Letting Leaders Lead

Contribution to 2020health report ‘Too posh to wash? Reflections on the future of nursing’

By Lou Harkness-Hudson, Unit Manager, Clinical Assessment Unit Rochdale Infirmary


The current culture in nursing is borne from a “can’t do” attitude which is compounded by a lack of innovative and visionary leadership. As a consequence, an innocuous lethargy has settled over the NHS, leading to disillusionment amongst nurses and a lacklustre approach to change.

Nurses are often not involved in the changes that have to be made on the shop floor and this leads to them feeling devalued. In turn this leads to resentments which can pre occupy members of the team leaving little time left to invest in the care they deliver to the patients they are charged with looking after. This creates an enormous amount of inappropriately channelled energy which I feel could be harnessed and used to making change effective which can be exemplified by the success of the CAU in my hospital.

The CAU is the only unit of its kind in the country. It is successful because everyone in the team has had a hand in making it so. It was borne from the Healthy Futures reconfiguration plan, which was introduced 12 months prior to its original planned date due to medical staff recruitment issues at Rochdale A&E, therefore necessitating its downgrade to an Urgent Care Centre (UCC). Linked to this was the reconfiguration of the 32 bed Medical Emergency Unit, resulting in the creation of a 12 bed, 10 chair ambulatory assessment area, with a maximum length of stay of 48 hours, named the CAU.

Referrals for the CAU are taken direct from GPs, the UCC, Community Matrons and repatriated patients from our other Pennine Acute NHS Hospital sites. We operate a 24 hour/7day service which is medically led and commissioned by the local Primary Care Trust. In setting up the CAU getting the right team was crucial. The selected staff have undergone a complete change in their ethos, perspective and roles in order to deliver the success of the CAU as a consequence they have evolved into a more efficient, understanding, empathetic and organised team who deliver an excellent service to the public.

This is the result of ‘thinking outside the box’ leadership. It is about having a co-operative approach to change. It is about embracing change from the bottom up and therefore taking ownership for change across all levels. Our mantra is ‘we never say no’ we want the service to be used by as many service users as possible. The model we are developing embraces all possibilities; the philosophy of ‘we can do’ is paramount to our success. As a team we are constantly exploring new possibilities and ways of extending our service even further, putting our patients at the centre of everything we stand for.

My leadership and the leadership of my manager has enabled every member of this team to confidently develop their own important role by maximising their own potential, contributing to the cumulative success of the CAU. In addition to this, the leadership of my manager, her faith and trust in my capabilities and our joint vision for the future has allowed me the freedom to explore innovative care delivery and implement change almost on a daily basis. The ultimate beneficiary of this model is the patient.

CAU is a relatively young service, having only been in existence for 10 months at the time of writing. During this time we have received much positive feedback from patients and relatives regarding the excellent levels of care provided. Nevertheless we realise that we cannot simply

rest on our laurels; we need to learn from mistakes made, eliminating the blame culture and using the lessons learned to improve our practice and do better next time. I feel that we have created an environment that is open and honest, where people can celebrate their success whilst also acknowledging that things sometimes can go wrong. In addition to this it is important to realise that the NHS is not the creature it was, nor will it ever be again and we as leaders must evolve with the needs of the society that we serve. Keeping that in mind, my philosophy is to treat CAU as I would a successful competitive business, generating standards which include privacy and dignity, good manners, a smile, care and compassion, excellent communication and trust, knowledge and expediency. This approach must encompass the highest expectations of care delivery and all that this entails. Leadership is also about effective empowerment of staff to have belief in themselves and belief in what we, as a team, are trying to achieve. In order to change the perceptions of nurses and motivate them you have to try to think how they think, acknowledge what is important to them and listen to what they have to say.

It has to be acknowledged that there are some ‘bad apples’ out there and that not all nurses deliver high standards of care but I don’t think that this is generic. I feel that if nurses are encouraged to feel good about themselves, believe that their opinion matters and that it is their power that drives change forward, then the NHS would become fit to deliver healthcare for the 21st century. Management is about control and power, leadership is about sharing that power, having the vision and innovation which enables the whole team to think outside the box and achieve their goals.

About Julia Manning

Julia is a social pioneer, writer and campaigner. She studied visual science at City University and became a member of the College of Optometrists in 1991, later specialising in visual impairment and diabetes. During her career in optometry, she lectured at City University, was a visiting clinician at the Royal Free Hospital and worked with Primary Care Trusts. She ran a domiciliary practice across south London and was a Director of the UK Institute of Optometry. Julia formed 20/20Health in 2006. Becoming an expert in digital health solutions, she led on the NHS–USA Veterans’ Health Digital Health Exchange Programme and was co-founder of the Health Tech and You Awards with Axa PPP and the Design Museum. Her research interests are now in harnessing digital to improve personal health, and she is a PhD candidate in Human Computer Interaction (HCI) at UCL. She is also dedicated to creating a sustainable Whole School Wellbeing Community model for schools that builds relationships, discovers assets and develops life skills. She is a member of the Royal Society of Medicine’s Digital Health Council. Julia has shared 2020health's research widely in the media (BBC News, ITV, Channel 5 News, BBC 1′s The Big Questions & Victoria Derbyshire, BBC Radio 4 Today, PM and Woman's Hour, LBC) and has taken part in debates and contributed to BBC’s Newsnight, Panorama, You and Yours and ITV’s The Week.
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