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That still in many ways in the health service, we behave as though the people whose needs we should most be worried about are people who are well apart from something being wrong with some part of their body. And that is not really what is driving demand. What is driving demand is people who have long term conditions, multiple conditions, often a combination of physical and mental health issues and social challenges as well. I spoke to a GP just a few months ago, one in three of my patients, she said to me, they're really talking to me about housing problem, not a health problem. So our model of care is broken in two ways. First of all, people who have long term multiple conditions bounce up and down, they're referred in and out and in and out and never really get the kind of holistic support and care that they need to be empowered. And secondly, when you're talking about people who have these kinds of challenges, often, the solutions are not just as I've said within the health service, I visited East Birmingham recently, fantastic work they do there on proactive care, neighborhood care. I sat with the integrated neighborhood working team as they built care packages in real time. And at the end, having watched them for half an hour or so, I said, what is the service that you lack? The thing you'd like to refer? You know, if you had more, you could refer more people to. And they said to me befriending, you know, so not a health service, not even really a statutory service, you know, a characteristic of communities which only really the community and the voluntary sector can enhance. So that's the second point, we're failing people because actually, our model of care is not sufficiently holistic or proactive. Um The third point, I don't need to, you know, go on at length, it's completely obvious and that is, you know, 80% of our health is not determined by what we do in the health and care system, it's determined by other things. So if we really care about people's health, then we do want to influence policy on housing and welfare and environment and planning and education and all of that. And then the, the converse of that, which is that we are really one of the biggest parts of the economy and our employment practices, whether our policies are sustained our role as an economic and social actor and anchor is absolutely critical to communities. So that's the third reason we need to join up and think beyond the kind of stovepipe of the of the of the health system itself. And then the final reason I'd say this is absolutely essential is that, is that collaboration, if it is to work, if we are to join up um health, other public services, the third sector business, actually, it's easier to do that the closer you get to people. But it it is also easier if you have joining up at every level, going back to East Birmingham again. I said, why is the neighborhood working so good here? And they said because we are also really integrated at place level and because we're also integrated at system level. So each level now, so so in order to get collaboration on the ground neighborhoods and places you need at every level up, but the hardest level to do it is at the top that is the hardest place to do it, which is why it is you need to think differently about doing this. II always remember a wonderful quote from a, a friend of mine who was a political scientist years ago and he said the problem with politics, he said is hard to reach people. Um And there's no one harder to reach than politicians. And and in a sense that is right, that collaboration is easier to do the closer you are to people, the harder it is the f the further away the the the more closer to the center, the more difficult it is. So second set of things I'm gonna say before finishing, how do we go about this, how do we, how do we achieve a more whole government collaborative holistic approach to our problem solving and to our services and to the ways we work together. So the first thing is it has to come from the top, it has to come from the first Minister from the Prime Minister. Uh It simply will not happen unless the person at the top is profoundly committed to a different model of governance. Um And at the moment in England, I think it's fair to say that, you know, labor got into power with its five missions, this big promise of doing things differently joining up differently. And at the moment, the jury is rather out because I think people's experience in government is well, they're not quite sure whether it's really happening. I understand, don't repeat this, don't tweet it, but I understand that the Prime Minister might make an intervention next week to kind of re emphasize the commitment of his government to working in a different way. So it has to come from the top, this commitment to different ways of working and connected to that accountability has to reflect that. So if you're in the cabinet, you've got a group of ministers. If the what those ministers, what that cabinet is accountable for are just the things they control. This will not happen. You've got to create some form of collective accountability. If things are gonna change. I I'm watching now as White Hall fights over the budget, which is coming in a couple of weeks. I can tell you the way they're fighting is the traditional way they're fighting every department fighting against every other department. That's not because these are bad people. That's just the logic of how bureaucracies work and that's why it's difficult to do this. Only if you can genuinely develop shared accountability. Second point linked to that is you've got to have objectives which really underline that. What are the things we're trying to achieve? And you have to say the things we're trying to achieve are those things that can only be achieved if we work together outside departmental boundaries in different ways. So, you know, if you want to reduce waiting lists, it's very hard to do, but you kind of can do it by pumping money into ACUs. Um and you can do it down that kind of stovepipe of accountability. But if you're committed to halving the gap in healthy life expectancy between the poorest and the richest communities, which labor is committed to, you cannot possibly do that if you just work in one department. So it's partly about moving from a focus on activity to a focus on outcomes. But it's also having a, a commitment to outcomes which require people to work together if there's any chance of them being able to be successful and then going one step down. So you've got to have leadership from the top, your shared accountability, you've gotta have a set of outcomes that pull people together and force people to work together. And then the next level down is that needs to turn into particular projects, particular problem solving projects. What are the things that you're going to change as a consequence of working differently in order to achieve your outcome? So in England at the moment, probably the best example of that is a focus on economic inactivity. No, uh we know it's an enormous problem. Nearly 3 million people of working age in England, uh not working for health and care related issues. A problem which is even worse in Northern Ireland. So how are we gonna change that? How do we tackle that? We've produced a big report on this recently and, and like any complex problem, it will not be del delivered through one pulling one lever. It's gonna be a combination of a whole set of different things. It will be probably improving the quality of work, thinking about how the benefit system works, thinking about how you support people out of work, how we, how we, how we get to people more quickly when they drop out of work because we know that the easiest thing is to keep someone in a job. The next easiest thing is to get them back in. If they've been out for a short time, it's really hard to get people back into work. If they've been out of work for more than say, three months. Right. So all of that, what can we do in the health service? You know, we know the profile of people, we know economically inactive. We know young people. It's primarily to do with mental health, older people. It's primarily to do with musculoskeletal issues. So, how do we target programs uh in the health service? How do we um emphasize the importance of economic inactivity? It might mean difficult choices about priorities. Um But are we willing to make those? So the next thing we have to do then is to say, what are the projects where we can demonstrate change by working together by, you know, department of work and pensions, department of Health, Department of Education, local government working together. Um And how does central government support joint approaches at, at at place level? And then the fourth point and I'm coming to an end now, you'll be delighted to hear. Um the fourth point is about capacity and process. So, you know, all of this is great, this kind of theory of, of, of, of leadership and accountability, shared outcomes projects. But in the end, it's about how people work together, you know, don't we all know that, you know, whenever I go anywhere in the country and I say to people, it's collaboration working. They say, well, it's all about relationships. Um I did a session with civil servants about three or four years ago. And I was talking about, you know, how do you work differently? And they all agreed that they needed to work differently. And I sent them into groups and I said, tell me the one thing that enables you to work differently and the one thing that inhibits you from working differently, and they came back with the same answer to, to both questions, the both questions, they said process. If the process of the way that we work is egalitarian, it's well structured, it's well followed through. There's a sense of clarity about it. Well, then we can do amazing things. If it's hierarchical, there's no proper support, it's not clear, there's no we follow through. It's just a waste of bloody time and most of the time it feels like the latter, not the former. So actually the way in which we organize people, the processes we put in place. And one of the things that's really struck me as I go around the country looking at uh health at the front line when it comes to things like care, coordination or neighborhood working. And II didn't think this would be the case, but actually physical proximity makes a difference. Actually being in the same room as people makes a difference. And this is actually, it's, it's interesting, isn't it? Because I'm political, I have a political background. And you know, the, the 1st 11 of the people who can recognize this actually going back years was the Bill Clinton campaign when he first got elected James Carville, his campaign manager could see that the policy people were putting in one way, the coms people were pulling another way, the events pull people were putting up. He created a war room. He said the only way to solve this is physically to put people in the same room and so they can solve problems in real time. And I see that. So I think actually, you know, as well as all the big stuff, when we think about how we're gonna get government to work differently, we've got to think about how we literally get people to be in the same spaces, solving problems together. And that's partly about solving problems at each level, you know, in government and in places and in neighborhoods. But it's also up and down, how do we create the kind of processes which mean that the people at the top are talking to the people who are delivering this stuff and vice versa. So we develop those kinds of relationships because an awful lot of this stuff and I'll finish with this point. An awful lot of this stuff is about kind of big things and strategy and objectives and targets. But the day to day reality of government is it's just constantly causing problems, there's constantly unknowns and actually the ability to ring someone up that, you know, that you have a relationship with and say, look how do we solve this problem is incredibly important in actually making this work in a day to day sense. I'll finish with that. Thank you. Thank you, Matthew. So, leadership for delivery, talking about leadership and leaders leading with renowned reputation for research right across health and social care. The Nuffield Trust is obviously perfectly placed to consider how leaders can help to create different ways of thinking, especially with such significant transformational agenda facing us here in Northern Ireland, we are delighted that Thea Stein has come from the Nuffield trust to pass on her words of wisdom. She's in a terrific position to guide us on what has worked. And you are invited now to consider your leadership and your leadership journey. It over to you. That's the theme of this session. But before that, it's over to THEA and then we'll take question. Thank you. Uh I haven't got 100 and 45 slide. I was like 100 100 and 12. So it'll be fine, worry not. Um So I'm going to talk about what does it take to be a leader in really, really hard times? I really dislike the word challenging. I think it's a way in which we pretend to talk about something about what it isn't. It's, it's really hard. I'll probably wander around because if I stand behind a lecture and usually people can't see me because I'm really short and I wear flat shoes. So we'll just deal with that. So what does it take to be a leader in really difficult times is what I'm going to talk about and a little bit about leadership skills for transformation. I just say a little bit about me. So why do I have the audacity to stand up here and talk? Because some of what I'll talk about will be from me and from my experience as well as from what we know from the literature and what we understand. So I work now as the chief Exec of the Nuffield Trust, which is a health and social care think tank, which works across the four countries. And it's an amazing privileged place to be. But I've done a lot of things in my career. I started is a clinical psychologist and family therapist. I've been a chief exec in the health service, the chief exec in the charitable sector, running an organization across the four countries. Carers Trust, which could be known to some of you. And I also ran a regional development agency. So I've worked in a huge range of different places. And if there's one thing I've learned is the challenges and how you face them, what you do about them is actually exactly the same wherever you are. And where I think we are is a place which is often summarized by this acronym VCA VCA. It comes from the American Generals and it comes from what you describe as a state of war and a state of war is something which is volatile, uncertain, complex and ambiguous. And those are the words that I would also use to describe where we are in health and social care. And often in public service generally, we are in a state where things are volatile, uncertain, complex and ambiguous. And if you start to think about it in that way, you need to understand therefore what the challenge is for all of us. And it is to be open to new ideas. It is to understand how we work in worlds where we have incomplete information. If you keep waiting to make a decision until you have complete information, you don't make a decision. So we've got to work in a way, we've got incomplete information. We've got to understand we're in a complex system. Often people think we're in a complicated system, they are different. Somebody once described the difference to me between complicated and complex in this way. Um If I've got a ball in my hand and I throw it out into the audience, generally speaking, we will know where it's likely to land because you can have an idea. And I'm quite sure I got, I'm using my left arm, I'm doing it this way where it's like I've got terrible eye hand coordination. So actually, you probably can't predict that well. But nevertheless, you probably can generally predict where it's going to go. That's complicated though. There's a lot of math there's a lot of science to work it out. Complex is if I'm holding a bird and I let it go, we have far more variables, it's far more random complex situations demand an awful lot of us. And we have to be leaders that understand what it is to be in a complex situation. And we have to be understand to be comfortable in a world that's ambiguous and gray. And I think that's really important. I like ambiguity and I like worlds that are gray. A lot of people feel uncomfortable in them. They want things to be very straightforward. They're not and they're absolutely not straightforward now. So what's the policy direction? I'm sure you've rehearsed this a million times during your conference. But it's the same. I think across the nations, we want to move care closer to home if only we understood what we mean by that. But that would be a different speech. We want to manage down waiting lists. We want to believe in the power of a I, not the way I say it. And I distinguish that from really understanding and embedding digital. We want to become more productive speech in itself and we want to work as a system. We want to be integrated, we want to work as a system. And the reason we want to do that is to do what Matthews told us, we know that if we can do all the this, we can actually move as well to prevention and we can flatten the curve and we can particularly understand where our, our, our older people's population are coming from. We can understand mental health demands, what's going on with our young people. And so we know what we want to do and we know what we're trying to do. But there's a really big context around that as well. We have, what I would see is a lack of parity of esteem, conditions and influence between the different sectors, between health and social care. That is absolutely real. I spent nine years as a chief exec of a community trust in England. It was a really big community trust. I ran a lot of mental health services, et cetera and I was quite successful in what I did. And so people would phone me up and ask if I wanted to apply to run a hospital because if I really was good, I obviously wanted to run a hospital because it was more powerful, wasn't it? It was more important, why wouldn't I want to go and run a hospital? There's lots of ways parity of esteem between the GP and a consultant. We do not have a conversation that puts social care on the same level. We never do and we certainly don't. Around the third sector, we have significant regulation and performance management around particular targets, which means that we talk a of the time about hitting a target. We all know the phrase, you can hit a target and you can miss a point. But we're doing that spectacularly. One of the ones that, that, that, that I've been aware of most recently is is within ophthalmology. Whereas in England at the moment, we are European leaders in the way in which we can do cataract operations. We are so quick in doing cataract operations, we are European leaders. We also have more people going blind. It's absolutely true because we are not prioritizing other parts of the ophthalmology pathway. We can really, really hit a target and really, really miss the point in England and in most parts of the UK, we still continue to look up as systems in a local level. We're always looking at what's going on above us. What what do they want there? We should be relentlessly focusing and able to do what Matthew was talking about, which is looking local, being local, relentlessly focusing on those of, of, of patients and of the community around us. So we've got this really complicated, ambiguous, difficult place in which we work. And yet at the same time, we all want. And I know there's a real enthusiasm for a new management paradigm and a new way of leading. We've talked about this for years across the health services. As I said, I'm a psychologist by background and Isabel Menses is somebody who work who wrote in the 19 fifties. Her work is still extremely relevant and she talked about the fact that in the health service, we deal with death and that we develop a whole range of rituals and a whole range of behaviors because actually what we're dealing with is death and pain and despair and lack of hope. And that's really hard and it's really hard to sit with and it's really hard to talk about. And so we have a load of rituals that we do around that. I've often noticed in the health service that when we're in a period of escalation or like I like to call it panic. Um that what happens is the center asks us more and more for more and more pieces of paper. You know, I'm very, very stressed, we're very stressed, we better fill in another return. Um That's what menses would talk about is our behaviors that we do in that situation. Messenger in England, Gordon, Messenger wrote a review of leadership in the, in the NHS. And he talked very much about external pressures such as performance metrics, stringent regulatory requirements rate or blah, blah, blah, blah, create a very difficult backdrop for compassionate leadership and collaborative inclusive behavior to thrive. So we've got this paradigm at the moment when we know what we want. I don't know you, but I know you know that it's about compassionate leadership, collaborative inclusion of leadership, but actually, it's really, really hard to do that within some of the context. We're in Julia Unwin. Um writes about the different um lexicons of language in public service. I won't go through all of this. But I really think it's interesting work. She talks about a rational Mexican and a relational Mexican. I always have to be careful that people think I'm saying irrational, I'm not. But we know, and again, Matthew talked about this, the language of the way we work. The language of what causes change is relationship, it is relational. It is what we do with others. But the language we often use in public sector and in the health service is the language of balance, fair, transparent, safe scrutiny, value for money boundaries. This is not the language that gets the clinician up in the morning. This is not the language frankly that made me as a leader come into work at the in the morning. But so these are different lexicons and yet we often frame our debates around one rather than the other. I wanted to talk a little bit about Shackleton mainly because I love showing the slide. Um This is the advert Shackleton put out when he was advertising for men to go on his um expedition with him. Men wanted. If you can't read the hazardous journey, small wages, bitter cold, long months of complete darkness, constant danger, safe return, doubtful honor and recognition in case of success. I just love that. Um And he got a boatload of people. Why do I put it up? Um Because Shackleton has emerged as somebody and I'll come back to it as who's been a great leader in our times, an amazing leader and he took men with him who answered that advert. And I think sometimes we feel a bit Shackleton, like I think it's not as bad as that, but it can feel really challenging the thing I want to talk about a little bit and I could talk about this a lot, a lot is at the base of what I think we need to all be doing collectively is creating the context of psychological safety. And that's at every level. It's a GGO back to what Matthew saying is, every level is from the Treasury to the Department of Health. It's from the highest levels of government to the front line. If you do not have the capacity to have as Edmondson would put it felt permission for can, if you do not have the ability to have that honest and open conversation, you will never go anywhere and you will never solve the problems that you have that we have at the moment, great systems, understand this already and great leaders in the private and the public sector talk a lot about psychological safety. My favorite example is the Google Aristotle project. The reason I use this one is because Google is not an organization that's out there full of love for the world. It's not an organization that's doing anything about compassionate leadership and things like and psychological safety because it isn't concerned about the bottom line and profit. It is. So, what they did was they set up a, a project, they looked at 100 and 80 teams across their world and they looked at what made their teams the best, what made them the most productive, what made their teams actually fly and they thought it was going to be the best engineer with the best data analyst, et cetera, et cetera. I mean, you're going to know where the punch line is going here. I understand that, you know that and of course, what they saw was that it wasn't that it was those teams that had the ability to share value, to share understanding, to feel like the civil servants that Matthew talked about to feel understood, to feel well led and fundamentally to feel psychologically safe across the world. Those were the teams Google have the most amazing data points. By the way, they were able to use data, for example, as to who sat next to who at lunch and who went. I mean, it sounds really weird to me. But anyway, that's what they did. And what would I say? I would say that often, we don't use the right data when we do use data. I'm really interested in ethnography. I'm interested in how we use what people really do rather than what we imagine people do. You've probably heard the phrase work has done uh compared to work as imagined. I think we create a lot of policy and we create a lot of programs based on the idea of work as imagined, not on the basis of work as done. All leaders Matthew has just described what he does and his leadership position need to get out of their offices and go and sit with people all the time. You do not create policy by data points that are about statistics alone. It's about the ethnographic interview. It's about the ethnographic observation. That's how we understand what's really going on in our world. So, back to Shackleton, there's lots of books written about Shackleton and he's an interesting man and he managed to keep that amazing group of people alive in an extraordinary situation on the ice, the boat when we all know the story. But it's an amazing story. And when you look at what Shackleton did, he really understood psychological safety in a way that he didn't understand that language. But he always tried to inspire optimism. Despite being in a very er world, he had a really clear shared purpose. He built unity and commitment. He always created a plan and an alternative plan and he was, is very flexible, which is something we have to be, we have no ability to be rigid in the world we're in at the moment. If our plan doesn't work, break it, start, stop, start again, do something else. We have to be humble in what we're doing. And he made all the tough decisions with his people and he provided that psychological safety. So finally, in my 150 slides, I think it's really important to understand when you're in a system that you are part your organization. I used to say is an organization without walls. All of us have to imagine that we're in that sort of world in which we can really reach out in a psychologically safe place to each other. I could have talked about masses of international evidence or around what leadership works in these complex times or systems that have actually done the changes that we all want to do. Denmark is one. They have actually done what we all say we want to do and you do that by knowing it takes time and you do that. But going right back to what Matthew was talking about, everything has to align and within that this way of leading has to have a chance of flourishing. Thank you. So we're opening up for questions to the floor Heather has the microphone there. Again, if you could make sure that you um indicate with your hand up nice and high, so I can see you sure because I have a spotlight in my eyes. So um questions from the floor about leaders. Thank you very much guys um about leadership um about what our two guests have been speaking about. Have a wee moll let me get as many questions as I can. Mark will have one from the front. Um The one thing I was one thing we, we heard about, they're talking about um leaders, understanding their workforce, their employees and their staff is there should there be an expectation or should you nurture a culture where the staff can also understand the leader? Oh, always. Absolutely. But that isn't necessarily the case. Not always. But I think I know what you're trying to do as a leader. Yeah. Absolutely. And, and I think translating, um when I was in, in the NHS, in, in England, um and I was, I've been in the NHS in Scotland as well. You often used to get missives from the center and it would say please cascade this to all of your staff. II used to go. No, I don't think so because I was bad. Um That's why I'm enjoying my job now because they don't, we don't communicate in the right way about the things that really matter. But actually, I've never met a front line member of staff who doesn't want to understand it, who doesn't want to, to know what we're all striving to do. And, and, and you've got to find the language and you've got to find the way of having that conversation. I mean, you, obviously you're a communicator. The problem is we often communicate in ways that people can't hear what, what we're talking about. But, yeah, definitely and, and Matthew, as you say, that's all part of the relationship building. It is. So, II think, I mean, look, Thea's talk was absolutely brilliant and um I think there's some kind of hygiene factors about leadership. I say this as a chief executive. So I'm speaking by myself and my own experiences, you know, you do need to spend time with people. Uh You need to understand your behavior is 10 times more important than your words. You need to understand that. It's only when you think you'll be physically sick, you say something one more time that people are starting to hear it. All right. You know, I remember sitting with the Secretary of State many years ago and she said, well, I made this speech and with these four points. And do you think, you know, what do you think people in the NHS think? And I said they have no idea. Absolutely no idea. They're still digesting what you said six months ago. Uh One, the one thing you said six months ago. So, you know, they're all that stuff you just need to be. But I think the deepest thing you need to be aware of as a leader is the way you see the world is because you're a leader, not because that's the way the world is. And for me that is the, you know, when I think about a leader, I spend quite a lot of time with a, a person who has many strengths, but their biggest weakness is they don't understand that the way they see the world and the problems in the world is partly because of where they sit in the organization. And I had a conversation with this leader. We were both in the room and they said, oh, people have been phoning me from out, you know, from outside here telling me really positive things. And I kind of wanted to say, did it ever occur to you that if you want a career in the organization then ringing the boss and going, oh, you know, I really think you're great, might be in some ways a reflection of their career aspirations. And maybe the fact that you're an organization where telling the boss what the boss wants to hear is good for your career. That might be what this actually tells you rather than the fact that the organization is great. So what you need to do as a leader is what you're trying to do is to build an ecology of change and improvement in which you as a leader play an important role. You are not trying to be the person who does everything. And I always go back to it. It my favorite m leadership moment. Vignette cos, you know, you all talk so much better than mine cos it's certainly more examples, so much more human. But um I'm trying to catch up now. I saw Miles Davis, the great jazz trumpeter on his last tour. And he played at the N EC in Birmingham and he had this big orchestra playing this music. He'd written fantastic music and miles just walked around and occasionally just pointed at people and, and then occasionally he would walk to the front of the stage with this trumpet and he'd kind of go ba, ba, ba ba, just reset things a bit and then the orchestra would carry on. And I thought that's how the leader I wanna be. I wanna be a leader whose orchestra is playing the music. And just occasionally they kind of go off a bit. I'll come back in, I'll do a little bit of that's how you need to be. If you are a leader who feels that you're rushing from playing this instrument to that instrument, to that instrument, to that instrument, conducting everybody writing everything you're failing. So that's a leader who wants to be in control rather than delegating and having a shared experience. No, he worked with his or, you know, he worked with these musicians they collected and there also was a high degree of, of, of, of um extemporary work in it. So this was a band that were playing their own way. They had a basic score, which they'd all agreed, but they were playing in their own way. And his job was just to enable that to happen, that creativity to happen. But just occasionally to come forward at moments where you just needed to reset a little bit, get something new going and that's the way you want to lead if you can, because you've created, you've created a creative environment. Yeah, rather than being in a situation where everything happens because of you. So trust others to be part of that trust that may be. But, but also doing, having done that sort of a really disciplined approach. It's not just about, oh, we all love each other. It's, you know, they were great, people knew what they were doing, had great skills, working together, confidence in each other. And that is the environment you want to create, Mark. Um Matthew, Thea Mark Taylor, I'm going to wear my surgeon hat. I have a few hats, but I'm going to wear my surgeon hat. Fantastic presentations. You're preaching to the converted in this room in many ways because collective leadership bottom up psychological safety, slight reality check in Northern Ireland. Uh lots of public inquiries, worst waiting lists in the UK, psychological distress surveys, Royal College of surgeons. Number of people really not happy, feeling, undervalued, feeling a psychological distress. How do we rectify that from the top down? And also what is our role as individual leaders to try and work around that current situation we find ourselves in. So without sounding trite because I, there's, that's when that's when it matters most, that's when it matters most to have the um the ability to sit with that psychological safety. I mean, at the core of psychological safety is the ability that you and I trust each other to be open. Um II started talking a bit about psychological safety because I was really interested in looking at why we weren't. I described it because it's probably a bit funny. I, we're not having productive conversations about productivity and at the root of that is because I think we don't trust each other and actually we have to trust each other to go actually, yeah, you're right. That surgeon does twice as many in a session as I do. And actually, I don't understand why she does and, and I'd like to understand or actually go, she does do twice as much, but they come back in. So actually, I do half as many. But those are readmitted and we need to have a conversation, but we'll never have those conversations about psychological safety when things are broken and when things hurt, which is what you're describing. There's never a more important time to have reconciliation and there's never a more time, more important time than to be humble and open about where you are. I think in psychological safety terms. Again, Matthew talks about a room that we, we go into sometimes together, both invited in where I observe the ability to hold the fact that people are angry and people are upset, which is what, um you know, Matthew's members are, some of which are here is the ability to hold that and listen to it and go, ok. I don't, I want to hear more. Tell me more. Let me, let me understand more. You, I, II couldn't think there was a more important time to go big on psychological safety. But final point, I'd absolutely agree with Matthew, that's from every level, every level. So I'm much more knowledgeable about the English system, the Treasury and the DHS C need a bit of marriage guidance counseling in England. You know, there, there's a whole range of levels where that safety works. The reason use an umbrella on my first slide is often talked about great leaders in organizations, hold umbrellas up for their own organization, umbrellas up for their teams and that's good enough. But ideally, it would be nice to put the umbrella down because the whole weather system feels better. So for me, truth and agency, I in the end is truth and agency. So the first is James Baldwin, the American writer said people can cope with almost anything once they know where reality is. And I think leaders often think it's their job to, to, to pretend that it's not as bad as it is. You have to lean into the truth, you have to give people the time and the space to tell their truth and show that you are genuinely listening because if people feel that you don't understand how difficult it is for them and and what you'll find in that truth making process is the truth revealing process is you'll often find that the problem is not the problem that it appears to be. There is something else that is the problem. And, and just think how much time you have saved in that conversation, which enables you to understand what the real problem is rather than the presenting problem. And this is what, you know, I mean, my goodness, clinicians, this is what clinicians, good clinicians say is it's not the presenting problem very often. I have to have the time and then I'll find out what it is. It's the the hand on the door, knock the door door moment of, of actually there's one other thing doc so you have to spend the time to get to the truth and then you have to say to people, but there are always choices, you know, and again, as a clinician, you know, you know, you might have somebody who's got a week to live, but there are still, is there still a difference you can make in that last week and there's still the difference that they might be able to make in that last week to how their relatives feel. So there are always choices, even in the most dire of circumstances, that is the nature of the human condition. But you can't get to the agency point, the choices point. And by the way, it has to start from, you as a leader, as leaders in systems. It is so tempting to say, oh, I wish I could do the right thing, but I'm not allowed to. I'm sorry, you are not paid to do that. You are paid to say however difficult things are folks, there are choices that we can make and here's the one I'm gonna make. Now, what are we all gonna do? You cannot, you have to be subversive sometimes if you say we're all screwed and there's nothing I can do about it. Blame the person above me. It's time to, you know, start playing golf or something. He at the front and then, and we'll take the pink jacket there. Uh Hi, I'm so excited about this. If you could introduce yourself to us. Thank you. I'm Isaiah K. I'm an NHS clinical entrepreneur. I'm a registrar and I work in Brighton the UK. So where do I start? Amazing talks? I'm so excited because I just had a personal experience from bereavement. My father and I was off work and I tried severally because I was very distressed after the loss. He was my best friend to come back into work. I felt completely alone. I felt completely, II didn't have psychological safety. And in the end, the way I came back into work was like I was standing at the edge and someone just pushed me and my thoughts were, oh, the support I was getting was, oh after this period of phase return, you start being paid less than what you were being paid if you are not 100%. And I'm thinking about if I'm not 100% mentally and physically, why should I do 100% duties and put other people at risk? So I started thinking the system hasn't, it's not fostering that safety to return to work and how many other people out there are struggling to come back into work because there's a one size fit all mo uh model which should not be so this. And if you speak up about this, they look at you like you're just whining and complaining, we should be looking at how we can help people come back safely to do what they love doing and stay in work and do what they do best. And I think that by the way, it is very important to the debate about economic inactivity. You know, if your choice is between being on a disability benefit or doing a job where you've got no prospects, you're not treated very well. And then when you've paid your childcare costs and your transport costs, you might be 2 lb a week better off. You know, let's why bother, why bother. And that's, you know, you, you know, politicians and right wing newspapers might say that's appalling. But you know, what, what choices would we make in those circumstances? So, absolutely, part of the economic inactivity story is we have to improve the quality of people's working lives. And of course, that's a huge issue in the NHS around retention as well. Yeah. And it, it, it is a surprise. It, it remained a surprise to me all the way through my career in the NHS and remains a surprise to me now that we are not exemplar in the way in which we are employers, we should be. Um And even where we're pretty good, we still are really poor exemplar employers around mental health. It's really hard as an NHS worker to say I'm not in work because I'm sad or I'm not in work because I suffer from anxiety, um et cetera, et cetera and it's really appalling, but it is where we are. I think there is work and I think there is hope. But as you would know, your experience is far from unique, which is sad. Ok, we'll just take one last question, Anne, if you could introduce the panel. Thank you. My name is Anne o'reilly Chair of the Northern Trust. So I just want to make a comment on the comment about majoring on psychological safety. Jennifer Welsh is the Chief Executive of the Northern Trust. She was meant to be here for most of this session. And one of the sleepless nights we have about the individuals that require to come to an emergency department as part of the reality of the lived experience for our staff. And indeed the lived experience of the individuals that come to us for care and treatment. This is where it, this is where leadership matters because Jennifer's commitment to psychological safety is a living breathing thing. And it's one of the things that I can rest easy at night about and the boards can rest easy at night about because she dropped everything and she sits in the emergency departments and she is there for the team and I have only been in the trust a year and a half and the multiple times she's had to turn up night and day, weekends or whatever and just sit and be there for psychological safety. And I think that is leadership at its very best. I really do. Yeah, I mean, I think, I mean, obviously it's a shame that the situation is such that she needs to be there as much as she does. Um, but it is being present for staff in a serious situation like that is absolutely critical. And if you look at, um, hospital systems that are often have very low ratings, um, I can think of some in, in, in, in England that I'm very aware of. It will often be that the staff will say, well, this crisis was happening and nobody was ever there. Nobody, nobody ever walked the floor, nobody ever came and saw us from the board. Nobody really understood what it was like and it goes back to what I was talking about and clearly you experience, you only really understand by walking around and being there. So I think, I mean, that that's inspirational. I think as a leader, it is important to recognize that that different leadership behaviors are necessary in different circumstance. And whilst your story is inspirational, I think it's important to say that sometimes being present, showing empathy, being part of the team is what's required, but sometimes actually taking yourself away being on your own or just the small group of executives because you have to make a decision and in the end it's going to come to you, you will have to make that decision and you'll have to enforce it whether you like it or not. That is what is necessary and sometimes just getting yourself out of the way because you've got great people doing great things and you can just stand back and watch it happen. That's the right thing to do. We have to have different things, neural forms of leadership and when something like that is unfolding, that is what is required. But she's also going to require to think how do we, I don't want to be doing this in a year's time and what are the kind of hard choices we have to make? So I'm not doing that. Yeah, exactly. Yeah, absolutely. Ladies and gentlemen, our thanks to Matthew and so thank you very much. So we're going to draw this session to a close in this room anyway, the specialist sessions will begin at 130 we do encourage you to stay for those a build your own after the workforce well being. And as I said, earlier, lunch will be provided in those rooms. And if you've booked for the health committee meeting, you can get lunch in the bar. Now, over the past two days, we have had terrific insight into the powerful work that's been carried out in our health and social care services, the difficulties that still need to be addressed. But more so the desire to make the system better for yourselves as professionals, but more so for the public of Northern Ireland. So it's been my pleasure to be here and, and, and thank you for your kindness, your chat and your networking with me. Over the last two days, it, it has really been an inspiration, especially as a service user, but just as a member of the Northern Ireland population. So we'll close this session and I'll introduce again, Jonathan Patten, who will say a few words. Thank you, Jonathan. Thank you, Donna. Good afternoon conference. Well, two days have flown past um if you've had a day or two like mine where it's just been session to session and conversation to conversation, then I hope it's been as beneficial for you as it has been. For me. It's been a complete whirlwind. Um But I've enjoyed every minute of it and it's a great privilege to be the chair of NI and be part of this great membership for HSE. So, I'm, I'm very proud to be here and be part of your organization, what I wanted to do, first of all, um By way of thanks, uh was to a number of people. Um My vice chair, Michael Bloomfield, um the Northern Ireland Director, Heather, our comms director, Mark Taylor, um to our NI A team here in Northern Ireland and all the work they've done for us to the C FED team coming across to help us and support us and make it possible to Donna for a expertly hosted. Couple of days. Thank you. Um You did a great job um to the lemon staff who have helped us and facilitated us and to the A V team making it possible and still keeping me live for the last few minutes. I also want us to say thank you a big thank you to A BPI and to BT uh without their support and sponsorship of the event. Again, it wouldn't be as good. The speakers wouldn't be at the quality they're at and we wouldn't have the kind of venue that we have so a great appreciation to them for what they do for us and how they support us for our speakers and our conversation and conversations and those who contributed from the floor and from elsewhere. Again, you make that come alive and you, you challenge what is said here and you start to get a, an, a conversation going and involve that. So again, thank you for your participation in doing that. I need to say that at this stage times are hard. Can you please leave your Lanyard behind as you leave us? Um We can't afford to send you home with that. So please, if you'll support us with that. Um As a special, thank you at this stage. I want to just say thank you to Heather, Heather. I have something for you. I think it's testament to Heather's engagement and involvement as the Northern director that this year we had Lords, we had first ministers, we had deputy first ministers, we had, we had ministers and indeed, for many of us, um the, it says here locked in with Tom Frawley, but I'm nearly sure it was just a closed session um that we had was extremely insightful and uh some of the best that the conference had been offer. II wouldn't do the conference justice by trying to summarize what we covered and what we considered and what we heard from a multitude of incredible speakers um on some amazing topics, but this was all geared for you and planned for you and delivered for you that it might challenge you and might make you think that as we close down, what are you gonna open up? Is it gonna be conversations? Is it gonna be your mind? Is it gonna be change? Is it gonna be culture. What are you going to open up as we leave here conference today? In my opening remarks yesterday morning, I said this true and committed leaders do not sidestep problems. They faced a discomfort and metaphorical method, nettles in their path. They commit to improvement, they innovate and they engage with the and collaborate with the stakeholders, which in our case is to deliver a seamless world-class health and social care service for every citizen. And that's the sole focus of what Nikon wants to do in the membership. And the reason that we try to make this happen, the temptation for us all is to say that's just great. I know who that was meant for, that was meant for her. That was meant for him. It's a good job. They were here to hear that, but actually, it comes to each one of us and it starts with me and it needs to then radiate out from each one of us into our teams and our colleagues in whatever setting we find ourselves in. So let's examine ourselves as we leave and see what contribution we can to be, that change and be that difference in the places we uh work and serve. I opened up yesterday morning with a quote um and Matthew mentioned Jim Carville again today. Um It was a political quote and I want to close with a political quote as well. It's 1981. It's Llandudno in North Wales and a boy in David Steele is giving his closing speech to the party faithful of the Liberal Party who gathered for their conference. And he says this go back to your constituencies and prepare for government. So my challenge to you today as we transpose that into northern Ireland is go back to your health and social care setting. I prepare to grasp metal. Thank you. And he