28 March 2014
Mary Agnew, Deputy Director in the Francis Implementation Team, writes about how senior civil servants in the Department of Health are getting closer to the front-line.
I recently observed my first Schwartz Round. The theme was ‘making connections’; the panel spoke movingly of individual patients who had affected them deeply, living on in their memories. This opened a facilitated discussion about how staff cope when, as one nurse put it, ‘Sometimes, it’s just too sad’.
Staff spoke of finding the balance that enabled them to be friendly without becoming friends. They talked of patients they had known over months or years and confronting their own feelings of loss, they told of balancing professional distance with an empathic human connection. The Round provided a safe supportive space to talk about the very personal and difficult aspects of giving compassionate care day after day, week after week, year upon year.
The Department of Health has a new programme to improve its own connections with patients and staff, to understand better the day-to-day realities of health and care. Senior civil servants now spend four weeks a year in placements provided by around 100 partner organisations – across all health sectors local government, and the third sector. The programme is expanding to cover policy teams: you can follow its progress through the Connecting blog.
The Connecting initiative – ground-breaking in Whitehall for its scale and ambition – was conceived in response to Robert Francis’ critique that the Department was ‘too remote’ and in recognition of the Department’s changed role in the health and care landscape. No longer the headquarters of the NHS, DH is now the ‘system steward’, responsible for setting the overall strategic and legislative framework, and accountable for ensuring its arms-length organisations work with common purpose. We no longer have many staff with direct experience as clinicians or managers in the service, though of course DH staff are patients too and the carers and families of patients. (My arrival at DH coincided with learning I had a 50% chance of being on dialysis in 10 years’ time. I, like many of my colleagues, have always viewed the NHS – at least in part – through a patient’s eyes.)
Some commentators were initially sceptical about the programme: would it make any tangible difference? Of course, many policy makers routinely visit the types of services they have responsibility for. But Connecting is on a different scale and, though still early days, is already changing the mood music of the Department, challenging implicit assumptions, and re-galvanising staff around our core purpose – to support people to live better for longer.
What is different about Connecting is that it’s an immersive experience and gives a real chance to go behind the scenes, to ask the stupid questions, to talk to porters and healthcare assistants rather than Chief Executives, to reflect and learn. And it’s different because it’s geared towards seeing the full range of services, so it challenges any tendencies towards a silo-ed approach to policy development. Slowly but surely, it is shifting the nature of the conversations in the ‘corridors of power’.
So far, I’ve done three placements: at North Essex Partnership University NHS Foundation Trust, focusing on their mental health services, at Central London Community Healthcare Trust, and at University College London NHS Foundation Trust. I spent time in a wide range of services, sitting in on consultations, handovers and multidisciplinary team meetings. I glimpsed the challenges of bringing together the right services and support for each individual: the young man feeling suicidal after a relationship breakdown; the witty, strident teenager with complex disabilities; the older man with frailty, confusion and blindness delayed in the emergency department; the unborn child who would need early surgery to repair her heart. I saw anger, pain, fear and sadness, and the health impact of homelessness, domestic abuse, and drug and alcohol misuse. And I saw joy, humour, relief and gratitude: the teenager still cancer-free two years on from her battle with leukaemia; the excitement of the woman in the early stages of labour with her much longed for IVF twins.
Connecting has been a challenging and humbling experience, sometimes personally difficult; several of the people I met will stay with me for a long time. What stands out is a focus on safety and improving the quality of care, delivered through impressive teamwork and often with extraordinary kindness. It reminds me why I come to work and challenges me to do my job better. As civil servants, we’re typically expected to be dispassionate and detached. Connecting allows us freedom to care, space to learn away from the tyranny of urgent emails, and an invitation to question and innovate. For partners, it dispels some of the myths about what we do and allows their staff to tell us and show us ‘how it really is’. A foolhardy few have spent time shadowing us in return, though I fear our days are usually much duller. Only time will tell whether our policy is demonstrably the better because of Connecting, but the cultural shift has firmly begun.
If your organisation would like to join our growing network of partners, you can find out more by emailing With my team, I have been complementing these Connecting placements with visits to Trusts to talk about progress and challenges in implementing the Francis Inquiry. We’d love to hear about your experiences. Please get in touch at