Speaker1: [00:00:00] Hello, I'm Suhail Mirza and welcome to this episode in Voices of Care. My guest today is Salma Yasmeen, CEO of Sheffield Health and Social Care NHS Foundation Trust.

Speaker3: [00:00:11] Voices of Care, the healthcare podcast. 

Speaker1: [00:00:16] Welcome, Salma to Voices of Care.

Speaker2: [00:00:18] Delighted to be here.

Speaker1: [00:00:19] Well, we're delighted to welcome you here. It's quite a big mouthful right, NHS Foundation Trust.

Speaker2: [00:00:23] It is, SHSC, you can shorten it.

Speaker1: [00:00:26] Okay, okay I'll do my best on that now. I wanted to cover quite a lot of things today with you. Obviously the focus on mental health being paramount, but I wonder if you could just paint a picture for us in terms of the trust's work. I think your vision around your clinical and social care vision is to improve, of course, the wellbeing of your population, but you cover a variety of services across. Is it 40 sites across the city?

Speaker2: [00:00:51] So SHSC Sheffield Health and Social Care Trust serves a population of about 600,000 people in Sheffield, delivering comprehensive mental health and learning disability services and some specialist services that actually span across South Yorkshire. So across a much larger footprint, we've got about 2700 staff that we directly employ, and then we also work with partners in the voluntary and community sector and commission and some posts there, which they host on our behalf. SHSC as a trust has been through a challenging time over the recent years, as many of you will know, and moving from turnaround, it's been on a really strong improvement journey and we're continuing that improvement journey. And at the heart of that improvement journey is our clinical and social care strategy, which really is about developing an approach which is trauma-informed. It really is about recognising the strengths that every service user will have when they access services and really harnessing those and delivering personalised care. Now, 3 or 4 years on in that journey, are we there? And, you know, the strategy was written until 2025. We're absolutely not. 

Speaker2: [00:02:09] We've got so much more work to do. And the other aspect is that actually we work in partnership with our partners in Sheffield, which feels really important, particularly given the importance of place and population health. And we work as part of the South Yorkshire Integrated Care System, and we work with other providers of mental health and disability services as part of a provider collaborative. They're all really important because they help us to think about how we can address the needs of our population and the population across South Yorkshire to level up mental health services. I guess it's important to think about Sheffield as a vibrant city. Most people will know it as a, you know, a big university city. But also I think it's important to hold on to the fact that while we've got some of the most affluent neighbourhoods in Sheffield, we also have some of the poorest and most underserved neighbourhoods. And that stark inequality between one end of the city and the other is also something that we as a trust are absolutely needing to pay attention to.

Speaker1: [00:03:17] Now, I look forward to delving into the health inequalities piece, and just to touch a little bit on the services. Some are secure, some are short-term interventions. Longer term, it's a broad range, from talking therapies to more clinical settings.

Speaker2: [00:03:31] Yeah. So we've got comprehensive community services. And we've spent a significant amount of time recently investing time with our primary care partners to develop an enhanced integrated mental health offer in primary care, so that one, we can stop people needing to come into secondary care when they're perhaps more ill or their needs are more complex so that they get early support and it's much more joined up. And that has felt really important. And I think the future of mental health care is about continuing to build on that and investing in that integrated offer with social care, with the voluntary and community sector and primary care being at the heart of that offer. And we then have core inpatient mental health services, which as a trust has been on an improvement journey we've really had to invest in because historically, this trust had a very strong focus on community services. And so we've been developing more therapeutic environments in our inpatient services. Most of the people that are in our inpatient services are usually detained under the Mental Health Act, which gives you some indication of the complexity and level of need that people have by the time they get into an inpatient unit. So the bulk of our services are in the community, supporting people in their neighbourhoods, in their communities and in their own homes. We also have specialist teams like the specialist forensic community team, that supports people that have been through the forensic pathway, about helping them to reconnect back into their communities and to perhaps access employment opportunities and find a different path. And we have specialist services that support people with autism and ADHD. Another area that nationally, we've seen a huge rising level of need and one that we will need to think differently about if we are to meet the level of need that's there in our communities.

Speaker1: [00:05:29] No, it's a very comprehensive system that you're covering. And I hate to remind you, I think it's been 30 years, 25 years, your journey in healthcare. You obviously took over the helm at the trust as CEO back in July 23rd. But just to touch upon, I think you've worked in the charity sector, but mental health has been a strand throughout the work that you've done.

Speaker2: [00:05:51] Yes, it has. And yeah, you're right. So three decades. Wow. But it's been an incredible journey. And, I mean, I feel enormously privileged to have had a really varied and diverse career in the NHS. I started as a nurse, trained as a mental health nurse. I'm still a proud registered mental health nurse. I think that's incredibly important in terms of, you know, bringing that clinical lens to the work that I do in my leadership roles. But I've had the opportunity to work on the front line in inpatient services, in community services and, and also manage teams in mental health services. But I guess in 2002, I think it was I took what now looking back at it feels like quite a brave and bold step and left the comfort of the NHS.

Speaker1: [00:06:40] And went abroad.

Speaker2: [00:06:41] Well, no, no. At that point I went to work in the voluntary sector.

Speaker1: [00:06:43] Oh, right. Yes, yes.

Speaker2: [00:06:44] Yeah. So that was really a pilot project where we were testing out community development approaches in the area of mental health, the relationships between ethnically diverse communities and public services were really at their lowest. And there was a huge amount of bridge building. There was a huge amount of working deep into communities to build trust. And I think that all of that work feels very relevant even today to many of the issues that we're facing. And that became a registered charity that's continued to serve the population for many years beyond that. Following that, did two whole system change programs. End-of-life care in Tower Hamlets and delivering race equality in Bradford. And then went back into my passion around mental health, at South London and Maudsley Mental Health Trust, working in older adult services and leading services there. Then I, you know, not like I'd gone far enough from Yorkshire coming to London, decided to go to the Middle East. And that's where I spent six and a half years at King Fahad Medical City, which is a hospital. Well, a medical city made up of eight hospitals and centres. 

Speaker1: [00:07:54] It's a whole system.

Speaker2: [00:07:55] Absolutely.

Speaker1: [00:07:56] You were really focused on giving leadership of the nursing provision.

Speaker2: [00:07:59] That's right. So director of nursing and transformation and the latter part of that worked with the chief nurse, Jane, and the chief exec at the time to develop a Change Institute, which was really focused, again, on supporting people through transformation and change, recognising that we're asking a lot of people to deliver their day job and to continue to transform and change.

Speaker1: [00:08:22] While bringing all of that leadership, I think, to mental health. I just want to take a quick look at the national picture. You've alluded to it. The King's Speech earlier this year in July talked about reducing waiting lists, etc., as you would expect, but it made a very, very clear commitment on behalf of the new government to increase provision for mental health services for young people and to place mental health on an equal footing and focus as physical health. I guess that's an imperative from the facts on the ground because it's a huge issue.

Speaker2: [00:08:51] Absolutely. And, you know, we have seen a rising need around mental health, particularly in our communities. This is pre-pandemic and we've obviously seen it, you know, exacerbated post-pandemic. And what we have to do is continue to work and to, I think, invest in good mental health care for people with serious and chronic, enduring mental health issues. That's not just about providing core mental health services. That also has to be about recovery-focused pathways. And we have seen investment in mental health services over the last decade. So we've seen the development of perinatal mental health services. We've seen the investment into primary care mental health workers. But despite that, I think that we need to continue to reform mental health services and we need to invest in them. There are hidden weights in mental health that are not acknowledged in the same way that they might be if you were waiting for a hip operation or, you know, a knee operation. So ADHD, autism. We've seen a huge rise in those services. And actually mental health services alone cannot deliver what people need. For many people who have ADHD medication, having a diagnosis, having secondary and specialist support will make a difference to their life, a significant difference. But for many people with autism, actually we need to work within our communities to develop much more neurodiverse sensitive environments and systems and processes.

Speaker1: [00:10:27] And I think we've seen some recognition. I think the appointment of the first-ever national medical director for mental health and neurodiversity learning disabilities, I wanted to touch upon. I mean, there's been policy in place back from building the right support plans back in 2015. Diving into your priorities, you talked about your vision 24/25 priorities. One of them is to transform the services you provide, mental health and learning disabilities. You've been very busy. There's so many, so much we could cover. But there are a couple of key points you want to bring to mind. I think you've had secured some funding in July for some provisions and units of quality improvement.

Speaker2: [00:11:04] So just staying with the theme of learning disabilities, I think. I mean, as a trust, we have stopped providing inpatient care and really shifted care into the community, recognising that actually the support that people with learning disabilities need is to live a fuller life and to have the right support wrapped around them at times of increased need. And some of that medication helps and some of it doesn't. It's about other needs. We're working with providers across South Yorkshire, to look at really implementing and embedding Stomp. So stopping the overmedication of service users, which feels incredibly important if we want to support people with learning disabilities to live a fuller life. And the other aspect that's really important is the whole inclusion agenda in 2024. We've still got much more work to do to make sure that people with learning disabilities get full access, equal access to universal healthcare, which is why there's been a really strong focus nationally on making sure that health checks are carried out. And annually we're thinking about the physical health as well as the mental health and emotional health of the people that are living with learning disabilities. Lots more that we need to do across our places to make sure that people have the opportunity to work to access educational opportunities, independent living, and as well as the right care and the right support for their physical, mental health and social care.

Speaker1: [00:12:30] And you talked about the whole system approach. Now, we've had a couple of years since the statutory provision of integrated care systems. So can you just talk a bit broader about that? Because I think you've made it very important about some of the partners in the voluntary sector. And dare I say, social care is also an incredibly important partner to the trust and across the region.

Speaker2: [00:12:50] Yeah, absolutely. I think integrated care systems are still finding their feet. You know, it's been a huge change to the way in which we work. We've gone from competition to collaboration. Collaboration is much, much harder. You will know that, but yet it's the only way that we will solve some of our biggest issues. So when I arrived in this trust, for example, I found that 30% of our inpatient beds had people in them that were clinically fit to be discharged. That's significant when there's huge pressure and demand on that urgent and emergency crisis pathway in mental health care. The only way that we've been able to unlock that and unblock that is to deepen our relationship, and shared ambition with the local authority to make sure that we're thinking about the people there and getting them to the right place, which will enable their recovery and help them to live a fuller life, because they're not going to do that on an acute ward. Socia care is critical if we're going to address many of the issues that we've got, which is about good housing, supporting people to live well in their communities and to prevent them needing secondary and specialist mental health services.

Speaker2: [00:14:02] And unfortunately, you know, there's been a real lack of absence of focus on social care for over a decade. And I think that many of the challenges we face are a direct result of that. So that's really important. The other bit I would want to draw out is integrated care systems and collaboration with other providers. And in my previous role where I was at South West Yorkshire Partnership Foundation Trust as the director of Strategy and Change, we worked in Barnsley with our primary care providers and our community services and mental health services and social care to think about how we can join up care, and that really was about putting the person at the centre, you know, stopping all these unnecessary handoffs between services.

Speaker1: [00:14:45] It's very disjointed.

Speaker2: [00:14:46] Waiting for ages for referrals to go through, really thinking about that proactive care and reducing the amount of time somebody has to tell their story. So I think there's the agenda around integration. I think we can deliver that if we work together as providers. And I think that the environment and the conditions that integrated care systems can set through provider collaboration, I think is the way to do that and move forward.

Speaker1: [00:15:14] Hopefully, we'll see that and mental health front and centre of the current review that's being undertaken with hopefully they say, a new ten-year plan for the NHS. I would.

Speaker2: [00:15:26] I would hope so and I would hope that there's a real focus on prevention. And while I've talked about mental health services and specialists and secondary, I also know that the only way to address, you know, parity of esteem in mental health is to make sure that we've got equal investment in prevention. So not overmedicalising people's issues, really thinking about what it is that helps people stay well. And it is hope, meaning and purpose. It's having something meaningful to do, somewhere safe to live, and good relationships. You know, they're at the core of what any of us, all of us need to live a good life.

Speaker1: [00:16:01] And just to touch down on that theme of good relationships and draw on one of your other priorities and parts of your vision, which of course, is healthcare. The NHS is quintessentially a lot of digital innovation, but it's quintessentially a human endeavour. And one of your key goals is to make the trust a great place to work. And I just wanted to touch upon that because there's shortages in the workforce, lots of pressures, of course, post-Covid restrictions. In terms of the support you give, inclusivity and mental health. You've touched upon your own workforce. I know that's a high priority and personal passion of yours.

Speaker2: [00:16:34] Yeah. So I totally agree, Suhail. You know, healthcare or you know, health and care is about people. People, people, people. And I really believe that if you invest in your workforce and in your people, they will deliver outstanding care and services. Most people that I know, and that I meet every day in my work and have done over the last three decades, they come to work to make a difference in people's lives. And one of the things that I do when we welcome people to the trust, one of the first questions I ask them is what makes you get up every single day and come to work? And most people will say to be part of a team to make a difference. And of course, for some people, they'll say it's also the remuneration, which absolutely matters as well. And as a trust that's been through a challenging period on an improvement journey, one of the key things that we're trying to do is create a sense of belonging and connectedness across the organisation, to break down the silos and the barriers that are there, and to skill people up. And we're also starting to think about targeted approaches with different groups of the workforce. So there's probably about four big areas that we've invested in. One is really helping us all to reconnect to a shared purpose. And that's through a real focus on work that we're doing with our partners. The desire cord around values into behaviours. You know, how do we show up for each other? How do we relate to each other? How do we communicate? How do you work together to deliver good care? How do we make sure that everyone counts? There are values, but how do we bring that to life? How do we embed that? What does it mean? And the second bit really for us has been investing in leadership capability at every level.

Speaker2: [00:18:18] I'm really clear that leadership happens at every level in the organisation. But you need to support people and develop them. So we're developing, we've got a leadership program that we're putting large numbers of cohorts through. And we'll continue that. And we're also developing and investing in in a good management program, which is about how do you lead inclusive teams. You know, how do you do good budget management.

Speaker1: [00:18:43] Compassionately.

Speaker2: [00:18:44] Yeah, absolutely. Because most people are promoted because they're good clinicians. And actually, you know, your first management job is really hard. I remember that it's really painful. And then the other bit that we're doing is really investing in our networks. You know, making sure that there's spaces in the organisation where staff can come together to talk about their concerns, their issues, actually what's positive, what's making a difference, and to help us ensure that we're developing an inclusive organisation. So working together in partnership with our networks. And then the final bit I'll say is really investing in that improvement, change capability and capacity, feels really important. So we've during this last couple of years, a huge amount of investment in QI and continuous improvement. We've got some brilliant leadership in the organisation around that. But really what we want to do is embed that culture and make it the way that we do things. This absolutely aligns to the work that NHSE have done around NHS impact. And I think that as a framework is very much what we're trying to embed in the organisation.

Speaker1: [00:19:45] Yeah, and as you say, leadership at all levels. The messenger of you brought that out very powerfully. 

Speaker2: [00:19:49] I suppose the other point I would want to say is that one of the key pieces of work that we've done over this last year is to really understand inequalities in our workforce. So, you know, really serious that we think of ourselves as anchor institutions in our communities. And what we understand is that the staff that have the highest level of sickness in our organisation, and we are an outlier. We've got large numbers of staff that have got sickness and absence, and we're trying to address that. But to really understand it, we needed to understand who that group were. And they are the staff that are perhaps in the lowest paid jobs, and they live in the most underserved neighbourhoods because we've mapped it across into their neighbourhoods. We know that we've got to have a different approach to support these people and our colleagues to stay well and to stay in work. And that's something that we'll be focusing on over the next 18 months as well.

Speaker1: [00:20:38] Now, I'm very keen to pick that up with you, because I think that's a bigger lesson nationally that we can pick up. One final thing about the workforce. You've talked about providing leadership and skills and I think training has played a really important part. Apprenticeship. The trust is used to support nursing and you've got relationships with local universities in terms of the medical cohort.

Speaker2: [00:20:58] So, you know, it's another area that I'm really ambitious over the next couple of years that we really think about ourselves, you know, as a, as a good training institution. We are working with universities, we host the trainees, medical trainees for the whole of South Yorkshire. And I personally meet with them with my medical director regularly to have a conversation about their role, their experience and how they're finding that right across South Yorkshire. But certainly in my trust and what some of the opportunities are for them to get involved in leadership opportunities from the start and of course, investing in nursing and diverse nursing workforce that we've got. We've also got staff that have left their home countries to come here. So we're paying real attention to how we develop that workforce, and don't leave them behind. And I think that that's going to be critical. But I think beyond that, you know, hospitals, healthcare is about all sorts of other roles, including people like our colleagues that work in estates. They feel very left behind, actually. And I'm really keen that we think about how do we support them to develop and recognise their roles and their contribution. Of course, digital teams are becoming increasingly important for us. They are. We're implementing an EPR system. You know, we're ambitious about our digital journey going forward. We have to be if we're going to be fit for the future. And I think all of these teams are incredibly important for us to be thinking about long-term what do they need to do and what are the core skill sets that staff across all these teams need that will ensure that we're fit for the future?

Speaker1: [00:22:35] And I think the bigger picture and thank you for that. I think the bigger picture, as you said here earlier, if we set this into context, the long-term workforce plan back in June 2023, envisages a huge increase in the numbers employed across the NHS. That's going to require making the NHS a place of attraction to work in and also offering its role, as you said earlier, an anchor institution and I want to touch on that because health inequalities is a high priority in all policy pronouncements. You talked about it earlier, Salma. I want to talk about the Pathways to Work Commission that you were involved in Barnsley, and what we can draw from that, because I think that goes to the heart of how we tackle health inequalities. Can you tell us a little bit about that? Because I think you were one of the commissioners with obviously it was chaired by the Right Honourable Alan Milburn.

Speaker2: [00:23:31] So I mean, enormous privilege to have been involved in a commission which was led by the Right Honourable Alan Milburn in Barnsley, a place that I spent six years working in and with colleagues. And, you know, it's a real credit to the leader of the council, who over the last couple of years really had been thinking about, you know, to make to achieve the goals of Barnsley 2030. How do you support people that are out of work or economically inactive? Horrible term, but let's just use it for the moment.

Speaker1: [00:24:05] So that's people. Sorry to interrupt. That's people who are out of work but not looking for work.

Speaker2: [00:24:10] Yes.

Speaker1: [00:24:10] And it's the numbers from what I saw. Alan Milburn, in his foreword to the report, which was published in July this year, talked about that number had grown from 6.2 to 6.9 million. So it's one of the most distinctive pieces of research into that subject.

Speaker2: [00:24:25] Absolutely. And you know, the importance of this piece of work is that actually it heard from a whole range of stakeholders. We heard from local people that themselves are described as economically inactive. Most of them want to work. And we surveyed people right across South Yorkshire, 75% of those people that we surveyed were out of work because of ill health. So that's the relationship. And I think that what I learned through this was that, you know, ill health and people being economically inactive, the two issues are inextricably linked, and we can't ignore that.

Speaker1: [00:25:01] And I think Alan Milburn made the point that this is a big debate. Why are people economically inactive? Is it perverse incentives under the welfare system? Is it societal alienation? But the report made it very clear. Like you said, ill health is the main driver. And yet policy up to now I think he said it's been directed at the wrong target.

Speaker2: [00:25:26] Sanctions, and, you know, there'll always need to be some level of consequence for that minority. But I think what this report really lays bare is that link between ill health and, you know, people being out of work. And also I think it does challenge some of the assumptions that we've worked with for many years. Most people want to work. What they need is tailored, bespoke support for employers to take a preventative lens to staff that are ill, and not for the machinery to kick in and for people to be out of work. But actually, how do you keep your workforce well? And when people are unwell, how do you provide them with really good occupational health services? And we haven't invested in occupational health services or wellbeing services or support in the way that we should. And going forward we are absolutely going to have to as employers. I think the other bit is creating pathways into employment that are targeted, that make sure that we understand in each of our places. So taking a whole place approach, where is it, where, where do people live and who do they trust? How do we create those pathways into employment and people like us in the health and care sector, you know, big employers, private employers stepping into that space and working together. So I think the report calls for reform. But a place based approach allowing some innovation and ownership at local level through combined authorities, through integrated care systems working together for their population. And I think that's at the heart of what integrated care systems have been set up to do. That is one solid way of addressing health inequalities. And I also think it will help with developing a much more inclusive approach to our economy and making sure that we're able to address our workforce shortages.

Speaker1: [00:27:13] It's remarkable because I think some of the stats I remember from the report, I may have got it wrong in my head. In Barnsley alone, a £10 million investment programme pilot programme to do exactly what you said would get £70 million of economic benefit. And I think if we increased that nationally, the participation rate, I think £23 billion added to the economy and it made a number of recommendations, as you said, devolved power, improve the figures regarding economic inactivity. But it did make a very clear set of recommendations around ICBs roles and the role of the healthcare system generally to partner with employers, etc. Are you beginning to see, I mean, it's very early, but are you beginning to see that and how will that actually manifest? Is there a willingness to actually do that?

Speaker2: [00:27:59] I mean, through the commission, you know, we did have commissioners that were working, I was working alongside, that were from the private sector, from industry, from the public, right, across the public sector. And it's a challenge. Workforce challenge is something that we are all experiencing. And I think all of us want to make a difference to the populations within which we work and reside. And I think there is a real commitment. I think people are looking for ways to work together to address this issue and to have a collective impact. And I think the time is now. I think the report's incredibly helpful in setting out a set of recommendations nationally, regionally, but also for us to take forward in our places. In Sheffield, we're working together with our partners. I know Barnsley, they're looking to work together to really take forward the pilot, which has already been prototyped. I mean, that's the thing about Barnsley, they haven't waited for the report to be published and then to plan what they're going to do. We were thinking about that right at the outset. I think there'll be lessons and insights that we can draw on from that and perhaps replicate regionally and nationally to some degree. But I think what we're talking about is freedom to innovate in place with partners, to make a real difference for your population and citizens.

Speaker1: [00:29:14] And really, it's the negative way of looking at the report is that there's these millions of people that are inactive. But the positive way to say there's a huge labour pool. 

Speaker2: [00:29:23] Untapped resource.

Speaker1: [00:29:24] Under-resourced there. And for communities that perhaps have been left behind, have an opportunity to have because the social effects are catastrophic of being left behind. So there's real hope there.

Speaker2: [00:29:34] Absolutely. I mean, I have to say, having been part of that programme of work over a year, I felt real hope. I thought there was a genuine appreciation of a complex issue of partners willing to work together, to collaborate, to really put the people at the centre and to try a different approach to one that's been flogged for the last ten years and perhaps not had the outcomes that we would have hoped for.

Speaker1: [00:29:59] And one final question. Just looking ahead over the next 12 months or so, your priorities are obviously they're set out in your strategy, but a lot of positivity about what you're doing at the trust, particularly around transforming mental health services for everyone in an inclusive way.

Speaker2: [00:30:13] Yeah, so really excited that over the next 12 months, we continue to transform community mental health services, and particularly starting to think about older adult services and how we really maximise the benefits of place working and system working to support people to age well and live well in older age, rather than just focusing on illness and really committed to thinking. Once we've landed the EPR, which is the big thing, Thinking about our digital journey and how we could create digitally enabled services and learning from trusts that have done this already and that are further ahead feels really important. And the third part is actually what can we do through collaboration to support people to develop pathways into employment? What can we do internally to really support our staff, to stay well and in work feels incredibly important at the same time.

Speaker1: [00:31:06] Well, on that hopeful vision. Salma Yasmeen, thank you very much for your time and coming to join us on Voices of Care.

Speaker2: [00:31:12] It's been a pleasure, thank you.

Speaker1: [00:31:13] Pleasure's ours. If you've enjoyed this episode of Voices of Care, please like, follow, and subscribe wherever you receive your podcasts. And if you want to find out more about how we're turning the dial on the health and social care debate, please visit newcrosshealthcare.com/voices of care. In the meantime, I'm Suhail Mirza. Thank you very much and look forward to seeing you on the next episode.

Speaker3: [00:31:33] Voices of Care, the healthcare podcast.