Weeknote: 14 to 18 November 2022

A laminated paper sign that reads
A highlight of the week: opening of the new user research lab in NHS Digital’s Leeds hub

What was hard?

A full-on week as we had an important internally driven deadline on our operating model in the new NHS England. There was a lot of work to gather information, collate it, and present it in a way that is meaningful for colleagues who know little about what our teams do. This has been going on for weeks now, and is certainly taking its toll on the people involved.

I feel responsible for some of the pressure myself because I am one of the people pushing to make this process as valuable as possible in setting us up for a new way of working. That sometimes means going about things in a different way than people expect, or have been used to in the past. I believe the approach we’re taking is the right one, but I know it’s not always the easiest.

The stress this process is putting on colleagues is compounded because we haven’t been able to find the time to plan and set out the process to them in advance. I’ve been on the other side of this before – when trying to get through a process but never really understanding what it looks like from end-to-end, or when we will reach the finish line. The risk is that diligent people who don’t understand the approach then put in extra work trying to second guess what might be asked for next, only to find that’s not quite what we need from them.

As one of Myron’s maxims goes:

The process you use to get to the future is the future you get.

What did I enjoy?

Despite all the above, the substance of the work for our directorate is coming together, and – within constraints – I believe it’s going to lead to an operating model our people will want to be part of. A lot of the work this week built up to checkpoints with a couple of our senior leaders, and both of them were complimentary and encouraging about the work. That makes a difference, and I hope I can transmit that to the teams I am working with.

Amid all this, it would be easy to forget the people we’re here for: our users, be they patients or frontline health and care workers. As in the photo at the top of this post, I spent a couple of days in the NHS Digital Leeds hub, partly to join my exec director in some important meetings, but also so I could see the long-awaited user research lab which opened this week on the ground floor. It’s going to make such a difference for our teams to bring members of the public in to test our products in this well-designed facility. I hope it leads to more in-person user research, and more teams getting their 2 hours every 6 weeks. Senior leaders are also showing their commitment to the importance of user research, including NHS Digital CEO, Simon, who cut the ribbon to open the lab. I hope I’ll be in the observation room soon, perhaps observing some exciting work that Lucy, the lead user researcher on NHS Pathways, told me about at the lab opening. I was peripherally involved in getting the lab set up when I looked after design and user research at NHS Digital. The hard work has been done by Rochelle (see her write-up about the lab here) and her community of user researcher and user research ops people. I enjoyed meeting some of them face-to-face again for the first time since March 2020. The lab is also a credit to supportive estates and tech services colleagues who really listened to the UR profession’s needs in speccing out the space and the kit.

What did I learn?

Spending time with former colleagues at NHS Digital, some of whom I hadn’t seen in person since March 2020, helped me understand how the different parts of our new merged organisation are all on separate journeys before we converge. I’m lucky to have a foot in both camps, having moved from NHS Digital to NHS England, initially as part of NHSX, about 18 months ago. Some of the fears NHS Digital colleagues have now about the merger sounded very similar to the ones that I and my colleagues had when the NHSX brand was retired back in January.

A lot of mistrust has grown up between people who are ultimately trying to do the same things, as a result of the way organisational boundaries were drawn, and incentives were set up in the previous system. I get frustrated (and probably need to control my frustration better) when I hear so much talk of “us and them” because it’s not long now until there’ll only be an “us”. If we let the old patterns of behaviour continue we’ll never unlock the potential of the amazing talent we have in all the merger organisations, including Health Education England, which completes the trio.

Identities matter. In the other merger I’m involved in, as a non-executive director at Leeds & Yorkshire Housing Association, we’re joining together with York Housing Association but taking on a brand new name: 54North Homes. I’m sure others will have worked through the pros and cons, but for the task I’m facing in the NHS merger, it would have been healthier if NHS Digital, NHS England and HEE had come together with a new identity, rather than keeping the title of one of the legacy organisations. That is going to make it harder for people from the other organisations to really feel like the equal partners that digital and workforce need to be. We’ll all get there in the end though.

What did I experiment with?

I enjoyed my couple of days working in the Leeds hub, and by the end of the week had decided I should spend more time there. Unfortunately office connectivity problems on Friday afternoon made for a frustrating end of the week, with Teams and phone calls being disrupted. I’d really been looking forward to some quality conversations with my team members.

What do I need to take care of?

We still have work to do to fully define the “to be” structures on which staff will be consulted in the New Year, and there are still some important decisions to be made. As a leader of a merged team, I need to ensure that the overall vision for the changes are well-understood, while at the same time helping people who come from very different perspectives to create a new way of working together in a different organisational context.

While continuing to support the overall operating model for our product directorate, I intend to get more involved again in my own portfolio of digital urgent and emergency care. I’m looking forward to a visit to North West Ambulance next week.

I’m fortunate enough to have brilliant colleagues who have kept things moving in the portfolio while I’ve been focused on the operating model work. That means I can now focus on a few things that we really need to get right:

  • seeing the overall urgent and emergency care strategy widely shared with everyone working on digital
  • clarifying how our digital teams work together with colleagues in policy and operations, who will also see changes in the new organisation
  • overseeing a joint business planning process for my team with policy and operations, so that in 2023-24, we’re funded to work together to a single shared set of outcomes
  • ensuring the new processes for finance, commercial, people, and assurance support our new way of working

I’ll be flexible on how we get there but stubborn about the principle, which was set out right at the start of the merger process, that we’re ending commissioning between one national organisation and another, and creating a partnership in which digital professionals use all their skills in the service of the most important priorities for the NHS and social care.

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