Mental health and the Ten-Year Health Plan: delivering on its bold ambitions

 Matthew Taylor

Hello and welcome to the latest edition of Health on the Line produced by Health Comms Plus on behalf of the NHS Confederation. 

Before I welcome our guests for today's discussion, a quick commercial break, if I may.

Many of us know that the landscape for integrated care boards is rapidly changing with new clusters of ICBs being put together as I speak. As I said in our last episode, the ICB is dead. Long live the ICB. 

We know there are many questions around how this new landscape will look and feel. So I want to encourage you to join us at our NHS Confederation ICS conference on the 26th of November in London, where we'll have all the answers to your questions. Just go to NHS conference website, to the events section to book your place. 

Now as part of our ongoing work on both influencing and now unpacking the implications of the government's ten-year plan for health, I want to discuss the impact of the plan on mental health. What does it say about mental health?

There are ambitious plans around 24/7 mental health neighbourhood pilots to bolster out-of-hospital services. There's a talk of wanting a more preventative approach to mental health, adding more mental health services to the NHS app, developing more dedicated mental health emergency departments or ‘MEDs’ as they will be called.

So it's a plan, not light on ambition, but as ever, it's all going to be about delivery and delivery, which has to start from where mental health services currently sit. 

So to talk about these issues, I couldn't have a better panel than the ones who are joining us for this Health on the line. 

So first we have Dr Ify Okocha, who's chief executive officer at Oxley NHS Foundation Trust. Then James Duncan, who's CEO of Cumbria, Northumberland and Tyne and Wear FT Trust, and our very own Rebecca Gray, director of our Mental Health Network. Ify, James, Rebecca, welcome to Health on the Line. 

I wonder if I can start by just getting a general view from each of you on the ten-year plan. Now you've digested it. Does it feel like the right plan for where the NHS needs to be over the next decade? If, I'll start with you. 

Ify Okocha

I think it does. I read it with a great degree of optimism and excitement. The vision is right, the content right, but of course it's going to be about the delivery, as you mentioned earlier.

Matthew Taylor

James? 

James Duncan

I would totally agree it's the right direction of travel, particularly I like the fact that we are talking about a ten-year plan and genuinely thinking of a ten-year plan. There is a lot in there that we've been talking about for a long time. It's a radical vision, the vision that we support as an organisation and fits in very much with where we want to go. So yes, a lot in it is good, but I'm sure a lot of the challenges will come out through the conversation.

Matthew Taylor

And Rebecca, I remember speaking to you a couple of months ago when various people had seen various drafts and the view then was that the mental health elements of the plan were pretty undercooked. Now a lot seems to have moved from that point. 

Rebecca Gray

Yeah, I mean, I was going to say exactly that. I think in the vast amount of speculation that we indulged in, or usefully or not usefully about what was in the plan for many months before its arrival, I think there was quite a lot of concern that mental health would be missing.

But not only is it present, but actually it's threaded through in quite useful ways, I think throughout almost every part of the plan. So I think actually as a sector we're more encouraged than we thought we potentially might be at this stage. 

Matthew Taylor

Great. Well, let's get into some of the kind of specifics and Ify, I want to start by asking you specifically about support for young people. 

Only this week, the Young Futures Foundation issued a report showing how mental health issues amongst young people are increasing. But as we all know, the waiting lists for children and young people are very long. Now, the plan says the NHS will embed support for children and young people's mental health in new young futures hubs. It'll roll out mental health support teams in schools. Do you think that if we put that together, that we can start to close that kind of demand capacity gap? 

Ify Okocha

Well, perhaps I could just help listeners, should they not know about the Young Futures Foundation research findings. They identified four key things out of a list of about ten that they believe have contributed the threefold increase in decline in mental health amongst young people, aged 14 to 24:

• reduction in children and youth services
• their worries about finances and affordability, housing in particular
• the impact of social media and smartphone
• and then their worsening sleep quality. 

And when you think about those and reflect on those, you'll see that those are not really necessarily things for the National Health Service. Those are things that society needs to grapple with. 

So my sense is that there's a lot more we all need to be doing as citizens, all hands on deck, families, society at large to help our young people. There's stuff that schools need to be doing, local authority, et cetera, and then there's some stuff that we, part of the National Health Service need to do.

I think that our effort to increase mental health support in schools is good. Broadly speaking, we're probably at 50 per cent of that and we need to achieve a hundred per cent in the next five years or so. But I think part of what we're trying to do, given the cost, because money is going to be a real issue in terms of how successful we are in delivering mental health support in all schools. But we want to then begin now to think about the ingredients that are necessary to achieve success. And given the sort of issues I've just mentioned that are contributing to a declining in mental health amongst young people, you can imagine that the issues will vary, depend on where you live or what part of England you're in.

And so we need to begin to think what are the ingredients in our provision in schools that will make a difference. And then stem is tide where we, intervene early; we identify, we intervene early and therefore not have the tsunami of young people needing mental health services from National Health Service at the rates at which we are seeing them come through.

Matthew Taylor

Well that's really interesting. James, and I'll just turn to you on this because obviously if you're a mental health leader, you look at those bits of the ten-year plan that are primarily about mental health, but there's a broader set of questions here about the whole agenda of social determinants, the kind of broader prevention picture with ICBs being scaled down, focusing on commissioning.

It leaves the question, well, where is that kind of broader thinking about social determinants of ill health going to come from? Because I absolutely agree with you Ify, in mental health, it's absolutely clear that a prevention strategy has got to go way beyond the National Health Service. We are going to have mayors on ICBs and some of these mayors are going to be leading prevention kind of innovators.

Are you concerned, James, that that broader kind of conversation about the social determinants of mental ill health, it might be lost? 

James Duncan

I'm actually not. I think we've got a real opportunity to focus much more on the social determinants of mental ill health. Not just the social determinants, but virtually everyone who is living with a mental health condition will be living with social issues, whether it be around work, whether it be around education, whether it be around loneliness, these things are just hand in glove. 

I actually think the main opportunity there is in neighbourhood health models, I think neighbourhoods and work out these much of the prevention work that is going to be actually meaningful will belong really a local authority boundary and within that neighbourhoods that work into that. So I think there is a real opportunity to get much more sophisticated around our understanding that population health and much more joined up around how we address the shortage of de determinants of ill health.

And one of the things I really think is fantastic in the ten-year plan is the focus on deprivation and looking at neighbourhood health and focusing, first of all in the most deprived areas because we all know that that deprivation is the most significant determinant of ill health, and we all know that pretty much across every health sector that 80 per cent of the activity is coming from the 20 per cent most deprived areas of our population.

I think that's really welcome. So I see this as a real opportunity. I don't see it as a step back at all. And sometimes as we look at population health and source determines on a very grand scale, well actually it gets down the granularity of what are we actually doing on the ground? 

Matthew Taylor

Rebecca, this question of, you know, I remember some time ago before you started with us that I persuaded Claire Murdoch to come and speak to our ICP forum because I said to her, you know, you really need to engage your people who want to think about mental health in the in the round, not just about it in the NHS.

ICPs are going, there's new structures of working. James is quite confident that we will engage with this. How about you? 

Rebecca Gray

Oh, absolutely. I think the concept of neighbourhood health is an articulation of something that's completely central to what a lot of mental health organisations are already providing.

You know, you well know Matthew, that we have NHS mental health trusts and combined community and mental health trust in membership who are really well placed to think about this, but partly because they were already working partnership closely with the VCSE. Large organisations like Turning Point or Every Turn that James' trust works closely with, who are more holistic wraparound support that engages people's whole lives. 

And so this is, yes, it's partly about preventative approaches, but it's all about the social and clinical support being completely connected. I think that the increased opportunity, absolutely this interrelationship with the VCSC and mental health NHS provision is part and parcel of what most trusts do to some degree, and can go much further and much faster.

I think probably the area where they still need to work harder is on the neighbourhood concept, is work with primary care because we know that some of those interfaces are still not as strong as they could be. We know that a lot of the feedback from primary care colleagues is that people are coming into waiting rooms presenting with a physical problem but actually it's a range of social and mental health problems that are fundamental to what's going on. And actually trying to serve that population well and trying to join up the dots between our different services has got to be what we're aiming. 

James Duncan

This is the real opportunity of the mental health 24/7 neighbourhood model.

There's a real huge opportunity here to think very, very differently and to break down some of those barriers and actually primary care absolutely engaged in this because, I think wouldn't take a real weight off primary case and GP shoulders as well by taking this forward. 

Matthew Taylor

One of, obviously one of the other big themes in the plan is around digital. And Ify I just wanted to ask you about this, because I know that you've done a lot in your trust thinking about how the workforce can use digital approaches. Obviously Wes Streeting hopes that digital can enable a real shift in productivity in mental health, do you share his confidence?

Ify Okocha

I partly do. I mean the whole productivity debate in mental health is one that we cannot put to bed. I think there's some hard evidence, especially with our acute colleagues, that productivity has dropped the degree to which it has dropped. You know, there's a lot of debate about it, but it certainly has dropped since the pandemic.

Whereas in mental health, you've got to remember that we've had mental health investment standards money to develop more teams, and that has required an increase in our workforce. And so you’ve got to bear that in mind. And even with that increase in workforce, there are other issues that are specific to my mind in mental health.

One of course is data metrics. You know, where nowhere as good as what you have with acute providers who are able to measure everything. And then there are issues about how we outcome, the work we do. To then attribute it to the impact of the work that the clinicians have done. We've had quite a number of really newly qualified people, and while we're supporting them to become more skilled that has an impact on the ability to deliver to the level we would like. And in mental health, everything we do is about people, right? We have no machines or equipment to deliver and therefore you need to think about what an individual does versus what an individual does via group, what an individual does in terms of supervising a bunch of people to do their work.

And so I think that the first starting point for us has got to be our ability to record an outcome, what we do. And until we do that and do that consistently, we won't be able to measure this whole thing about productivity as is often talked about. 

I personally prefer to talk about the evidence of time that people spend providing care. That's the language we use in my organisation. And so we would often think about what are the things that get in the way of you having more time to care. And so we are piloting ambient voice recognition because creations tell us I spend an hour with someone, I then spend another 45 minutes writing up the notes. Whereas if we can use AVT, then clearly you wouldn't need 45 minutes to write up the notes. And then we have a number for that digital things we've put in place to enable clinicians to spend more time with patient to the electronic prescribing, for example, which makes it a lot easier.

So I think that we will get there, but I cannot confidently say the degree to which this would happen because as you know, every single thing that we're trying to do takes time and effort and given the wide array of things we need to do, it really depends on which ones you want to focus your energy on, because unless you do that, you just wouldn't be able to run as fast as you can in any particular area.

Matthew Taylor

James, one of the things clearly the plan is trying to do is to encourage more people to use digital channels to access services and indeed digital kind of forms of care. There's been quite a lot of innovation in the mental health sector in this space and I think in recognition that it's not that digital is just a cheaper way of doing things, but actually it can often be a better way of doing things for patients.

What’s your perspective on the digital possibilities? 

James Duncan

Just before I answer that, which I will answer, just building on what Ify said there. We talk a lot about productivity, don't we? But I always have a simple view of what productivity means, and it's the value generated over the resources that you put in.

We've got lots of information about the resources and the inputs, and particularly mental health, we really struggle to say, what's the value generated, what's the outcomes? Do we see people improving? Do we see people getting better? And that's where we've got to focus our efforts because we've got to get a better understanding of the value we're generating or else productivity just becomes working harder and doing more things and a lot of those things are actually counterproductive. So just something that we just need to put a market down there.

In terms of the opportunities of digital, you're probably aware of a book that was a famous book from introduction of information technology in the States, the productivity. Paradox of technology, which actually talks about how, as it was introduced in the states, productivity went down. And I think that's probably where we are. We've introduced digital technology, but a lot of that is just replication of paper systems. And we've got to sort of rethink the whole approach to digital technology. 

So where do I see the big opportunities? I see two big opportunities. One is around better understanding of population health. We have a huge amount of information about the population that we serve, and we use it really poorly. You know, international companies are trying to get hold of that data, so that's a real opportunity for us to say, how do we get a better understanding of our population health and how do we use AI to better understand it?

The other big opportunity, I think, is in shifting the power from organisations to people. Now, the plan talks, as you've said, Matthew, it talks about the NHS app and taking control of their own health and wellbeing. And ultimately we should be setting a path to say we talk about all the issues of information governments and how we share information. Ultimately, information should be owned by an individual and not owned by organizations. And I think the direction of travel that we need to take. 

I think the other thing in all of that is though we need to just make sure that the digital offer is one of our offers and not the whole of our offer, and particularly as we're starting on this journey because there is such a risk of digital exclusion. There is such a risk, particularly in the people and populations that we support, making sure that digital is part of our offers and for those people who can engage with the digital platform, let's make it a really good platform, but let's make sure that there is a wider offer for those people who can’t.

Rebecca Gray

Matthew, can I just come in on the digital put? 

Matthew Taylor

Of course, Rebecca. 

Rebecca Gray

There is some really exciting stuff kind of further up ahead and I'm really interested to know what the innovator hubs that are talked about in the ten-year plan mean and what that will deliver. There's a great promise around the kind of technologies that sit alongside clinical teams and aid in diagnosis and treatment.

I think there's probably quite a lot of potential around wearable technologies. There's some interesting work around wearables and prediction of relapse in severe mental illness and technology that will work alongside biomarkers for things like bipolar disorder. Interesting work to develop platforms that would allow people with relatively severe actually mental health challenges, stay sitting within a kind of lower level of support for longer in terms of able to monitor their conditions.

So we always moan that mental health has had like much more limited research funding as it has over many decades, but that there's been a bit of a shift from welcoming the IHR and the MRC in recent years, and I think we'll see some of that coming through.

The app, that’s an interesting one. There's something in the plan about the interlink straight through talking therapies, and that's important. You know, the big expansion talking therapies will not be possible without a significant amount of digital facilitation of the systems and also some degree of delivery. I think there's also the ability of the app to support the linking through to community resources. 

And this question of how do you connect the support that people might find beyond healthcare in the community is a really interesting one to think through. And also the kind of bringing back of the health app store. That's interesting. We know that people may benefit from some CBT based self-help apps. We've just got to make sure that  they are as evidence-based as possible. Always the case with app technology, it can be challenging, but there's some promise there for maybe a little bit further upstream. 

Ify Okocha

May I just contribute a couple of things, if I may.  So, I wanted to also say that there are many places today, many organisations, trusts, in particular, that already have health patient engagement portals.

We've got one where if you come into our service, you have access to it. Many organisations do. And what we then need to try and do is how we push information to users of services and they also push information to us and we can use that as a way of guiding them to resources that are out there in the community. 

The real bit that we now need to do is make sure that each of these portals developed by many organisations all link through the NHS app. So the single point of accessing them will be the NHS app, or else if you receive care from three or four organisations, you'll have to have three or four of these.

And then the other thing, which I know that James and people around where he's already doing is set in London where develop things that were developing their website to host approved self-help guides, because there are lots and lots of things out there, app stores, et cetera. But it's about how we get a panel of experts to review them and consider the ones that are really relevant and important, and we can then kite map those for people to access. 

So there's quite a lot going on, in addition, of course, to what Rebecca said, which is in the five to ten-year period from now. 

Matthew Taylor

Great. Well, thank you all for that. Let's turn to another theme. You've already talked about it a bit, which is this care closer to home.

So obviously, and as you know, Rebecca and I never tire of telling people, the mental health sector's been on this journey successfully for, and radically, for decades. 

Rebecca, what do you hear from other members around this kind of 24/7 model and people's hopes for it and what the kind of key success factors will be?

Rebecca Gray

So I think it's good to recognise that the 24/7 model essentially captures ingredients that do exist in what's called the Community Mental Health Services Framework, which I think there's general consensus, the principles of which around in terms of adults’ severe mental illness, there's consensus around that actually implementation of that and the transformation that was hoped would sit alongside that hasn't necessarily been as consistent as I think people would hope. 

It does mirror an awful lot of what already happens in lots of different trusts in different places, and I'm not undermining any way its potential – I wasquite close in my last role to the development of the plans for the 24/7 model in Lewisham.

But it also is inspired by places like Navigo, which is a community interest company that provides mental health services in North Lincolnshire that have taken this much more joined up holistic social and health model for some time. 

So I think it shows promise. I think there is a challenge in the plan, which is unsurprising, in terms of we know, we say this as the Confed a lot, that the lack of capital funding is going to create challenges if we are very reliant on new spaces to deliver some of this change. We're going to have to both be allowed within the NHS  I think, organisations allowed to free up their own spaces and land and use receipts from those disposals to create new spaces and also think imaginably across sectors, local authority, NHS, voluntary sector, about how new spaces are created. Both things like 24/7 pilots, also the neighbourhood health centres that will be more broad. 

So I think there is promise there, but we know what the key ingredients are and it's really about how do you make models like that work in different spaces, in different communities, in the way that really works for populations.

The other thing that I was going to tag onto this, because I think there's lots of things that are, are promising in the ten-year plan, our members talk about, the neighbourhood digital. The other thing that I've not mentioned I think is important is the promise of modern service frameworks. And Ify and James will have strong recollection of national service frameworks that were develop for, we may all not have same views of this, but I think there is some potential here because I think that while all people in the NHS will say that they want to make sure that they can design according to the needs and driven by and with their local communities, and that there will always be variation on what that looks like on the ground, I also hear quite a lot from leaders that they also think there should be more consistency to some extent in terms of what patients can expect from a care pathway, what that should look like, making sure it's genuinely evidence-based. And I think the modern service frameworks, we're not sure yet whether there'll be a mental health strategy or implementation plan, or whether this is all just about the modern service frameworks, yet, we're still waiting to find out more. But I think there is some real potential for having a consensus around what does good care look like that integrates some of the other elements of the plan, like the assertive outreach. 

Matthew Taylor

Let me pick up on that point and to come to you Ify because one of the key challenges and questions, opportunities around the ten-year panel is around the kind of local operating model and your ICB has really moved very quickly on that to announce who's going to be playing that kind of integrator function at a place level.

And you are going to be, Oxy is going to be part of that. This is intended, along with other things in the plan, just to make sure that we, we look at things in a more systemic way and that we address the issue of failure demand in acute hospitals. Now, part of that, for example, is rollout of mental health emergency departments. Obviously, there's going to be a different way of funding the UEC pathway.

 So I know it's a big question Ify, but when you, in terms of your place, in terms of your system, in terms of the partners working in a more collaborative way around issues like mental health and emergency care, how confident are you that we could shift through the gears and work in a better way?

Ify Okocha

I'm quite confident about that, you know, and so, just to go back a few steps. You talked about the fact that mental health specifically has been working in communities for decades. That is so, a lot of people we look after will look after in the community, tiny percentage ever come into our beds, that's always been the case.

I like the idea of the national service frameworks that helped us decades ago to develop our services and I think now that we also need to be thinking about some kind of framework to help us as we develop the neighbourhoods arrangement. 

You've picked up on the fact that we’re going to play a role as an integrator in Bexley. We've had an arrangement with the council for the last seven or eight years. We've been working very closely, we supervise local authority staff, they supervise our staff in our teams, et cetera. We work really well with the voluntary and care sector, we work particularly well with general practitioners in the area, and so I think that we're really quite ready to take on the next stage of things.

The other points to make, we’re not one of the pilot sites for the 24/7. We also, certainly not in my part of south-east London, we don't have the mental health emergency department. Both we've got other things. We have our community mental health hubs where we see 600 referrals a month that is staffed by voluntary care sector, local authority, NHS and other organisations where we provide support to people who pitch up with a range of issues.

You know, be it housing, be it benefits, whatever else it may be, and we try and support them. So we're already doing that. In out-of-hours, we have recovery houses where when people pitch up in ED and they don't need to be in hospital, but they're in crisis, we take them to a recovery house. They spend a week or ten days in the recovery house provided and serviced by voluntary and care sector, not NHS.

So we've got bits of things that we're bringing together to enable us to redefine and to improve the provision going forward. Even though I've talked about framework for neighbourhoods, I think it's important to realise that one has to tailor it to the needs of the local area, and that's what we're doing.

In some other parts, they'll have different issues that they need to contend with. I feel particularly pleased that when people pitch up in ED today as an outcome measure for us that only 13 per cent of people who pitch up in ED ever end up in hospital. The rest, we address their needs differently, and the majority of people who pitch up are not known to us.

Matthew Taylor

So Rebecca, to end with you on this, this question, you know, as you and I have discussed, there are so many ways in which mental health has been ahead of the rest of the service in, in digital, in engaging the community in voluntary sector in terms of care closer to home. There is a real opportunity within the ten-year plan that plays in system level for mental health to play a strong integrating role, a neighbourhood role, a system role.

Working with members, how do you think we can best support our members to grasp this opportunity? 

Rebecca Gray

I think what our members are asking for is support on some of the key areas where they know there is much work to be done, but also that there is a case to be made really clearly. So, it will not surprise you Matthew, if I talk about share of spend.

We know, recent data shows that share spent on mental health is about 8.7 per cent, it's slightly down on, on where we'd hope we'd be. Everybody in the system, I think, recognises that's too low. That can be true at the same time as all the points that Ify and James have made around the potential to improve productivity and to spend what we better. A much cited piece of data recently, Matthew, you and I have both talked about this, from the East Birmingham Integrated care teams demonstrated that if people in communities are support in the right way, you can reduce expenditure on all sorts of areas of healthcare, whether it's GP time, A and E attendances, but you do need to invest more in mental health support. 

And I think we need to tell that story, and that will only be supported in part by us really getting to grips with the metrics, with the data, with understanding cost and value and the value we get from our input. So there is a picture there around to challenge the system, but also a story to be told.

And also a narrative. I think members are crying out for the narrative around mental health to be given the nuance and complexity that it sometimes misses. So Jim Mackey, when he came to speak at our Mental Health Network conference in April, said that he felt he'd been guilty of something, which is very common in parts of the healthcare system, which is seeing mental health, mental illness, just as one thing, and not totally recognising the complexity of need and services. And I hear a lot of members saying that it's brilliant that we are focused on meeting more need upstream, talking therapies, engagement with schools, but we can't neglect the needs of those with severe mental illness and those with learning disability in that focus, and recognise those two things are not always connected.

But I think the plan does speak to some of this, and I think this plan does illustrate a growing recognition of the place of mental health and the interconnection between some of the government ambitions about wider health, the economy work, and where mental health sits. 

So there's a lot to do. Our members want us to do more convening, whether it's around development of new tariffs and productivity and what's going on with performance data at the moment, which is creating some challenges, but they're also looking for support on making sure that we tell that really clear narrative about the role of mental health services in both providing that really excellent specialist care that so many provide, but also playing into that wider model that drives care and support in a more holistic way, upstream and hopefully prevents mental illness. 

Matthew Taylor

Well, look, it's been a fascinating conversation. We've only scraped the surface of so many issues. Ify and James, we're going to have to get you back on again very soon. Thank you and Rebecca also for joining me on Health on the Line. 

Well, thank you so much to my guests, Ify, James and Rebecca for sharing your thoughts with us today. And as I say, do keep an eye on our website where we'll be posting lots of opportunities for members to get involved in discussions around how we work to make this plan a reality.

That just leaves me to introduce our leader in six interviewee, which this time is Tom Gurney, director of strategic communication and engagement for Hampshire and Isle of Wight ICB and co-chair of the Confed’s ICB comms forum. He spoke a few days ago to my colleague Sarah Miller. 

Sarah Miller

Now, Tom, what would you say is the kind of most pressing issue for you right now? What's your biggest challenge? 

Tom Gurney

I think the most pressing issue for me and probably other communications professionals out there, particularly within ICBs and probably NHS England I'll guess, is this parallel discourse that we have around the ten-year plan with our internal and external audiences. 

So externally, the ten-year plan, this is a great vehicle for change. It sets the strategic direction for the NHS. It's got ideas and innovation and new models of care that will address people's real-life issues today and give them hope that improvement and progress is going to be made. So that's all really positive. It's really important we promote and frame it in that way. 

However, it's slightly different from an internal audience point of view, because at the moment, many people I'm sure recognise, that the reform means that a lot of staff, particularly in ICBs and NHS England, it's an unsettling time, they're not quite sure what their futures are, and it means it's more difficult for them to fully engage in that sort of long-term vision and hope, if you like.But of course, it's really important that they are engaged in it because they are the very people that have to help deliver it. 

So it's about finding the balance between setting out a positive picture of the future, if you like, but not being tone deaf to how people are feeling at the moment. Which is a challenge, but obviously that's what we're here to do, isn't it?

Sarah Miller

What is the area of improvement or innovation in your area of work that you are particularly proud of or excited by? Or something you're really pleased that you and your team have achieved. 

Tom Gurney

I think there's a lot of things I'm proud of. We had this big consultation, formal public consultation that we did last year around new hospital, which was seen as best practice at the time. Really, really proud of how we've built in people's voice and their views in terms of shaping some of the decisions that we've made around that. 

But I think what I'm most excited about is how do we make that better? How do we, not just consultation, but how do we make public engagement and bring public voice much more into the work we do?

And I think the part of the reform, and I talked about just now around, it's difficult and it's a challenging time, but obviously there's loads of opportunity as well to do things differently. And one of the big things for me is that opportunity to really bring public voice, and notice I said public voice and not just patient voice, but public voice much more into the NHS and how we work, I think with the new models of care and neighbourhood health providers, there is a real opportunity to do it differently. And also ICBs becoming much more strategic commissioning. 

And so that is something I'm really quite excited about because it's something I think we do a lot of work in the NHS just to try to get voice in what we do, but I think if we can be really honest with ourselves, we could do a lot more.

Sarah Miller

Now, obviously you have a very busy job, but when you do get a bit of time to yourself, what do you do outside of work? 

Tom Gurney

Well, actually I've got another full-time job and that is being a dad of four small children, 12, ten, seven, and four. So you say I've got a busy job, well, I've got another really busy job and I think most working parents will say the same, I'm sure.

But obviously kids, absolutely fantastic, brilliant kids. So rewarding. Bring joy to your life, keep your grounded, perspective, et cetera. But I'm not going to lie, I mean, it's tough. It is really difficult trying to juggle work-life balance and just the spinning plates that you have to deal with. 

And I think, I think we probably don't talk about it enough. My reflection is at the moment, you know, with social media, probably people expect you to live that Instagram life and be perfect. You can have it all. But the reality is actually it's pretty chaotic when you've got four kids and you've got to embrace the chaos, accept that, and do the best you do.

So I really enjoy it and I try not to compare it and be a bit kind to yourself really? Because you can't, you can't do everything, can you? 

Sarah Miller

No, absolutely. I can relate to that one, a hundred per cent.

If you were NHS king for the day, what's the one thing or one reform you would love to introduce? What one thing would you love to change? 

Tom Gurney

I think the last thing the NHS needs right now is more reform. I think we're crying out for some stability now. Obviously, reform, innovation, ideas, change is needed. My own reflection of in NHS years, over 15 years now, it can be stifling if you're not given enough time to embed and actually see some of the improvements through. And it feels like just when you are getting somewhere, things change again. 

So I think with the ten-year plan, I'm hoping there will be an a period of stability to actually make some of the innovation and reform work. 

So I think if I was king for the day of the NHS, I would just give it a bit of time. 

Space to breathe because  you can strangle the NHS a little bit with too much change.

Sarah Miller

In terms of sort of leaders that you look up to and you think that's the kind of leader I would like to be. Is there someone that you have in mind? It could be a health service leader or just somebody, a politician or a leader in another sphere that you think that's a great example of a leader.

Tom Gurney

So, I've been lucky to work with a few really good chief executives. There was Adam Dole in Sussex, I think's a fantastic leader and our current chief exec, Maggie McKay. I think two very different styles, different ways of leading, but I think just being a chief exec of any NHS organisation really, really difficult.

But what I would say is when I actually think of leadership in the NHS, I do not think of the classic chief exec or director, director of that, I actually think of my mom and the reason I say that's because she was a nurse for 40 years and when I was a teenager, actually my weekend job was being a housekeeper at our local hospital.

So while my friends were working in McDonald's, et cetera, I was serving the dinners at East Surrey Hospital and I was often on the ward where my mom was a sister and just seeing her and other nurses, so it's not just her because it's just incredible to see calm under pressure, making decisions, working in extremely difficult situations and then also obviously doing it with real compassion and putting the person and patient and their families at the centre of it. 

When I think of NS leadership, that is what I think, and that is why I work in the NHS, and that is really what inspired me. 

Sarah Miller

That's lovely. And given what you just said about busy family life, would you have time for the odd film TV series or podcast, or are you going to tell me that you mainly watch Bluey?

Yeah, mainly Bluey and you picked to be perfectly, honestly. 

But no, I think when I get a chance to watch TV, this is an opportunity for me to be a highbrow, isn't it, and prove how sophisticated my tastes are. But no, actually I actually like a bit of light-heartedness to relax. I like comedy. I watch a lot of sitcoms, et cetera. Some good, some not so good.

But I think something I watched really recently, which is probably my all-time favourite, and I watched the reruns recently, is The Thick of It. I don't think you can beat it. I just love it. And of course, as a comms director, how can you not like Malcolm Tucker, which by the way, I bear no resemblance whatsoever. Just make that clear. 

Sarah Miller

That's brilliant. Lovely. Well, Tom, thanks very much for joining us for Leader in Six. 

Outro

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