop in, you know, because the child poverty issues are significant. Something like 47% of children in our population are living in poverty. Now, if you think of that early start, early start challenges that we have and the health impact for children in their early years.

Speaker1: [00:34:02] It's enormous.

Speaker3: [00:34:03] It's enormous. So we want to do what we can to support some families to have access to help to get some resources. We're doing some fantastic work, I think, although it's early starting, we've been doing some work with the Race Health Observatory on this for parts of our population who are pregnant, having babies, different communities, different challenges. But when we look at, you know, the 192 languages are referred to, when we look at the reading age of the letters that we send out, we look at and obviously it's more complicated if you haven't got English as your first language. They're all sent in English. And then we look at the, the way it's described and, you know, you look at it and you go, okay, I can understand that if you're a clinician or a leader who knows about that service. But if you don't, some of the language is...

Speaker1: [00:34:55] Bewildering.

Speaker3: [00:34:56] It's bewildering. Exactly. So what we've been doing is working with some communities, and we've been coming up with some information leaflets that actually don't have any. Or they have very limited text in but lots of illustrations.

Speaker1: [00:35:07] So it's visually explaining.

Speaker3: [00:35:08] Yeah. And the safety impact around that as well as people being more informed about the care they're going to get and also how they can be partners in the care. Just addresses some of those inequalities in terms of how you get the outcomes that each and every patient should deserve. So they're just a couple of points. I could go on forever on this because it is honestly... We have we have a public health doctor, right? We have a directly employed public health doctor working with us, doing a fantastic job coordinating some of the work we're doing inside and out with public health teams in the boroughs that we serve. And we're just about to recruit a public health doctor for dental health to work with our community teams in the LCO, the local care organisations, and also with our children's health services and out in the community because we know it goes with poverty. Dental health is a massive issue. You get that wrong, you could not just have bad teeth, but you can have really poor health, cardiovascular health for years to come. So we're trying to join together some of the expertise that we have as well.

Speaker1: [00:36:06] And one final point on that, if I may, you begin talking about scale. We talked about 30,000 workforce. Now tying it back to health inequalities. As we know the determinants of health are varied and they're socioeconomic, employment, housing, etc. I just want to touch upon the work that you're doing there as a local employer, as an anchor institution. I think the stats are in your local demography. Something like 19 out of 100 people are economically inactive. So there's a huge imperative to, as an employer to help people into employment, etc.. I just want to touch it briefly because I know you're really passionate about the NHS being a facilitator for people's economic advancement, which has health benefits.

Speaker3: [00:36:49] So there's a range of things we're doing actually. So if I give you a few. So we do work a lot with work with schools to make sure that we've got a future pipeline of people and that is going out not just to schools where they've got a high throughput of people going to do A-levels and then going to university. But for schools, all schools in our area, because we given the number of people we employ, what we're going to need to look like in ten, 20 years, we need to be trying to excite people about wanting to see a place for themselves, coming to be part of the NHS for the future, whatever type of role they want to do. So we have been doing quite a bit of work and engagement with local schools. We need to do more of it to make sure we've got this future pipeline. And it's seen as not just a job for a few people who have go to university and get a degree straight out of school. But for those that actually who are going to have a different career path, they're going to go for having a family first, but will live locally and want to develop a career later in life. And we need to provide opportunities for all for that. So we're doing work just in terms of general engagement with schools, universities to make sure there's a pipeline. We're also had some fantastic initiatives with our colleagues, the Prince's Trust. So we have some patients with learning disabilities that would have traditionally would not have been able to get access to certain roles.

Speaker3: [00:38:07] And we've been supporting small groups of individuals who've come in, and we've provided support for them to do the right type of roles for them, the roles that they're interested in, roles that they can make a fantastic contribution and do make a fantastic contribution to parts of our organisation. And we are looking at how we can scale that up. And we've been doing some really interesting work. I think it's interesting working with so I'll give you an example with one of our community diagnostic centres. So we have in Harpurhey, in North Manchester, real pocket of social deprivation. A really diverse community and, and also we've just placed this CDC, community diagnostic centre right in the community on the high street. We kind of tore up the rule book in terms of how we're recruiting. So we didn't just rely on NHS jobs, right? What we did was we started to talk to community leaders, people in the community about why we were putting the CDC in the centre of the community and why it was important. And we started to go to job centres and community centres to start to talk about the jobs that we had available. So we're very confident we've got the right people to do the jobs, and they have the skills to do the jobs that we've recruited to

Speaker1: [00:39:22] From the local community. 

Speaker3: [00:39:23] From the local community. But we've learnt an awful lot that many of the people that we've recruited would not have ever, they wouldn't have known about NHS jobs because they just, you know, why would you unless you knew you wanted to go work for the NHS?

Speaker1: [00:39:34] Specifically looking for it.

Speaker3: [00:39:35] Exactly. So we've managed to get people who are new entrants to the NHS, and they'd obviously heard of it and been having services provided from it, but they had never saw themselves being part of it. And we are looking at how quickly we can roll that out again in our communities, because it's helped with getting more community engagement. It helps with some of the trust issues I was describing. And also helps us to make sure we're better, we're catering for some of the specific challenges that some of our communities may have when they're trying to access services. And we're more informed about services not being accessible. It's about how we are making them accessible for certain communities. You know, people who need to go on the school run, you know, for their children and we send a letter out saying, you've got to come at 9:00 in the morning. You know, it's trying to understand… 

Speaker1: [00:40:30] The small things can make a big difference.

Speaker3: [00:40:31] The small things make a big difference to individuals and the organisation. So it's been great insight, but we need to do more of it. And I'm quite you know, can we try and scale up that learning as quickly as possible?

Speaker1: [00:40:41] Well, it's the first year of your new strategy. I hope you'll come back in the future to see how that's gone, because it sounds really exciting. And on that really positive note, Mark Cubbon, thank you very much for your time. 

Speaker3: [00:40:52] Thank you. Thank you for inviting me.

Speaker1: [00:40:53] No, it's been a pleasure. If you've enjoyed this episode of Voices of Care, please like, follow, or subscribe wherever you receive your podcasts. And if you want to learn more about how we're turning the dial on health and social care debate, please visit newcrosshealthcare.com/voicesofcare. In the meantime, I'm Suhail Mirza, thank you very much and look forward to seeing you on the next episode. 

Speaker2: [00:41:14] Voices of Care, the healthcare podcast.