Weeknote: 31 January to 4 February 2022

Strips of sunlight cast through a window cut across the herringbone pattern of an old wooden floor
A trip to the gorgeous Bowes Museum at Barnard Castle. Much to love there but my favourite thing is the floor

I don’t usually do my weeknotes as a march through the days, but it seems appropriate for this week, as a time of transition. This was the last week of working under the NHSX brand, before my directorate and I become part of the new NHS England Transformation Directorate.

Monday

We started the week in a pre-announcement holding pattern. Senior colleagues knew that an announcement was likely to come this week, but the timing and some details were uncertain.

Usually our Digital Urgent and Emergency Care (UEC) Monday stand-up is a relaxed chat about the weekend and easing into the week ahead. I felt bad about rushing it on to work talk, and then leaving dead on 15 minutes past because I needed to catch up urgently with an HR colleague to clarify something for the coming organisation changes. Behind every box on an organisation chart or row on a spreadsheet, there are people with careers, families, and hopes for the future – many of whom have faced personal challenges through the past 2 years of the pandemic. We need to care about every one of them, and consult them about changes that affect them directly.

I had a few one-to-ones with colleagues, and enjoyed an update to the NHSX senior leadership team from Dr Natasha Phillips, our Chief Nursing Information Officer, and colleagues working to make digital better for the nursing profession.

Tuesday

After the 111 senior management team with NHS England colleagues, I had a good catch-up with Lucy, the lead user researcher on NHS Pathways, then a meeting with Finance colleagues to clarify some things about our Digital Transformation directorate budgets for next financial year.

By midday, there was still no news of the impending organisation annoucement. I had promised my senior colleagues in the directorate that I’d keep them up to date, even when there was not much new to report. It had been 7 days since we first alerted them to the prospect of some changes, so I sent a short update saying “no news yet”.

Our Digital UEC assurance board was in the afternoon. As always, Jacqui, my deputy and clinical lead, chaired the board sensitively and shepherded the discussion so that we covered important decisions in a natural order, and heard what everyone had to say.

Later in the afternoon, Jacqui, Brin and I had an introductory meeting with Imogen, who is joining Digital UEC in a couple of weeks as Head of Product. We talked about some of the big challenges facing urgent and emergency care, and how Jacqui and Brin are working with their teams to bring clarity and pace to the complex world of digital strategy and delivery. I think we’re going to get on great as a leadership team.

Just after 6pm, I commuted from my home working desk to the sofa in the next room. At 6:30pm, the message came through: the organisation announcement would be out tomorrow, and we’d have a narrow window first thing to tell the affected teams, including mine, before an all staff email at 10am. Massive thanks to Yvonne, who rapidly set up a whole directorate meeting. We went for 9:15am, mindful of colleagues who had school or nursery drop-offs to do. Jacqui, Nayeema and I exchanged messages and I opened a Google Doc to write down a few bullet points we’d need to share. More messaging about the nuances of the changes, and ensuring we would all be able to get the message out so that colleagues didn’t find out first from an email.

Wednesday

An 8:30am senior leadership team call to confirm arrangements for the day.

My teams would be remaining in the joint unit of Department of Health and Social Care and NHS England, but with a different reporting line for me, and 2 deputy directors. I would also pick up a “dotted line” report to James, the executive director of Product Delivery in NHS Digital, which is to become NHS England’s CIO function. I shared my bullet points about the changes with James, to make sure we had both got the same message.

At 9:15, we got the Digital Transformation Directorate together to tell them about the changes. We talked about the purpose of these interim changes – to start bringing teams together where they already work closely – pending a bigger restructure to follow. We stressed that we are moving whole teams, not changing line management arrangements except for at senior levels, and no one’s terms, conditions, or employer will change. And at 10:03am, the email landed in all our mailboxes.

Looking at my calendar for the rest of Wednesday, I reallise I then had to do a fair amount of rapid context switching as “business as usual” meetings about Digital UEC were interleaved with team meetings to discuss reactions to the new organisation structure.

The next few months, while we’re in this interim organisational state, will be critical in moving on the strategy and policy for both UEC and digital transformation more widely. Patients and frontline staff wouldn’t thank us if we turned inwards and slackened the pace of recovery from the pandemic, or of reforming health and care digitally. My job now is to make sure we use the new structures to accelerate that change, and continue to put people at the heart of everything we do, rather than slowing back down again, or forgetting the people we’re here to serve.

My last meeting of the day was with a group of people who will hold us to account on that – the community of NHS Chief Information Officers convened by Sonia Patel, who becomes our system CIO. One of the plus points of the restructure is that I’m looking forward to working more closely with Sonia and her team.

Thursday

Another day of context switching, supporting people to make sense of the changes, and a bit of preparation for Friday’s focus: the retirement of the NHSX brand, which for the past 2.5 years has been driving forward the digital transformation of health and social care. We had an all staff event with Dr Tim Ferris, who heads up the new Transformation Directorate that we’re moving into, followed by an open session for NHSX colleagues to discuss what it means for us.

Friday

Digital UEC colleagues recently decided as a team to move our weekly retrospective from lunchtime on a Friday to 9:15am. We spent the first few minutes joking about whether we should just leave the calendar invite saying “lunchtime”. We used the retro as more open space for colleagues to talk about their hopes and fears for the integration of NHSX into the new Transformation Directorate. In our team we have people who have been with the NHS for their whole careers, some who are very new to it, and others like me who have done a few years in different NHS settings but also worked in other kinds of organisation. From all of them, I was struck by the strength of feeling for the open, inclusive culture that NHSX’s leaders have worked hard to create. This is especially important to the colleagues who for different reasons are most likely to have experienced discrimination in closed, hierarchical workplaces. When Matthew Gould’s blog post dropped just after that retro, I knew that everything Matthew said about the culture was true.

At 12:15 we got together for an NHSX brand retirement all staff event. We heard from a patient who talked about the impact of remote monitoring on his care, meaning he could get home from hospital sooner and safer. Senior leadership team members shared their highlights of our time working together under this banner, and we watched video messages from a few of our most powerful advocates. In my own contribution I mentioned NHSX’s commitment to user-centricity and patient involvement, including the brilliant patient and public voice board we have for digital UEC. I’ve worked in NHSX for less than 12 months, but feel like I’ve been a friend of the family since the beginning.

After a conversation with colleagues about some on-going interoperability standards work, I went for a short walk. Back at my desk I put on my headphones and broke out some sticky notes. As we move into a new way of working, I needed to rethink my own medium term objectives, to make sure I give my attention to the right things over the next few weeks and months. I’ve written those up into a set of notes that I will share with my immediate colleagues and my new line managers next week.

Postscript – I write these weeknotes for myself, and publish them as a discipline that means everything I write here I would say to any of my colleagues, or to patients and the public. When I got to the end of this week’s note, I realised that sometimes weeknotes are also a way of unbundling all that’s gone on in a busy week, and refocusing for the next. I’ll be back on Monday with a different email footer, 2 new managers, but the same brilliant teams, and work to do for patients, families, and frontline staff.

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