Whose edge counts? #theEdgeNHS

Quick post from me. Today there is another NHS support programme being launched, the latest is #theEdgeNHS

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‘The Edge is brought to you by the Horizons Group of NHS Improving Quality. The Horizons Group is a small team operating at the edge of current thinking and practice of change and transformation in health and care. Its remit is about sharing the disruptive power of connecting to influence change, leading edge knowledge, transformation and innovation. The aim is to support colleagues in health and care to think differently about the ‘rules of change’ and make sense of it in their own context, leading to effective change practice and better outcomes for patients’

I’ve written before about my experience and concerns of these NHS leadership or support programmes. I have always been sceptical of any organised responses, my natural preference is to usually be outside the crowd. Too much conformity makes me nervous. However my thinking has moved on hugely in the last twelve months, mostly due to my exposure to the dirty reality of life for Sara Ryan and her family following their son’s preventable death. I am aware enough to know that Sara’s experience and LB’s death is just one experience, you could say one anecdote, however the messages that we have received since we started the JusticeforLB campaign would suggest that it’s just the tip of a very big iceberg. I’m not going to use this post to talk about the campaign, you can find out about it here, or about the draft #LBBill launched yesterday to try and really change where the edge is when it comes to support given to learning disabled people, you can find out about that here.

I’d like to just draw your attention to this excellent talk given by Anne Marie Cunningham in Canada at a medical education conference last week:

It’s an hour long, so find time and grab a brew, but it is brilliant. Anne Marie talks about how social media has, and can, change the way that doctors are trained. She also talks about how it can be used badly, my favourite slide on this:


I’m interested in The Edge, I’ll watch and see how it develops. It was suggested that it might be useful for campaigns, based on this page I’m not so sure. All of these suggestions appear to be about campaigning, within the constraints you’re facing. I’m not sure the focus should be on rocking a boat without falling out, I’d like to see a few more people within the NHS standing up, getting out of their boat, and swimming with those who were thrown over the cliff edge a long time ago.

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This is not to say it is all bad or deeply flawed. I suspect it will genuinely offer something to many people who work, and potentially feel trapped, within the NHS. I applaud it for that. I can not imagine how hard life must be for some of those people, especially those who raise concerns or blow whistles within the system, only to be ostracised and scapegoated. If The Edge will help with that, improve the wellbeing of those people, then it has a place.

What I can not see is how it can help those who the NHS has really destroyed. Those who it continues to destroy. Those who need it more and have no resources, HR departments or salary to support them. The aim, as articulated above on their website, is ‘to help colleagues’ so please can we not pretend everyone can join the conversation, why would anyone want to put the effort into climbing the cliff edge to join a conversation at the top that will benefit the system that is so quick to kick them back over the edge once they’re too controversial or too skilled at shining a torch on the dysfunction that exists within the NHS?

If we really want better outcomes for patients, then we need to start genuinely coproducing with them. If you really want to bring ‘patient leaders and front line change activists’ into things, then a professionally led campaign from within the NHS is unlikely to cut it.

I’m going to stop now and I wish The Edge success. I also wish people could be honest and open about what it is seeking to provide and how realistic its approaches are in that. I’ll leave you with some recommended reading of my own! The context for why this presentation was put together is here.


0 comments on “Whose edge counts? #theEdgeNHS”

This is a really powerful and thought provoking response to #TheEdgeNHS and it has taken me a few days to reflect and formulate a response. This is a personal response and I’m putting myself on ‘the edge’ by saying this but I can identify with both camps i.e. (1) those within the system and (2) those kicked out / alienated by the system. I’ve been in both and experienced the emotions and sequalae. It was my choice (and also my fortune) that I had the opportunity to climb back in the boat and try to do good from the inside out. Of course, I have an @NHSIQ hat on too, and I genuinely believe that we have an important role to fulfil in supporting those within health and care to connect with others who hold similar values, beliefs, ambitions, concerns to form a community around a shared purpose. The Edge is only the start of this community which is intentionally targeted at those who may feel disenchanted, frustrated, undermined, alienated or invisible within an organisational context. I do hear and accept that those on the ‘outside’ may see this as overly organised or contrived, but from the ‘inside’ this is (a) the safest and (b) the most ‘acceptable’ way of starting a movement. I say ‘acceptable’ in the sense that it is easier and safer for people who may feel anxious or fearful about being seen to join such a movement. Moving from a state of pre-contemplation to contemplation to action is swift and smooth when conditions are least threatening, and let’s face it, many of these people with change activism in their hearts are necessarily guarding their careers, reputation, wellbeing, professionalism, values and livelihood (think Maslow).

My hope is that everyone who kindles a burning ambition for change are able to find common ground, regardless of their relationship to the system (inside or out). I believe that we’re all fundamentally saying the same and wanting the same thing, but because of our diversity of experience, environment and DNA, we will approach it in very different ways. We must also be mindful of those who are at different stages of their journey to The Edge because to many, the language and concept of employee activism, rebels, radicals, social movements and even transformational change in the NHS is alien.

I would love to see your blogs firing conversations and debate on #TheEdgeNHS, just as much as those of others like David Gilbert. Herein lies the value of diversity and long may it continue and grow.

Helen Bevan says:

Thanks George for this thoughtful piece. We have produced The Edge because we have been getting such a great response to our efforts to hand-pick links on the latest thinking and practice on transformational change and tools for change and making sense of them for a health and care audience that is activist in change . People from a wide variety of backgrounds told us that creating the ability to have conversations and connect with others around this kind of knowledge was one of the highest value things a national improvement body can support.

We wanted to take this knowledge and connectivity to another level, hence The Edge. It’s only the first edition and we want to listen and improve it. It’s being co-created with a big group of people.

I hope you will be able to contribute to future editions.


anniecoops says:

A really thought provoking blog. It’s interesting how each of us uniquely responds to ‘campaigns’ and what we perceive maybe to be organised ‘stuff’. Equally our unique sense of where we see ourselves in the world we live in.
I recognise your point about edges that ‘in or out’ are different.
I always feel at an edge because I chose to be there. It’s naturally where I gravitate toward. I dislike corporatization. I have learnt through years of reflection that those choices are deeply personal.

But I still applaud those who try to help others to reflect and understand where they fit and how they can powerfully and personally take up their unique position and also usefully connect with others.

For me The Edge is very very welcome. I respect the team at nhsiqs ability to seek out and curate resources that will help me to think and hopefully ‘be better’.

I also believe they listen – I would encourage everyone to add their sixpenneth worth too. In that way the resources remain the diverse rich resources people like me need.

Don’t ever stop thinking out loud George. We need you and your edgy thinking to help us move on. X

I agree with you. I think all this ‘rocking the boat and not falling out’ is very organisation-centric and not person-centric. What’s wrong with rocking the boat, tipping the boat over and building new boats. It all feels like the same voices saying the same things about being ‘innovative’ – oh look, we can use social media – look, we can tell each other how great WE are without ever actually DOING anything. “We’re change agents, we have one day a year where we pledge to smile at patients” – and not so much changing or including anyone outside their comfortable space.

I always think back to that slide Bevan seemed to like sharing about being ‘one of us’ or ‘negative’ which you blogged about a while back. Having a ‘school for radicals’ (what genuine radical needs a school to be taught by those with the power’.

IT just seems like another club. I wish there were something genuinely for people who thought differently in the NHS but this is not it. This is run by the same leadership-type people who dislike non-conformity in any way that doesn’t tell them how great they are at every moment.

Wish I was less cynical but this is from watching and observing from a position have initially having hope to one which sees everything coming from NHS IQ as very ‘samey’ and corporate-think.

sarasiobhan says:

As a complete outsider, I agree with Ermie. If you have to justify and state your edginess, you ain’t really edgy, it’s more of a performance thing 🙂

carolLRead says:

Thank you for this comprehensive blog post George outlining your interest in The Edge and watching it develop. I always enjoy your posts as you aim to examine, identify key points, review and reflect on the issue, bringing a different perspective to light.

I work in a small DGH trying to bring about innovation in clinical care it is challenging & requires tenacity. I am passionate about supporting others to achieve innovative care working with other professions, patients, social care, charities & students. Social connection is important to develop networks and The Edge alongside other social media options offers a way for people to do this. Curated knowledge enables a quick way for individuals to access topical information that can help them in their day to day work. I taught myself flipboard so that I could curate existing knowledge in an engaging format & share online. This was well recieved with people following & retweeting my flipboard magazine which shows that individuals are interested in this approach. I will be using my curation skills to support NHSIQ develop The Edge whilst continuing my work at the DGH.

The first edition of The Edge was posted last week and The team are open to others ideas to make this virtual hub develop into a key resource for Health & Social care. It would be great to have contributions from bloggers like yourself and patients to spark debate.

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