Talk Health and Care

Filter the content using the categories listed on the left of the page to find blogs, news, updates for challenges and how your ideas are being put into action.


I’m Rupy, a doctor specialising in General Practice and Emergency Medicine, and I am a firm believer in the power of healthy, delicious food to prevent illness. I am also founder of ‘Culinary Medicine UK’ a non-profit organisation that teaches doctors and health professionals the foundations of nutrition and how to cook.

I know from my experience working in hospital medicine that it’s really difficult to eat well during a busy shift, particularly overnight, when we wouldn’t usually be eating anything at all. But I also know how important healthy eating is.

I learnt how to manage my own medical condition through diving into the research and seeing how my nutrition and lifestyle affected my condition. But too often, when at work in hospital, I see colleagues reaching for a chocolate bar from the vending machine or eating large packs of crisps on a nightshift because of lack of options.

If we, as medical professionals, can’t look after ourselves nutritionally, how can we expect our patients to? And how can we look after our patients to the best of our abilities, when we are facing the problems caused by a poor diet – fatigue, burnout, poor concentration?

The Hospital Food Review panel invited me to talk at one of their panel meetings about my experiences and opinions. Now they want to hear from you.

This is our chance to tell the Government what would help us to look after ourselves at work. What helps or hinders you from eating healthily? Is it having more time for meal breaks? Does choice put you off going to the canteen – or maybe even the quality of food you find there? What would your ideal meals look like in a hospital of the future? 

You can find out more about Dr Rupy on his website at and on his social media below.





Images courtesy of Faith Mason.

Good, nutritious food is vital for our hospital staff to be able to feel and perform at their best.

I was delighted to be asked by the Health Secretary, Matt Hancock, to lead an independent review into hospital food – that is, food served and sold in hospitals to patients, visitors and staff. I have worked in the NHS for 26 years and am now the Facilities Manager at Taunton and Somerset NHS Foundation Trust.

As a former Chair of the Hospital Caterers Association, I am passionate about providing great quality food in our hospitals for the whole hospital community.

I want to raise the bar for hospital catering. I have visited Trusts across the country, from Bath to Newcastle, and seen examples of fantastic catering services. But some hospitals face bigger challenges than others.

My aim is for the Review to spread the good practice that is already happening, and to set out recommendations to support all hospitals to raise their game. I am currently visiting as many sites as I can across the country, meeting catering teams, dietitians and clinical staff and tasting the food for myself.

But I can’t go everywhere. That’s why I am launching this Talk Health and Care Challenge – to hear from you, the people on the ground who make our NHS great.

Whether you are a doctor, nurse, receptionist, porter, cleaner or manager, I want to hear from you. It is vital that we look after NHS staff wellbeing, and this includes making sure you have access to great-tasting, nutritious food.

Without taking good care of our staff, we can’t hope to take good care of our patients.

Your input will inform the recommendations that I make to the Government. Make sure you have your say.

This blog has been authored by Dr Navina Evans, Chief Executive of East London NHS FT and NHS People Plan workstream chair (Making the NHS the best place to work).

There is still time to tell us - what will make the NHS the best place to work for you! 

Thank you to everyone who has already taken the time to join in the discussions and share ideas on how we can make the NHS the best place to work. Since the challenge went live on 7 October 2019 we have received a wealth of tangible ideas on what we could do to improve the working experiences for our NHS people. These range from:

  • On site free car parking and gym facilities
  • Normalising flexible working
  • Improving IT systems

We want to hear from all #OurNHSPeople. Tell us about the great things we should all be doing more of and the things that need to change. The feedback so far has highlighted that more of the same is not enough, and that the NHS workplace should be more collaborative, inclusive, agile, flexible and multidisciplinary.

Focusing on our people, their working environments, career development and ways of working isn’t a ‘nice to have’. We know it results in better health experiences and outcomes for both patients and the communities we serve. It is critical to the success of the NHS.

We know the NHS is full of committed, inspiring people with incredible skills and together we can make the NHS the best place to work. We can only develop the right solutions if we properly listen to our people and act on what they say.

Your feedback is hugely important to us and will help us to shape our thinking and priorities.

There is still time to tell us what you want and need.  Let’s take action – together - now.


Speak Up Month is coming to a close, and I believe that there has been even more activity this year than last. Freedom to Speak Up Guardians have been finding innovative ways to raise awareness and encourage workers to speak up to them. There have been events held, trees planted, cakes baked, pledges made, flags, ribbons and even a SpeakUpulance – yes, that is a Speak Up ambulance!

In the 2015 Freedom to Speak Up Review I recommended that every NHS employer should have a Freedom to Speak Up Guardian – a named person who is trusted by staff and by their leaders to listen, to advise and to facilitate getting the information to the right place to ensure that appropriate action is taken.

My recommendations were borne out of hearing evidence from NHS workers who had spoken up previously about patient safety and other concerns, but had suffered bullying or intimidation, or witnessed inaction when action was desperately needed. When this happened, they had nowhere to go for help and no-one to make sure their information was taken seriously.

The activities during Speak Up Month seek to raise awareness, not just of the Freedom to Speak Up Guardians, but of speaking up in general. Freedom to Speak Up Guardians send a message that workers can feel encouraged and safe to speak up – that it is the normal thing to do.

So, although you may be wondering what all the cakes and twitter hashtags have to do with speaking up, this month has been about making guardians and their work even more visible, so that no one can say they don’t know who to speak up to. The support from organisations to promote the guardian role that they fund and support also sends the message that they are listening organisations that want to act on what their workers have to speak up about.

Guardians bring matters to the attention of leaders so that something will be done. It is one thing to encourage workers to speak up, but that effort is meaningless unless they are heard, and action is taken on what they have said. That’s why it’s so important that concerns are investigated properly, with the right support on hand for staff, managers and others involved.

This month the National Guardian’s Office also published its Freedom to Speak Up Index which shows that organisations which support speaking up get better CQC ratings. This should encourage trust boards to focus on the benefits of encouraging an open culture and to appreciate the importance of the Freedom to Speak Up.

If workers feel listened to when they speak up and confident that their leaders will support them and embrace their issues as opportunities to learn and improve, then that will encourage them to speak up again.

Those who speak up are to be celebrated, they are an invaluable part of any organisation. Valued and engaged staff provide excellent care to their patients. If patient safety is our number one priority, we simply cannot afford to shoot the messenger. We need to focus on the issue, not the person raising it.

That’s why I want to take this opportunity to thank all those who have spoken up for all that you do to make the NHS an even better place for our workforce and for our patients. Speak Up Month may be coming to an end, but let’s make it Speak Up Month every month. Together we can make speaking up business as usual.


Speaking Up - how far we have come

Posted by Alison Bell 11 months ago

I’m Alison Bell, Freedom to Speak up Guardian for University Hospitals of Derby and Burton NHS Foundation Trust. I’m passionate about our NHS and really believe it’s one of England’s best institutions. However, I know that as with all big organisations sometimes things go wrong.

Having spent time on site as a Union rep between 2001 and 2007 at Mid Staffs I have personal experience of what happens where staff don’t feel safe to speak up and where their voices are not heard. There were some very dedicated staff working during that time and yet they were unable to deliver the care that was needed.

Having that personal experience meant I was very interested in becoming a Freedom to Speak up Guardian when the role was created. I was appointed to the role in January 2017 to Burton Hospitals NHS Foundation Trust and at that time was also asked to cover Derby Teaching Hospitals NHS Foundation Trust as the two Trusts were planning to merge.

I’m really proud that both Boards recognised the value of a supportive speak up culture throughout the merger process and chose to appoint a shared Guardian to help develop this. When I started as a Guardian the initiative was still very new and the main challenge was to spread the word – across two Trusts, covering five very different sites.

It was also really important to build effective and supportive relationships across the Trusts. I recall there was some trepidation when I started as to what Freedom to Speak up would mean – was I coming in to increase blame and look for faults? Building those relationships has been so important.

If my time at Mid Staffs taught me anything it’s that when we look to blame others it doesn’t end well. It leads to more cover ups, fear and stress for all involved. When I look back on those early days it’s amazing to see how far we have come.

The merger, as with any large organisational change, has caused challenges to our staff but all along we have tried to keep the focus on the benefits its bringing our patients. However, we are only human, so some staff still had issues they wanted to speak up about and the fact that we had already merged the guardian role has, I believe, reaped rewards.

When our staff have spoken up about issues linked to the merger I have known exactly where to take them, the supportive relationship is already there and at a more senior level the Board has been responsive to taking actions.

Since I started as a Guardian I have received 303 Speak up cases covering a huge range of issues, but every single one of them is important to the staff member who speaks up. I’m proud to say that some of these have had a real impact on changing the environment for staff and even more improving the care for our patients.

The largest number of cases have been related to bullying and harassment, unfortunately a common theme across most trusts. As a trust we are currently looking at how we can respond to these types of issues faster, with compassion and more effectively as formal cases are time consuming, can be stressful and don’t always have better outcomes than doing something more informally. Its certainly safe to say that no day is the same. I can be meeting someone off site at a local coffee shop one minute and then the next attending the Board meeting to deliver the Freedom to Speak up report.

I think one example that has stood out for me involved a nurse coming from a high profile clinical area to speak up about some concerns with patient care. This involved issues with medicines management, information governance, lack of appropriate equipment and the layout of the clinical area. After meeting with the nurse off site she agreed that she would come with me to meet a Nursing Director responsible for the area. She was nervous as she was due to move to a new area of work and worried in case this would impact on her move. It didn’t. The Director put her at her ease, listened to her concerns and agreed the next steps with us. Some of the concerns, particularly governing the medication were rectified immediately.

One concern was regarding the pathways for treating paediatric patients. A new pathway was designed to increase input from the paediatric nurses and this was implemented within three months. Some took much longer, like improving the layout of the area, but the whole department has now been updated resolving the visibility issues.

Throughout the process I was able to let her know what was happening and why some issues were taking longer to resolve. The nurse moved on to her new role and is now also a Speak up Champion due to the ‘fantastic support she received at a very scary time’. This is only one of many examples where I think staff having someone to come to they can trust is making a real difference.

As is clear by the numbers of staff who do speak up this is a busy role. I have 20 Speak up Champions from all five sites who support me with getting the message out there and are a great listening ear for others wanting to speak up. I know we could always do more, but there never seem to be enough hours in the day. I am privileged to do a stand-alone role as a guardian, so everything I do is dedicated to improving our speak up culture for staff and ultimately giving our patients the safest care we can.

In addition to being a guardian, I am proud to say I am also the Chair for the West Midlands Network of guardians. We are a brilliant network of guardians who support each other and we’re always on the phone sharing ideas or offering a listening ear. We are also like a hive mind – between us we have some amazing initiatives on increasing awareness and we are also good at sharing how we have resolved complex issues.

We meet as a network every quarter, so as chair I will organise this alongside my deputy. We always try to ensure our network meetings are a mixture of information-sharing and peer support. This can be an isolating role at times, so we all try our best to be there for each other.

Overall, I think this is a fantastic role which really is seeing some tangible benefits. It isn’t easy but who said changing culture was?

The NHS employs over 1.3 million people.  People who care for our communities -directly or indirectly - and look after us and our loved ones at times of need. Every one of our NHS colleagues deserves the best support we can offer to improve their everyday experience of working in the NHS.

 The evidence is clear; if our staff experience is good, outcomes improve. Satisfaction rates among patients and service users increases, patient mortality reduces, our organisations’ performance ratings go up, staff absence and turnover go down, and the NHS spends less on agency and bank staff.

In June 2019 we published the Interim NHS People Plan. The Plan places those who work for the NHS at the front and centre. It sets out our ambition to create healthy, inclusive and compassionate cultures; fulfilling careers supported by the best training and professional development; and to make sure everyone feels they have voice, control and influence in their role and their work environment.

We are already working with NHS colleagues across the country to tackle key issues such as staffing shortages, promoting positive workplace cultures, supporting diversity and inclusion, and enhancing health and wellbeing. Some of you may already be involved in this critical work and doing great things in many different parts of the NHS.

We have listened to what you have already shared but, given the size and breadth of our workforce, we would like to gather more of your views. That’s why we are asking you, our NHS people, to tell us directly and in your own words, how you think we can make the NHS the best place to work for you. 

Please join me and support my passion - our passion - to put our NHS people at the very centre of the NHS. 

Tell us what you want and need.  Let’s take action now - together - to make the NHS the best place to work.

Prerana Issar, NHS Chief People Officer


Speaking up to drive change

Posted by NHS National Guardian 11 months ago

To provide the highest quality compassionate care to patients, NHS workers need to feel valued, supported and free to speak up. The learning and improvement that speaking up can provide is a key factor in driving change in the NHS.

The role of the National Guardian for the NHS was a key recommendation made by Sir Robert Francis’ Freedom to Speak Up Review, that was published in response to the Mid-Staffordshire scandal.

I took up that post in October 2016 and have overseen the start of a culture change in the NHS that is embedding the principle that speaking up should become business as usual.

Since it was established, my office has overseen the rollout of Freedom to Speak Up Guardians in every trust in England, as well as guardians in other parts of the healthcare sector.

Trusts have been providing data for two years now, which has shown more and more speaking up by NHS workers. In total there were over 7,000 cases brought to guardians in the first year and over 11,000 in the second year. Nearly half of the cases in the first year were related to bullying and harassment and a third of cases related to patient safety. We have shown that high performing trusts have better speaking up cultures, as perceived by Freedom to Speak up Guardians.

The early success of Freedom to Speak Up in secondary care has led to the expansion of the remit of the office recently to include primary care, with in-roads also made into guardians in the independent sector and national bodies.

We have recently recruited to new regional posts with a real focus on integration. We have learnt some valuable lessons from the rollout of Freedom to Speak Up in trusts and recognise that models of working in other parts of the health sector are going to have their own challenges and we need to find different ways of ensuring workers feel confident to speak up.

Confidence is a key word in relation to speaking up, as it is essential workers believe that speaking up will make a difference and their voice will be heard if they are to approach a guardian. So how do we persuade an NHS worker speaking up is the right thing to do for them and the organisation they work for?

Well, partly it is about the guardian role itself and making a real effort to explain what it is and how it can help workers who may not want to speak up via existing routes, such as HR, staff side or their line manager.

Speaking up is a relational exercise and Freedom to Speak Up will only work if listening up occurs and it is embraced by the organisation as whole. Only by welcoming feedback and walking the walk when it comes to acting on the information from speaking up will confidence be instilled in the rest of the workforce and encourage others to speak up too.

My office is an independent, non-statutory body, not a regulator, so our whole approach is about working with organisations to make Freedom to Speak Up effective. Leadership is absolutely key to making a success of Freedom to Speak Up, so we aim to engage hearts and minds, rather than impose conditions.

That said, there are contractual obligations that apply to organisations that are subject to the Standard NHS Contract, and Freedom to Speak Up is part of the Well Led Domain of CQC inspections. There is also a lot more emphasis on speaking up in all walks of life and I believe this is having an effect too.

Workers rightly feel they have the right to speak up. Organisations that do not embrace this and see speaking up as a gift to inform learning, are increasingly out of step with the way of the world.

I’m proud we have made such significant steps in health and while the catalyst for change was tragic, what Freedom to Speak Up has done is set a new way of working in motion. I’m pleased to see that picking up speed and making a difference and I am optimistic it will continue to permeate into every part of health.

Last October, we launched the first ever Speak Up Month. At a national level this saw an event take place at the House of Commons and supportive messages come from the Secretary of State, the Chief Executives of NHS England, NHS Improvement and the CQC, amongst many others in the form of short films and statements published on Twitter.

At a local level, guardians put on over 100 special events and launched a variety of publicity campaigns that included the widespread reference of the campaign hashtag – #speakuptome – used over 5,000 times during the month. Cases of speaking up jumped from 2,600 in the second quarter, to 3.600 cases in the third quarter (when Speak Up Month took place).

I myself travelled over 2,000 miles around the country over the course of the month visiting various trust events. This year I will similarly be out and about, and I am looking forward to seeing health organisations celebrate how they encourage their workers to speak up.

I hope those of you that engage in the campaign directly, or via Talk Health and Care, can help raise the profile of speaking up and promote this important issue. By making speaking up business as usual we can all improve patient safety and the wellbeing of workers.

Dr Henrietta Hughes, National Guardian for the NHS


It’s been fascinating seeing your responses to this month’s challenge. It’s so easy to assume that work-life balance means the same thing to everyone, but it’s abundantly clear from your responses that it’s a very variable, nuanced and personal concept.

For me, having a balanced life means working on early morning trains rather than staying away overnight, so I can spend time with my family in the evenings, riding bikes to meetings across London so I can get a change to my day, a bit of exercise and some fresh (ish!) air and at a more fundamental level effectively being in a job share with David Prior as we bring NHS Improvement and NHS England together and flexibly sharing the responsibility of leading the combined organisations.  So I am definitely a firm believer in flexible working!

Your responses to this challenge have shown that’s only a small part of the picture. For some staff, it means the opportunity to work from home more often, or to change working hours at short notice. For others, especially clinical staff, that kind of flexibility often isn’t possible, and it’s more important to know, as far in advance as possible, precisely when you’ll be expected to work.

There are some great examples of NHS organisations innovating in this area, For example the work at Essex Partnership University NHS Foundation Trust which illustrates the benefit for the organisation in rolling out flexible working arrangements, at West Midlands Ambulance Service NHS Foundation Trust where they have changed their approach to flexible working, or at Derbyshire Community Health Services NHS Foundation Trust where they have supported managers to deal with flexible working requests.  But it’s clear that there’s more that the NHS can do, as a modern employer, to make working more flexible, and the NHS a better place to work. In the Interim People Plan, we’ve talked about ensuring that the workforce feels they have a voice and are in control. This includes a commitment to promoting work-life balance, flexible working and clear and timely rotas.

Something else that’s come out from your responses is that, for some of you who do work flexibly, your experiences haven’t necessarily always been positive. You’re concerned about how time away from the office might impact your career progress, and some of you have stressed that the solutions that do exist to promote work life balance aren’t always optimised for shift working, or 24 hour rota periods.

It’s been great to read of people’s experiences, positive and negative, and please do keep sending them through to us. I’m particularly interested in the comments about annualised rotas, and it’s something we’ll be looking at closely with trusts who have managed to make it work.  If we’re going to continue to attract talented and passionate people, it’s essential that we consider employees life as much as their work. So thank you again for your ideas and your engagement - let’s keep the conversation going!

This blog has been authored by Dr. Charlotte Gascoigne, Director of Research and Consultancy at the Timewise Foundation

Ensuring nurses have stable schedules is critically important, as research has shown. Now we need to take action.

Why? Because in nursing, ‘flexibility’ often means varying one’s working pattern each week to meet service needs, leaving nurses with little work-life balance. The exception is the ironically named ‘flexible working arrangement’ (FWA), which may provide a stable schedule that is the same from week to week. But FWAs are rationed, with parents getting first priority and others feeling that their needs are ignored.


53% of nurses say schedule stability is important to them.

We’ve looked at how to achieve increased schedule stability for those nurses who want it. We interviewed 275 nurses from ten wards at two hospital trusts: 53% said a stable schedule that was the same from week to week was important to them.  We then worked with ward managers and e-roster teams to identify improvements to the rostering process. Here are three key recommendations:

1. Increase the number of roster requests each month. Our research showed that this can be an alternative to FWAs as a means of improving nurses’ satisfaction with schedule stability.

2. Change the language of work-life balance to reflect what’s actually possible – and to include all nurses’ preferences, not just parents’ preferences. Not every nurse can have a fixed pattern, but every nurse can be asked about their ‘shift pattern preferences’. Many nurses expressed a preference for a stable pattern that is the same from week to week, but others had preferences around night shifts, recovery time, weekend working, and how shifts are spread across the week.

3. Use technology to create more opportunities for nurses to input into their working patterns. In addition to the date-specific requests which nurses already make for each month’s roster, nurses could also input into their working patterns at two other points. First, long-term shift-pattern preferences (in the categories listed above) could be input into the auto-roster (as preferences, not rights). And secondly, last-minute requests could be facilitated using apps. All these opportunities need to be positively welcomed as means of attracting and keeping staff. 

So far, so interesting. Now what?  More work is needed by both central stakeholders (including NHSE/I) and hospital trusts – and it’s needed now.  The service needs to recruit 40,000 more nurses in the next five years. This will only be possible if we can stimulate a higher quality conversation about what work-life balance really means in a highly-constrained environment like nursing – and if we put nurses’ work-life balance much higher up the policy agenda.


Why flexibility matters

Posted by Robert DHSC (Admin) Sep 6, 2019

We are Kate and Aasha. NHS staff and founders of a movement called @FlexNHS. We both work flexibly and have needed - still need - flexibility to balance being mums to young kids with pursuing jobs we love.

We know how much flexibility and work life balance matters. In sharing stories over Twitter, we created @FlexNHS as space to share stories; to seek support and to look for solutions. Sharing those stories - raising our voices and the voices of staff working across the NHS is a powerful agent for change.

We need practical solutions to provide better support for staff. Flexible working in the NHS is undoubtedly a challenge. Solutions need to be built around the challenges of 24/7 services; need to take in complex shift and rostering systems; and must be able to be delivered in a fair and equitable way.

Flexibility isn't a one-size fits all solution. It can be both structured (a set shift pattern) and dynamic (flexible start times). It needs to consider the individual, team and service provision. Some of the solutions might be organisational - looking again at policy and practice; or investing in tech to support remote and mobile working.

The NHS is full of people who care, who want to make a difference and who, collectively, every day, go a million extra miles in their jobs.

Flexible working could make the difference between staying in a career you love or leaving it. It could make the difference between the NHS keeping highly-skilled, needed and sought-after staff, and losing them. We hear these stories every day from nurses, doctors, midwives, managers, administrators...We advocate strongly that flexibility is for everyone and not only those with caring responsibilities - because all our time is of equal value. But for both of us, right now and over the last few years, flexibility at work has meant we can continue in jobs and careers we love, while bringing up our kids - and that means everything.


A valued and rewarded workforce...

Posted by Julie Ogley Jun 14, 2019

A report by the National Audit Office (NAO) early last year on the adult social care workforce in England concluded that “Social care cannot continue as a Cinderella service – without a valued and rewarded workforce, adult social care cannot fulfil its crucial role of supporting elderly and vulnerable people in society”.

Fast forward to today and we need to reflect, be honest with ourselves and ask if the sector has moved on.

Here at the Association of Directors of Adult Social Services (ADASS), we are challenging ourselves to think about some of the key issues. In the absence of a Green Paper, we need to be more positive in thinking about what we would want to see from a workforce strategy. We ask that employers and employees use Talk Health and Care to do the same.

Whilst there will be debate about how change can be delivered, what we can all agree on is that change is needed. It is shameful that social care is often viewed and referred to as a low-skilled profession, when the people who work in care are highly capable and accomplished.

We need to be ambitious for the sector and its staff, consistently reminding ourselves and others that a highly skilled, dedicated, compassionate and appropriately remunerated and appreciated workforce is a key component in supporting people to live safe, well and fulfilling lives.

We must debunk the myth that there are no career opportunities in the sector and promote the different entrance routes into the profession, progression opportunities and career pathways.

If we allow ourselves to have an overstretched workforce, with insufficient training and lack of career opportunities we risk staff not feeling the reward that comes with caring for people. We want to aim high and to be ambitious for care staff, so we need to acknowledge and reward the challenging roles they have.

Join the conversation and add your thoughts today to the challenge ‘How does your employer value the work you do in social care?’.

Julie Ogley

Director of Social Care, Health and Housing at Central Bedfordshire Council and President of the Association of Directors of Adult Social Services (ADASS)


Rewarding employment…

Posted by Vic Rayner Jun 6, 2019

Those who work in care understand just what a privilege it is to really support people to live the life they want – to deliver great quality, timely and valuable care and support, and to offer care that respects the dignity and rights of the individual.

It is skilled work. It is hard work. It is work that is both emotionally and physically demanding.

There are many excellent employers out there who do understand just how important recognising and rewarding staff is. In regular surveys of employers by the National Care Forum, members have highlighted the success of schemes which have incorporated some or all of the following approaches:

  • Annual bonuses
  • Employee referral reward schemes
  • Schemes that reward attendance, long service and outstanding acts
  • Peer voted schemes to reward individuals or teams
  • Discount and loyalty schemes for local services or retail outlets

However, I know there are a number of additional things that great employers are seeking to do, and that we must do more of in the sector as a whole.


Paint the Bigger Picture

We know how hard it is to attract people to work in care. It is important for employers to paint the bigger picture of what individual staff contributions achieve. Great social care is about social justice and human rights. A powerful reward for many is being part of a movement that is transforming not just individual lives, but societal opportunities and expectations for communities that have previously been excluded or ignored. Great employers will tell this story through their external and internal communications, so that people can rightly feel proud of the work that they do.


Flex the opportunity

The sector employs nearly 1.5 million people, many of whom work part time and on variable hours contracts. However, it feels like there is more that we can do to reward staff with flexible working practices. There are, for example, many other comparable sectors where practices such as compressed working hours, greater use of job share across all roles, part year working (employing people only for a fixed number of months), offering greater flexibility of work location, or enabling short term movements are on the table for employees. There are lots of models of flexible working out there and the technology in care is catching up to enable these to be managed seamlessly.


Person-centred employment

The social care sector prides itself on the delivery of person-centred care, yet there is less evidence of a commitment to person-centred employment. Everyone who works in care is an individual, with their own life and their own commitments outside of work. The approach employers take towards recognition and reward should also concentrate on what is offered to support the person in and out of work. Strategies that recognise the financial pressures, health and wellbeing challenges and caring responsibilities of employees will go a long way towards staff feeling that their employer not only provides care for others but also, very importantly, cares for its own too.  

Join the conversation and add your thoughts today to the challenge ‘How does your employer value the work you do in social care?’.


Vic Rayner is the Executive Director of the National Care Forum (NCF).

The NCF is the strongest voice for not-for-profit care providers in the UK. More details about the NCF can be found at Stay connected to Vic via @vicrayner or


Rewarding care workers

Posted by Karolina Gerlich Jun 3, 2019

It's the look on the face of an elderly person when I make them smile, as we joke and play games; or the pleasure I get when I support a person to improve their health and wellbeing. These are the reasons why I love the work I do: looking after people and putting smiles on their faces every day.

There is nothing quite so rewarding as being able to make the lives of other people better.

I started working in social care as a part-time job but soon realised that caring for people is where I feel most fulfilled and useful. For the past ten years, my jobs have included being a live-in care worker, a personal assistant, a homecare worker and supporting people in care homes. Working in social care can be hard at times but is also very rewarding. It comes with a huge responsibility for people’s daily lives which makes it a profession that requires many skills.

It is a job like no other.

People do not enter social care to make big money, but I think we can only expect care workers to deliver care with respect and dignity if employers extend that same treatment to their teams. Part of this is recognising the difficulty of the job and the skills required and rewarding that properly.

The Professional Care Workers Day on 4 September, which celebrates care work and recognises its contribution, is one way of rewarding staff. The day encourages the social care sector and wider society to acknowledge the fantastic contribution that care workers make.

Showing appreciation can be achieved in different ways, not all of which must include spending a lot of money. ‘Thank you’ cards and emails are a good start and I hope that many organisations use them. It is so easy to focus on problems and mistakes and forget about celebrating success. We want to encourage moments of positivity where great work shines.

There are many great examples in the industry of perks for care workers - from salary stretching schemes and discounts on shopping to bonuses for taking on last-minute shifts.

I urge you to share your great practice in rewarding success and hard work. I would also encourage you to share new and innovative ideas of what can be done further to reward excellent care work.

Join the conversation and add your thoughts today to the challenge ‘How does your employer value the work you do in social care?’. 

Karolina Gerlich

CEO National Association of Care & Support Workers

Knowing how to motivate people to do challenging jobs is an issue that is pertinent to managers across social care. We know from careers experts what the elements are that keep people fired up: feeling appreciated; sharing values with your organisation; colleagues – and chances to socialise with them; opportunities to develop and progress; and support to do your job well. How then, to apply this knowledge to the question of rewards and recognition – and when money is tight, can the sector show thanks to a hard-working workforce?

Manchester City – a football club whose wage bill could solve the social care funding challenge in an instant – upset one star player when it failed to mark his birthday with a cake. Even the highest-paid want personal touches that make them feel valued. And things like a birthday card from the boss – with a meaningful message – can mean a lot.

The point about shared values is important. Social care is about supporting people, and if we support recipients of a service, we should support providers too. Getting a work/life balance matters to staff, so where possible employers should allow some home-working. Staff wellbeing should be promoted, rather than simply relying on their resilience: with the chance to buy extra leave, with wellbeing days, or with relevant health support, like physiotherapy sessions.

Social care is rooted in the community, and that could be expressed in reward schemes – like giving volunteering days or establishing discount schemes with small local retailers or coffee shops. And, social care is about choice so apply some personalisation to any discount scheme.

Personally, I’d take the cinema over the gym any day.

We are motivated by our colleagues. Team lunches, fun away days and Christmas parties do bring people together. No-one understands the pressures and pleasures of work more than our peers, and the chance to relax and form bonds with them matters.

Another great way to form good bonds – which feeds into a fundamental part of working for any social care employer – is having a varied training and development programme. Here at the Social Care Institute for Excellence, we consistently find that access to good quality supervision, training courses, shadowing opportunities and support with professional registration is the biggest motivator an organisation can provide its staff. Because, ultimately, people want a chance to do their job well. Professional development helps with this – it brings people together, away from the coalface, and it shows that they are valued.  

Reward schemes and discounts are a useful part of the bigger picture and, when thoughtfully provided, can be a big help in motivating and retaining staff. But the key principle remains that if a workforce – which cares about what they do – is given the right support and working conditions they will do the best job that they can. 


Hugh Constant

Senior Manager in Consultancy & Training

Social Care Institute for Excellence

This almost certainly won’t be the first blog you’ve read on the subject of workforce, which is a challenge facing almost every local authority.

In Oxfordshire, ensuring that we have enough people working in social care is our number one priority.

Despite our strong local economy having very low unemployment rates, adult social care faces strong competition from other sectors such as retail and the area’s high living cost is off-putting for many. In the South East, the number of adult social care jobs will need to increase by 48% by 2035 to keep up with rising demand – that’s another 125,000 jobs.

Making social care staff feel valued and rewarded has formed a key part of our approach in addressing these issues.

We are fortunate that in Oxfordshire we have two associations who represent a significant proportion of our providers. It became clear in our discussions with them that sometimes it’s the smaller things that make a real difference to their staff and mean they are more likely to stay in their roles.

As a result, we’ve focused a lot of effort into looking at what could make the difference in someone deciding to stay in the sector. This has included key worker housing and supported care leadership programmes, alongside our value-based approach to training programmes, which are designed to help providers choose candidates who are more likely to remain with them.

We’ve also spent time looking at how else we might make the lives of care providers and their staff easier, with one example being the agreement to provide a number of parking permits for use by carers within central Oxford. Whilst this may not seem like a ground-breaking solution, it actually made life easier for the carers who didn’t have to worry about trying to find a parking space or getting a parking ticket. As our care providers told us, sometimes at the end of a long, hard day it’s the small things that can make the difference!

It’s important to recognise that the challenges we face aren’t just issues for Oxfordshire as a local authority:  they also affect our health partners and care providers. Several providers have created a comprehensive package of employee benefits as part of their strategy to tackle workforce issues. We strongly believe that it is essential to work as a system across health and social care to tackle these challenges, and that our care providers are key to making this a success.

In Oxfordshire we feel that we have started our journey  to improving recruitment and retention by making staff feel valued, but we realise there is still a way to go. We would love to hear what steps you’ve taken – however big or small – to address your own workforce issues and make your staff feel more rewarded.

Join the conversation and add your thoughts today to the challenge ‘How does your employer value the work you do in social care?’. 


Lucy Butler

Director for Children, Education and Families and Interim Director for Adult Services

Oxfordshire County Council


The other side of recruitment

Posted by Annette Baines May 2, 2019

Annette Baines, Programme Manager for Recruitment and Retention at Skills for Care, talks about people who need care and support being the ultimate beneficiaries of a settled staff team.

Like the thousands of adult social care employers, Skills for Care knows that attracting the right staff with the right values, behaviours and attitudes is vital.

At Skills for Care, we don’t deliver direct care, but we do invest in the culture of our own organisation to show how we value our staff.  One of the ways we do this is through staff-wide wellbeing initiatives which show how much we value them and what they do. Initiatives have included a month-long campaign focusing on the mental or physical wellbeing of our team; peer and other support for those who are also carers; or even supporting people to get their work/life balance right.

We know that the great majority of the 1.47 million workers in adult social care experience far higher levels of job satisfaction than in many other sectors – not least because every day can be different and rewarding, as shown in the government’s recent national recruitment campaign. But turnover rates in the social care sector are still far too high, with factors such as pay, working environment or not feeling valued influencing people’s decisions to leave.

Skills for Care spends a lot of time talking to employers who have low turnover rates to find out what they do to retain their staff. We then produced our ‘Secrets of success’ report, sharing many of the smart things those employers do to keep their very best people by making sure they know they’re valued. They include:

  •  Investing in learning and development as well as embedding the organisation’s values and celebrating achievements;
  •  Involving staff in decision-making and paying above the local minimum wage so staff feel valued for the work that they do;
  •  Being as flexible as possible when setting working hours and shift patterns;
  •  Supporting staff by taking into account their responsibilities outside of the workplace as these can affect performance at work. 

Making sure your staff are physically and mentally fit for work goes hand in hand with providing a positive workplace culture, so listen and act upon what your team tells you.

There’s no magic solution to keeping your best people but employers who have used ‘Secrets of success’ say it has helped reduce their turnover rates.

Which employee benefits and reward schemes mean that you enjoy working for your employer? Are there any employee benefits or reward schemes you would like to see introduced in social care? Share your ideas now.

Find out more about support for your organisation’s recruitment and retention at

By Matthew Winn, Chief Executive of Cambridgeshire Community Services NHS Trust

I have the privilege of leading an organisation providing community health services across the East of England and I see outstanding individuals and teams make a huge difference every day.

Working in community health services provides our staff with the opportunity to work as partners with GP’s, mental health professionals, social workers and the voluntary sector (to name but a few).

The services often co-ordinate the care for patients and, as a 365 days-a-year operation, the teams provide a continuity of professional care that is not found elsewhere in the NHS. They operate with a high level of autonomy and responsibility.

Community health services is a catch-all description for a wide range of very important services and staff who predominately work in the homes of residents or in community clinics. To give a taste of what happens every day:

  • Children’s nurses, therapists, doctors and support staff see every child and their families at least five times in the first years of their life. They also support families and children as they grow up with their developmental needs, complex disabilities or the impact of a single long-term condition.
  • Specialist dentistry staff provide clinics for children and adults with complex disabilities; they often undertake minor oral surgery for local patients who are scared of going to a high street dentist.
  • Sexual health and contraception doctors, nurses, pharmacists and counsellors provide vital treatment and preventive care to all ages.
  • Community nurses, therapy staff and GPs work together to support the most frail and unwell members of our communities – a high proportion of whom rarely leave their own homes.

If you are starting out, returning to the NHS after a gap or looking for a fulfilling role to finish your career community health is the place to develop and stretch yourself, in a wide variety of stimulating roles. As a Chief Executive of a NHS Community Trust I would encourage anyone interested in working in community health services to get in contact with your local NHS provider and ask to spend some time with local teams to see if the opportunity is right for you.  


By Austin Chinakdizwa

I am a Community Matron working in Luton alongside “At Home First” care co-ordinators, who support our intensive case management model. There are lots of advantages to working in community care. On any given day, I can communicate with all the different parts of the health and social care system to access the services my patients need. This allows me to pull together packages of care that help older people (in particular) to stay safe and healthy in their own homes, which is often exactly where they want to be.

It’s so rewarding to work across teams and organisations to help patients achieve their goals. Another great benefit is being able to see the positive impact of our work over a longer period of time.

Austin (left) and his colleague Sue, a pharmacy technician.

Austin (left) and his colleague Sue, a pharmacy technician.

One disadvantage of this model is that, across the broader NHS, community clinicians don’t get a lot of recognition for the work we do. The preventative role we play in people's health is becoming increasingly important to the health and social care system, so we need to shout about it more.

Raising the profile of our work is key to encouraging more staff to work in community settings. It is also important to emphasise the training opportunities, innovative projects and good work life balance that we can offer. We also need to work with students and universities to train and recruit for a range of roles. We don’t just need nurses – we need co-ordinators, healthcare assistants and health trainers too. The NHS is at a crossroads, shifting from hospital to community care, taking a more preventative approach. This means there are many attractive and exciting opportunities to try out new approaches and ideas, which we need to better publicise.

In Luton we’ve been making special efforts in the last six months to work more collaboratively with the Luton and Dunstable Hospital, Luton Council, GPs and all the other players that support the health needs of our local population. Thanks to daily huddles, weekly multidisciplinary team meetings, and many other measures, we can now go above and beyond to improve care for our elderly patients who might otherwise end up in accident and emergency. More support for schemes like these will be essential if we’re going to make patient care safer. We also need to make better use of clinical expertise for system improvement projects, enabling us to think differently and be more creative. If we have all this, then we’ll be able to succeed at building the new service model that our health system and our patients need in order for it to thrive.

By Jenny van Maurik, Clinical Lead and MSK Physiotherapy Specialist at Cambridgeshire Community Services NHS Trust.

Our First Contact Practitioner (FCP) pilot is part of a national NHS England directive to establish musculoskeletal (MSK) practitioners in primary care. We run daily clinics at Granta Medical Practices in Cambridge where patients with musculoskeletal conditions, who would ordinarily have been seen by a GP, are now able to see a MSK specialist physiotherapist instead.

Working in the community offers numerous benefits to GPs, patients and practitioners. Between 20-30% of GP appointments are MSK related and having an MSK expert on site has helped to reduce GP workloads. In addition, patients get quicker, direct access to MSK specialist assessment and advice, and tend to be more relaxed in familiar surroundings, closer to home. Patient satisfaction rates are also high.

We can request MRI scans, x-rays and blood tests, and also refer patients for physio and link with GPs for prescriptions. Patients are able to be directed to the right person at the right time, enabling them to be directly referred onto hospital for surgery when needed. Our initial findings show fewer patients are referred to secondary care and more than 70% of patients simply require guidance to self-manage their condition.

There’s been mention of the pilot leading to fragmented physio services as experienced physios are taken into GP practices while junior physios are left in physiotherapy departments. Concerns have also been raised that moving specialist physiotherapists out of the hospital setting will reduce their knowledge over time. However, these risks can be minimised by assessing the skills mix and ensuring MSK specialists maintain links with hospital orthopaedic teams.

Emphasising the benefits of early intervention – in terms of reducing unnecessary appointments and investigations and speeding up patient access – is key to encouraging more physios to work in the community. The FCP initiative offers an exciting opportunity for physios to upskill themselves and having a forward-thinking, dynamic multidisciplinary team within the primary care setting will entice more staff to this role.

Two factors that would enhance our day-to-day life working in the community are improved IT and better links with hospital imaging departments. We’ve experienced issues getting acute hospitals to accept referrals for investigations. MSK specialists working in the community should have the same rights as their hospital counterparts. Fundamentally, it’s about putting patients at the heart of care.


In November last year I concluded a review into what can be done to empower NHS leaders to lead.

There are many key changes I believe the health and social care system can do to support their leaders – both current and future. Some of this work is already underway. For example, NHS Improvement is already taking a more central role in the NHS, evident in its recent decision to create a new Chief People Officer role within the senior leadership team.


But if we want to go further – and truly empower NHS staff – we need to ensure the next generation of leaders have the skills they need to take on these challenging roles. There should be a renewed focus on our future leaders and how we support them and NHS Improvement and NHS England should continue to align their work and set a clear and strategic direction for the NHS. I was pleased to see that since my review the NHS Long Term Plan has set clear direction on how the system will work together and the roles respective organisations will play.

It seems timely, now that the NHS Long Term Plan has been published, that these issues be revisited and these changes are made in the NHS. The conditions in which NHS leaders work are often stressful and difficult, with great responsibility and the highest stakes. Over time, this has had a detrimental effect on the working culture. This must change and should be led by leaders at all levels – they each have a pivotal role to play in changing culture, setting the tone within their organisation. NHS leaders should ensure they model the highest standards of behaviour and if they are supported to thrive they can support their staff to deliver high quality care for patients. And to thrive, they must be encouraged to celebrate their successes and learn from their mistakes.

Changing a culture is about people and their behaviours. That’s why I believe the performance management process of NHS leaders should be updated. It should be common practice to get 360-degree feedback and any behavioural issues handled during an appraisal. And, if a national standard for performance management is set, regions can be given more freedom to manage performance locally. In turn this would provide reassurance that this need not be a fearful exercise. Mistakes can be discussed more constructively and learning from mistakes can become a normalised process.  This is one way that by empowering leaders to lead the NHS can change its culture and in turn start to embed a Just Culture.

From your feedback on #TalkHealthandCare it has become apparent that staff across health and care thrive when leaders support you and strive to create open, honest and compassionate workplace cultures. So what else would you like to see change in your organisation to achieve this aspiration? Share your views below or comment on the creating a Just Culture in the NHS and Social Care page.

Years of research and evidence has shown the positive impact of engaging with staff across different sectors. Many of the most successful businesses in the UK, from John Lewis to BAE systems, have a clear commitment to staff engagement. This has helped them to be more productive, innovative and successful. 

But the case for engaging with your staff is arguably stronger in the NHS than in any other sector. We have evidence that staff engagement is closely linked to patient satisfaction. High staff engagement also helps to improve decision making and reduce staff absence.

The Care Quality Commission (CQC) is responsible for assessing the quality of care delivered by health and social care services in England. CQC has recognised the importance of staff engagement, and now includes it as a central element when they assess a service.

The trusts rated as ‘outstanding’ by CQC have the highest levels of staff engagement recorded in the NHS staff survey. From mental health services in Northumberland to large London teaching hospitals, staff engagement and quality care go hand in hand. 

Engaging staff at all levels

Staff engagement should happen at all levels of an organisation. At team level, staff can be involved in developing ideas to improve quality and solve problems. At ward level, they can help change the way services are delivered. And at overall organisational level, staff can help shape the future of their organisation. 

The ways in which NHS organisations involve staff range from large-scale ‘Big Conversations’, to ward-level ‘quality huddles,’ to simple actions such as senior leaders getting out on the wards and listening to staff.

In addition, many NHS trusts are using technology to improve engagement. Whether through simple mobile apps to rate their satisfaction or more in-depth online feedback platforms, trusts are embracing digital tools to engage large, diverse and often dispersed workforces. 

The NHS staff survey shows high levels of staff commitment and motivation. The NHS has a good record on involvement at ward level but can do more to develop overall engagement and spread good practice. The key now is to build on existing examples and make sure the NHS listens to the views and ideas of staff who deliver its services. 

Steven Weeks is Policy Manager at NHS Employers

Roger Kline
is Research Fellow at Middlesex University Business School

Duncan Lewis is Professor of Management at Plymouth University Business School

24% of NHS staff in England report that in the last 12 months they have been bullied, harassed or abused by their managers or colleagues. This does not include the full impact of incivility or of witnessing bullying.

Such behaviours adversely impact staff wellbeing and ultimately the quality and safety of care. Bullying has been a factor in many scandals affecting the quality of NHS care. Bullied staff are less likely to admit mistakes, raise concerns or work in affected teams.

We have made a comprehensive estimate of the financial costs of bullying.  It is at least £2.2 billion annually. We drew on available research and data sources to calculate the impact of bullying on resultant sickness absence costs to the employer, employee turnover, diminished productivity, sickness presenteeism, compensation, litigation and employment relations costs. 

This is likely to be a considerable under-estimate because it excludes primary care, national NHS bodies, legal costs, the financial impact of rudeness, and the impact on those who witness bullying.

Research makes clear that the traditional reliance on policies, procedures and training must change since evidence suggests that in isolation they will not change toxic cultures. Employers must be proactive, not waiting for individuals to raise grievances, exit or go sick. It is organisational climate/culture that allows bullying to be so common so there must be honest reflection on leadership behaviours that permit, encourage or collude in bullying.  Holding managers and staff at every level to account for their standards of behaviour can radically reduce bullying. However, this requires independent voice mechanisms that NHS staff trust and believe will work for them.

It is possible to reduce bullying even amidst funding and workforce pressures. Our work provides compelling reasons why the NHS (and Ministers) cannot afford to look the other way.

The price of fear: estimating the financial cost of bullying and harassment to the NHS in England:



It was the threat of divorce which galvanised me to push for a different style of working. I’d had years of unfriendly registrar rotas, long commutes and difficult exams in order to get to the golden prize of being a consultant.  And now I’d arrived, I was somewhat disappointed.

It felt more like a bronze medal. Other doctors still talked to me as if I were a junior, patients were still waiting too long for beds but worse than that, the rota was still affecting my home life. I had made promises to my wife that all her issues with my working life would be resolved by my new consultant job, but I was still doing shifts that didn’t often coincide with nappy duty and I missed my eldest kid’s first nativity play.

The rota was hard; we were down on consultant numbers and often lacked middle grades. I also felt somewhat aggrieved about the fairness of it all, when I covered for sickness or stayed late it was often done at my own expense.

After 6 months in post, I wanted to decrease my clinical work to do more at the medical school. But the medical school commitments were never fixed and it was hard, within the existing system, to make the job plan I needed work for me, the department and the medical school.

As time moved on, I started resenting what I genuinely love doing: being on the shop floor treating the variety of patients we see, with their multitude of problems and pharmacologically enhanced personalities.

The consultant rota needed to be adapted to take account of increasing out of hours requirements, and to suit the staff better. In addition, the Trust had asked the consultant body (with our agreement) to start doing shop floor nights.

So, a few of us pondered how we could introduce a different way of rostering – annualised self-rostering.  This had to meet the Trust’s requirements, ensure that we got remunerated for what we did and paid us for when we stayed late. We put the idea to colleagues and got the green light of our clinical lead. So, with a crash course in Microsoft Excel and the support of our management team, I went to work.

I’m now proud to say that we now have an annualised rota system, with self-rostering and a whole lot more flexibility for the trust and for staff than we used to have. In simple terms, the way we do it is to:

  1. Calculate for each consultant what they could offer the department. First people decided how many clinical sessions they could work on their contract.
  2. Then we take that and work out how many sessions each person will therefore do annually.
  3. Then take account of other demands on time that will reduce available clinical sessions (everything from CPD time to bank holidays).
  4. We then work out how best to use those sessions for the departmental needs – essentially designing a roster.
  5. Staff then self-roster onto the template according to their preferences.

We pre-allocated weekends and certain shifts to ensure fairness, but otherwise everything was self-rostered. I did lots of evening/night work as it fitted in with childcare. Others did day shifts if it suited them better. People did what suited them and as long as all the shifts were covered safely, then everyone was happy. If you wanted leave, you just didn’t self-roster. 

It has helped us move towards 24/7 working, allowed consultants to go on secondment. We have also used the template to roster for our junior doctors (including middle grades) – and it helps with their sustainability too.

Our experience hasn’t been perfect. The rota doesn’t fix the intensity of the work during the shift, flow problems or difficult speciality doctors, but it makes it easier to deal with.

I think annualisation and self-rostering can help people be persuaded to go into emergency medicine as a career. It increases the attractiveness of the speciality, especially for less than full time staff, and helps with sustainability.

At the college, I have been involved in working with a team developing resources for use by others. We are developing a guide to self-rostering which will be published later this year.

For me personally, I have noticed a difference to my wellbeing. I have cut the number of my clinical sessions, and work those sessions at the medical school instead. I have also had the time to pursue other interests such as writing, being a crowd doctor, running critical appraisal courses and being involved with the Brighton Marathon.

But most importantly, because of the new roster and ability to self-roster, this year I did attend my kids’ nativity plays. It may not have been the traditional nativity story (there was a penguin present at the birth of Jesus) but at least I was there – something my fellow school gate dads, doing traditional 9 to 5 jobs, were unable to do. It was also the first time that I remember other people being  jealous of my rota and my work-life balance.

I am happy to answer questions and how it could be implemented at your work, (or give more info if you want to work in a nice place by the sea with this style of working!). I can also provide more information on the rota software we helped develop and now use. For any questions, please email

I'm Beverley Latania - Principal Social Worker at London Borough of Newham and co-chair of national PSW network.

Local authority offices are busy, hectic places where many people are thrown together. Not everyone will get on with each other – that’s ok, that’s normal.

What’s not normal is to turn that dislike into something bigger, where staff start to gossip, impersonate others or isolate a single member of staff. This is bullying.

Bullying and discrimination in the workplace can take place in many shapes and forms. It can come from colleagues or managers, groups or individuals, and it can be subtle or in your face – either way, it is not acceptable.

As a manager, I remember a situation where a fellow manager would constantly go back to an individual worker about their work, stating it was not good enough, telling the staff member to rip it up and start again. At first, I thought that this was harsh but maybe it was how the manager led his team to make sure work was produced to a high standard. I tried to normalise it. However, after a couple of months I started to recognise this was not the case and he was singling out this member of staff. 

Eventually the situation was resolved with help from a supportive supervisor who was able to mediate between the worker and the manager so a beneficial working relationship could be established. Not everyone may be that lucky, but there’s normally one person within a team or organisation who you can approach, share how you’re feeling and who will be able to offer some advice. It’s important to share as the first step in getting some help and support. 

If I were to be faced with the same situation again, I would step in and approach the staff member one to one to offer support and ascertain what was going on, with a view of discussing it further with the manager. Sometimes it takes someone on the outside to raise the concern so it can then be addressed in a suitable manner or to be formally investigated.

There are many stories online about cases where staff have had to put up with the bullying, where they were shut up or pushed out if they spoke up.

It is vital that we do all we can to prevent this from happening, not only because we care about our staff and their wellbeing, but also because of the overall effect this has on how an organisation functions – 11 million days at work are lost every year due to stress at work.

Keeping staff safe and supporting one another

Most local authorities will now have a whistleblowing policy in place. These policies are designed to enable staff to speak up in confidence and report issues that can help to alert HR to poor practice.

Camden Council’s Raising Concerns at Work sets out clear guidance on the expectations from staff, managers and the organisation. More importantly, it offers top tips for staff and managers on how to report a concern. Newham Council’s employee code of conduct outlines that every staff member must be accountable for their behaviour and how it could be perceived by others. As part of supervision, reflective spaces are offered to staff to look at their knowledge, skills and developmental needs. These are just 2 local authorities which have placed an importance on tackling this area, I know there are many more.

However, good policies alone are not enough. We, as social care staff need to support each other, take cases of bullying seriously, question and challenge it when seen and, most importantly, report it.

My name is Emily. I’m a trainee nursing associate and have been working in care at a nursing home run by Amber Care for 8 years. I really enjoy it. Prior to becoming a trainee nursing associate, I was a healthcare support worker and having worked with my manager for six years she encouraged me to apply.

I’m now coming towards the end of 2 years of training. This involved one day a week learning with other trainee nursing associates in a variety of health and care settings. I really enjoyed learning new knowledge and skills while getting to know others with the same motivation as me.

My role supports the nursing team and means that I can provide hands-on care to service users at a higher level than I was previously able to do. It enables me to share my knowledge and skills within the care team. My role as a nursing associate helps me to support the team to provide more hands-on care. It also helps my colleagues feel better supported with increased confidence to develop their skills and knowledge.

I’ve been trained through one of the test site partnerships, as part of the national pilot for trainee nursing associates. It has identified that there is a gap between nurses and seniors where people like me can develop upon skills we already have and learn new ones.

The nursing associate role also makes me feel that our work is recognised as part of the wider nursing and social care professional. I feel proud to be part of innovative and new ways of working to improve the personal care we can deliver in health and social care.

The nursing associate role is a new one which will be registered by the Nursing and Midwifery Council (NMC) who will set standards for nursing associates. 

The nursing associate role will enable many existing staff in care roles to progress their careers through further training, and for those who want it, it will enable further progression on to registered nurse training.

Starting out on my journey to become a mental health social worker last year was really daunting, but I’ve loved it.  

I am doing my training through the Think Ahead programme, a 2-year graduate programme for mental health social workers. I spent my first year working in community mental health services with Tees, Esk and Wear Valley NHS Foundation Trust (TEWV). In my second year I’ll work as a newly qualified social worker in an Early Intervention in Psychosis team. I’m looking forward to continuing learning in the second year, and I’ll be carrying out original research as I work towards my master’s degree. 

I’ve already gained so much training, development and support. These are some of the things which have been vital to my experience.

Access to high quality, varied training  

Think Ahead introduced me to the knowledge and underpinnings of being a mental health social worker, including learning social interventions at 3 levels: individual, family and community. These interventions have become really familiar to me, and are now embedded in my day-to-day practice.

I’ve also had access to a huge range of training through TEWV. I’ve completed training in many areas, including the Mental Capacity Act, trauma and managing emotions, all of which I have been able to put into practice. This focus on training has made me feel really valued as a member of the organisation.

Understanding different teams

Being able to work in and shadow several different teams has also been really valuable. I have mostly split my time between a crisis team and a community mental health team, but I’ve also spent short periods of time working in an older people’s team, children and adolescent mental health services and a hospice.

I also had loads of shadowing opportunities – including Deprivation of Liberty assessments and Mental Health Act assessments. This has helped me understand processes and the nature of teams in different areas.

Support from other staff

I’ve been really supported by my manager and by other staff. Informal support from my fellow trainees on Think Ahead has also been invaluable – they understand best what I’m going through! The social work network within TEWV has also been a great opportunity to get to know other social workers in the organisation.

Weekly meetings

Weekly case consultation meetings were a requirement from Think Ahead, following a format developed by the University of York, who are the academic partner for the programme.

I came to really rely on them for helping me face challenging situations. The meeting format allows application of theory and research to a situation, and enables you to draw on other people’s experiences and perspectives. I’ve been able to develop really robust care plans from those meetings, and will keep having them in the future.

Overall, I’ve really enjoyed my learning experience and although it has been challenging, the training and development opportunities have made that challenge easier. I now feel confident and competent in many areas of my work but I will continue to learn through these opportunities. Investing in and supporting staff is vital for them to feel valued and ensure they enjoy their role.

It is well documented that people with severe mental health illness have a significantly lower life expectancy than the UK adult population. Sadly, the majority of this disparity is due to factors such as smoking. Smoking rates are estimated to be 40% among people with severe mental health illnesses.

At Tees, Esk and Wear Valleys NHS Foundation Trust, where I work as the smokefree lead, we provide mental health services to people in County Durham, Teesside and most of North Yorkshire. My role is to implement a smokefree policy across the trust for service users, staff and visitors.

While the health of our service users is a huge focus, the health of our staff is also important and we need to make sure that our colleagues understand the importance of what we are trying to achieve. It’s not helpful if staff take breaks and come back smelling of smoke when we are implementing a smokefree policy. We encourage staff to lead by example, by not smoking during working hours, and have put measures in place to support this.

There was a lot of initial work behind the scenes. We have an internal smoking cessation and harm reduction leadership group involving staff from a wide range of disciplines along with service users and carers, as well as sub-groups looking at various elements, from information and training to policy and communication.

The trust covers a large area, with a lot of staff and service users to communicate with. We work closely with the communications team to make sure information is cascaded through relevant channels.

The success of the project largely centres on the buy-in of staff and service users. However, it’s our staff that are central to our overall success – it’s so important that they are on board and support our ambitions.

Staff can purchase nicotine replacement therapies from Lloyds Pharmacies on 3 of our main hospital sites. We also promote stop-smoking services and confidential stop-smoking drop-in clinics too.

Myself and smoking cessation trainer and support Lynda Tench communicate with staff directly, through training sessions, as well as supporting corporate staff inductions to make sure that new staff understand the smokefree policy.

We’ve also recruited smokefree champions across the trust, who work with us to promote the smokefree agenda to staff. They help keep up the momentum of the project and are involved in a variety of activities from general awareness sessions to supporting cessation clinics in the community.

We are currently running 2 promotions across the trust in the run-up to and during Stoptober. The first is a campaign to encourage staff to pledge to go smokefree using the British Heart Foundation’s ‘I/we quit at work’ pledge. Secondly, we are also setting a challenge to our smokefree champions for them to come up with innovative ways to deliver our smokefree messages during Stoptober. Both campaigns involve a prize draw for staff and it is hoped that it will give a fresh boost to our smokefree campaign.

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A man at a desk with head in hands looking at a document

I'm Head of Workplace Wellbeing at Mind, where we're helping employers recognise the importance of mental health.

Working within the health and social care sector doesn’t make you immune to developing mental health problems. If anything, the unique pressures can mean it’s more important than ever to look after your wellbeing.

The causes and symptoms vary from person to person, so it’s important to identify your own triggers and the best coping strategies for you. Lots of people find it helpful to make sure they take breaks when they can, ideally outside, don’t routinely work over their contracted hours and get as much physical exercise as much as possible (more information at

Workplaces are now recognising it’s time to take mental health seriously, but we have a long way to go. Too many employees still don’t feel able to talk about it or seek support in the way they would for their physical health. According to a Mind survey of nearly 45,000 employees across 74 diverse organisations, nearly half (48 per cent) have experienced mental health problems at their current place of work, and only half of those have talked to their employers about it.

In October 2017 the independent government-commissioned employment review ‘Thriving at Work’ was published. This review highlighted some startling statistics, including that every year, around 300,000 people with a long-term mental health problem lose their job in the UK. The scale of the problem is so great that it costs the economy between £74 billion and £99 billion a year.

The government accepted all the recommendations made, committing to take steps as employers to promote mental wellbeing at work, with positive implications for those that work within NHS and social care, among others.

Mind works with employers to help them tackle the causes of work-related stress and poor mental health and promoting wellbeing. We urge all employers to create mentally healthy workplaces and implement workplace wellbeing initiatives, such as flexible working hours, employee assistance programmes (confidential, 24-hour support line), subsidised exercise classes and buddy systems.

Above all, we want all staff to work within an environment where they feel able to talk openly if they’re struggling with their mental health and know that if they do, they’ll be met with support and understanding, rather than facing stigma and discrimination.

If you do not get the support you need, or feel discriminated against, seek advice from Acas or Mind’s legal line (email

Under the Equality Act 2010, employers have a legal duty to provide reasonable adjustments for an employee who has a disability, which can include a mental health problem if it has a substantial, adverse, and long-term effect on normal day-to-day activities.

If you have a mental health problem and you want the protection of the act, you have to tell your employer about it. Adjustments will need to be discussed but might include things like changes to working hours, work space or roles and responsibilities.

Lots of employers and employees don’t know where to start when it comes to workplace wellbeing. With funding from the Royal Foundation, and support from 11 partners including the Work and Health unit, Mind has launched the Mental Health at Work gateway, which has plenty of information from a range of trusted sources.

People working or volunteering within police, fire, ambulance and search and rescue services in England and Wales can also benefit from our Blue Light Programme, tailored to the more specific pressures of 999 workers.

Every client is an individual; working in care is about human beings, discussions, empowerment and confidence. As a service we blend these values with an ambition to keep our clients safe and at home, with an emphasis on mobility.

I learnt early on that communication is key to safe moving and handling. Mobility is so important to independence, but there’s more to it than just knowing the right exercises to take someone through or how to use a hoist.

Gentle guidance, patience and discussion ensure that the people we support feel secure and have confidence in us. Talking to people means they are involved in their care, they know what to do and we know what they want. This on-going discussion gives carers confidence and empowers them, as they are part of a person’s decisions.

Imagine returning home from hospital, a very secure place, and arriving home to a carer saying, “come on, up you get”. They’ve already decided what you can do and need to do, and they expect you to be able to do it. That is not how it should be. So much of our work is about trust, so our approach is to ask people what they want to do and what they can do. We listen to them and work as a team.

Primarily this means our clients get to set their own pace. For people who have lost mobility and independence it can be an uphill struggle, so we may have to start with small steps. Similarly, we know that people have good days and bad days, so what someone wants to do and can do each day is an on-going conversation.

This strong person-centred culture is part of how I train and support staff. I’ve been training moving and handling for 9 years and I tell my team that if they are assisting a client to mobilise then the first step is communication.

Training gives people the practical and theoretical knowledge to support someone, but you cannot teach everything in a classroom. So, I visit each carer and their client at the client’s home to make sure that we are all happy with how things are being done and how equipment is being used. It means we can offer support that is tailored to the individual’s abilities and needs.

My approach to communication extends to how I lead my team. As a service we thrive on feedback. We listen to our staff, our clients and their families and have a digital care management system that means we can keep very individualised care plans up-to-date instantly. This includes individualised hoisting and moving and handling plans which are kept in each client’s home for the carer to refer to when they are working on their own with their client. If a carer is having an issue, they are always able to contact either me or another member of the management team for guidance 24 hours a day. 

The feedback we receive from clients and their family members means we know we aren’t just doing a job, we’re making a difference to people and that makes you think, “Yes! We’ve accomplished something!” 

 Care Concern Home Care have been rated as Outstanding by the CQC who praised their “strong, visible person-centred culture” and who noted that staff were “exceptional at helping people to express their views”. You can read the full report here

There have been multiple major reports recently recognising that doctors want the way they work to be different. The foundation programme career destination report 2017 showed that only 42.6% of F2s progressed directly to specialty training. The latest GMC report on training pathways reveals that the 3 most common reasons for not entering training are:

  1. dissatisfaction with the training environment
  2. health and wellbeing
  3. uncertainty about specialty choice or career direction

Feeling some of the above, I thought about Australia, I thought about a masters, I thought about travelling, and I briefly considered training. But really, I wanted to dedicate time developing clinically in a trust I already enjoyed working in, while also having the opportunity to have paid time working on quality improvement, research and teaching – and to continue to live in a city and flat I love, to boot.

Fortunately, such a job exists… Reflecting on my short- and long-term personal and career aims I applied for one of the 12-month clinical fellow posts at Brighton and Sussex University Hospital Trust (BSUH) established by emergency department consultant Dr Rob Galloway (@DrRobGalloway) and the team.

14 months and a further reapplication later, I feel I couldn’t have made a better choice. I chose working for an organisation and department that values me and treats my work and life with equal high importance. I chose fully integrating within a team, making friends, and work colleagues who enrich my life personally and professionally.

I also chose being part of an engaged group of doctors full of quality improvement ideas who, with our split clinical and non-clinical posts, have the time and resource to effectively implement them. Through this post I have been able to support significant and lasting changes within the trust and region, be involved in award-winning improvements having national recognition, such as our single clerking and acute floor model, and learned skills that have opened doors to opportunities I didn’t know existed.

Rotas don’t have to stay the same as they have always been. Our shifts are designed ergonomically, gradually adjusting your body clock – from early, to late, to night. Your annual and study leave is guaranteed. If you want to get married in June next year and have 2 weeks off after, you can. Flexibility and cover is built into the rota, so sickness and absence has less of an impact. A large pool of doctors as fellows makes swaps for study and annual leave much easier and just a simple Whatsapp away. Moreover, we have no locum spend and no rota gaps. For the registrars and consultants, we use innovative software called Health Rota, which makes self-rostering and preserving work–life balance much easier.

Valuing doctors with jobs and rotas that respect and cultivate their personal and professional needs keeps us refreshed and motivated to keep working long term for the NHS, not only benefitting the staff but also the patients within it.

We have just been featured by the British Medical Association as an example of best practice as part of their medical rota gaps campaign and feature. Our video lets you hear more about our experience, and more detailed information is on NHS Improvement.

We need a change in culture and how our employers, regulators and educational bodies design how doctors work. Our fellow-posts and rotas at BSUH are an example of a growing resource of how we can do things differently and for the better for all doctors. We hope this is just the beginning of good things to come. Fourteen months ago I might have left the NHS, but now – provided practice like this is spread more widely – I am looking forward to the future.



I'm Programme Head of Workforce Innovation at Skills for Care, a 6-foot plus, white middle-aged bloke and I have been bullied and witnessed discrimination and violence at work at different times in my career.

In each instance I talked to my manager about what had happened to me or what I had witnessed, I followed organisation policy and procedure, and I was never completely sure that the outcome was what I had hoped for.

Each time it was my fear ‒ of those I worked with, of my manager and my senior managers ‒ that had the biggest impact on what happened next.

Fear is not an emotion that many of us like to confront and it takes many forms in the workplace. If I report the person bullying me, I fear they will bully me more. I fear that others look at me sadly, thinking to themselves: “how brave, to stand up to the bully,” “how stupid,” or “it won’t end well for him”. I fear that if I tell others that what they are doing is discriminatory, I won’t be taken seriously.

When raising concerns about violence at work, there can be fear about what people will say. “Well, as long as no one gets really hurt, let’s not say any more about it.” “We are being inspected soon and if they hear about this it might affect our rating.”

Is fear about the consequences of standing up to bullying, confronting discrimination and protecting people from violence in the workplace a reason not to act? The answer is: we must act. However, the reality is that many of us will find reasons not to.

We might do this by pretending the bullying doesn’t really hurt. Being relieved when the bully moves on to someone else. Convincing ourselves that the person being discriminated against is just being over-sensitive. Unconsciously deciding that a certain level of violence at work is to be expected. Eventually, that might mean going and finding another job, leaving the bullying, discrimination and violence for others to cope with.

If I think more widely about bullying, discrimination and violence at work, I also see a direct link to the productiveness (or lack of it) of the workforce. Bullying, discrimination and violence damage the quality of people’s care and support, and ability of workers to do a good job.

Bullying can make people frightened of challenging poor practice. Discrimination can create a narrow workplace culture where anyone that doesn't conform is marginalised and the knowledge they bring is not taken seriously. Violence can increase absenteeism, burn-out and turnover. 

Standing up to bullies, challenging discrimination, not tolerating violence at work is hard. But, in my experience of each of those things, the key to success is to not face any of this alone. A bully will usually be bullying more than one person. Discrimination will impact on everyone in different ways. Violence at work will lead to people getting badly hurt.

Open and transparent conversations with your colleagues and managers is key. Everyone will be frightened about changing things, but fear can be lessened if you act together. You are never on your own.

Like any other sector, bullying can be an issue for people who work in adult social care. In this blog, I reflect on my own experiences and what can be done to tackle the problem.

I think the subject of bullying in the workplace is complicated. I have worked in social care for many years and the truth of it is, over this time I was once accused of bullying and have also felt bullied myself.

When accused of bullying by a colleague I had a responsibility to line-manage, I felt quite desperate that this word was used to describe how I made someone feel. I read the Acas definition over and over: “bullying may be characterised as offensive, malicious or insulting behaviour, an abuse or misuse of power through means intended to undermine, humiliate, or denigrate or injure the recipient.”

I didn’t recognise these words as a description of anything I intended to be when managing my colleague’s performance issues at work. The matter was resolved following an investigation, yet the feelings I was left with felt unresolved for some time afterwards. I imagine the feelings my colleague felt were unresolved for some time too. I watched her distress in investigatory meetings and I’m sure she observed mine.

When I felt bullied I felt distressed too, out of control and a great sense of injustice about the way I felt treated by a colleague. 

Looking back and looking forward, the lasting thoughts for me are about how we make people feel working with them when we go about doing our job, and also the feelings of people with care and support needs we work with in our social care job roles. I always conclude that how we make people feel can be more important and more lasting than what we actually do, with the memories of how we felt about something being more lasting than our actual experiences. 

As a social care practitioner, I believe the best protection we can adopt to look after people – whether our colleagues or people we provide care and support to – as we go about meeting our job responsibilities, is to be continually reflective on the values that inform how we think and behave.

Checking out with ourselves: are we doing what we need to do in a caring way, giving due consideration to how we might make someone else feel and are we doing it in a way that treats people fairly and with respect? Sounds simple – just always think about the impact of how we behave on others and ourselves – like I said, it’s complicated.

NHS doctors gathered around in hospital

I registered as a pharmacist and started on the NHS Graduate Management Training Scheme (GMTS) in September 2017. I joined the policy & strategy stream in London and have worked in different areas within the NHS before and during the scheme.

Throughout my time in the NHS, I have experienced many teams and seen different levels of empowerment. To me, empowerment is about supporting people to do their best. While on the scheme as a graduate trainee, it can be very difficult to make an impact within the NHS as you are seen as a junior member of the team.

During most of my time in the NHS, I felt empowered by my colleagues and senior management to make an impact. For example, when working on a project alongside senior clinicians to improve patient safety on the wards, I noticed a gap in a different policy area which could also result in a compromise for patient safety, but was not part of the scope of the project.

I raised this with the management team and my team, who expressed much interest as no one had brought it to their attention before. The management team said they were happy if I were to run with this idea to see how it worked out and report my findings back to them. I enjoyed this, as I felt trusted and valued by my colleagues. I was the only person going to be working on this, but I didn’t feel isolated as I knew I could knock on a colleague’s door for help due to their open door policy.

In turn I have been able to bond with and develop meaningful respect for them, and feel comfortable discussing problems with them, knowing they will listen. My findings have shown that since I introduced my idea there’s been a change in the way the service works that has had a positive impact on patient safety.

As part of the GMTS, I have developed personal mental techniques to empower myself, which I developed during the study days. Led by a facilitator, we confidentially discussed real-life problems and used a structured approach to help each another solve them. The technique has enabled me to enhance my leadership skills and become more strategic in the way I work, which makes me feel more confident about the decisions I am making.

To empower a team, the key is leadership, which through living the values, creates the culture. In my experience, there was a clear drive to be supportive of staff and help them do the best they can, allowing leaders to deal with barriers to delivering good patient care. The training from the GMTS provides the groundwork for good leadership that empowers all staff to move towards a vision and provide high quality care.

Staff at Middleton Hall

People often tell me how impressed they are by our facilities at Middleton Hall Retirement Village. 

I frequently point out that it does not matter how much we spend on facilities, it would be wasted if we did not have the best people working in those facilities. We’re fortunate to have a great team working here, but it may not be a total coincidence.

For me, there are 8 key areas that have contributed to our success in social care.

1. Visible leadership

It starts at the top. Our directors all work in the business and are highly visible and accessible to staff and residents. This includes a weekly drop-in with me, when any employee can come and ask questions or talk about their concerns.

2. Vision and values

Middleton Hall is driven by a clear vision and strong values that are consistently demonstrated by its leaders. Our senior managers and directors can be found eating with residents, attending resident and staff meetings and taking part in events.

3. Making sure staff are supported and enjoying their job

We understand that there’s a clear link between customer satisfaction and employee satisfaction. Our leaders cannot deliver care and support personally to all our residents.  However, we can ensure that our employees have the right support and training and, most critically, enjoy their jobs – I’ve been known to loiter at the staff entrance asking people finishing work how their day has been!

4.Recruiting on values

We recruit on values and attitude rather than experience. When we opened our newest care facility last year, over half the new recruits had not worked in a care home before.

5.Enjoyable, educational training

We have our own training manager but also use external trainers. Our training is both technical and values-based, and is designed to be enjoyable as well as educational – past sessions have featured the New Zealand All Blacks and the Haka!

6.Values-based management

A key part of our management process is Middleton Hall’s ‘values commitment’.  This looks at how our people go about their jobs rather than what they do.  All employees are measured against our values commitment at least once a year. 

7.Planning to improve services

Each manager writes a service improvement plan for their service each year. These plans are based on our company objectives and key performance indicators. The plans are then shared with their teams, linked to individual objectives and employees are asked to contribute ideas.

8.The 3Cs: challenge, change and communicate

The ‘3Cs’ encourage everyone to take responsibility. We all have a part to play in challenging managers or colleagues, being open to change and communicating.  Our monthly employee newsletter highlights achievements, outlines what’s on and shares best practice. Meetings are timed to communicate up and down the organisation. 

Does our approach work? Well, 96% of employees say they would recommend Middleton Hall as a great place to work, residents and families have rated the service as ‘excellent’ (60%) or ‘good’ (40%) in last year’s customer satisfaction survey, and the Care Quality Commission has given Middleton Hall an Outstanding in every area – but we can always do better!


Secrets of success in adult social care

Posted by (Account removed) (Banned) Sep 4, 2018

Young woman and her carer

Frustrating, hard work, under resourced, viewed as low status and often under recognised – I wouldn’t swap my career in social care for the world!

I began my career in social care as a care assistant in 1979. Since then I’ve moved across social care jobs, into the NHS, lecturing, and learning and development, but never far away from the beating heart of social care. What always strikes me is that I, along with many of the 1.47 million social care workers, love my work despite the many challenges the sector faces.

Skills for Care’s report Recruitment and retention in adult social care: secrets of success gives us an insight into what makes the people at the heart of social care love the work they do, and shares best practice so that we can learn from each other’s achievements.

There are around 21,200 separate organisations working in social care. Unlike many sectors, you don’t need to have a statutory qualification to become a care worker, and job descriptions vary greatly from organisation to organisation. The absence of these factors means that a coherent, meaningful career pathway isn’t always obvious. However, this does not mean the sector is low skilled.

During my time in learning disability services I worked with a fantastic support worker who, once a month, supported a young man to watch live wrestling (think WWE). He loved to sit in the front row, shout and get fully involved. She hated wrestling with a passion. As she sat with him and joined in, you would have never known. No qualification was needed, but what was needed was a values-driven approach to support that young man and enable him to live the life he wanted.     

We cannot underestimate the skill and knowledge needed to deliver personalised care and support in a pressurised work setting, and we must not underestimate the personal challenge that parts of the work can bring.

While for some people social care is simply a job that may be convenient or may be the only job available, for many others, social care in all its forms is a passion and a vocation for people who want to make a difference, add value to people’s lives and enable people to live the best lives possible. Many in the social care workforce turn up each day and night 24/7 and give their all despite what can be thrown at them.

Recruiting and keeping staff

In the Secrets of Success report, Skills for Care sets out some tips from employers who recognise the current issues and are doing something about it.

We’ve learned that many of the sector’s challenges can be addressed if employers:

  • advertise in the right places and in the right way
  • adopt a values-based recruitment approach and tell it like it is
  • offer taster days or shifts
  • invest in a good induction and offer meaningful ongoing learning and development opportunities
  • involve the people who receive care and support, their families and advocates in the selection process where appropriate
  • develop a positive culture that recognises workers as the most valuable resource   
  • deliver compassionate leadership

The full report is available for the sector to read, discuss, embrace and build upon.

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