The act of trust

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As part of the Academy’s two year story, we have asked a range of people from across health and social care to share their own stories and experiences of what leadership means to them.

TOBY LEWIS
Toby Lewis

I joined the NHS 20 years ago. I signed up because I believed that a society is judged by how it looks after the most vulnerable, whether perpetually excluded or temporarily disabled.

Two decades on, I have the huge privilege to lead an organisation in the West Midlands delivering care from 150 locations. Our purpose is to become renowned as the best integrated care organisation in the NHS. We will leave it to our patients and communities, including the most vulnerable, to judge our success.

The mission has to be based on values that work, because they deliver partnerships of purpose, and allow diverse communities to speak up and describe what they need. Without that listening spirit we will fail; either fail our staff or fail our patients.

Most of my time is spent trying to persuade people to do what they want to do anyway. I am constantly struck every day by the willingness to do the right thing, but also by the barriers we construct for ourselves that get in the way. We express them, usually as money or technology gaps. But my experience is that more commonly we lack confidence in ourselves to deliver, or we are fearful of what will happen if we shoot for the moon and only hit the stars. Often, secretly, we lack confidence in others, and prefer not to be disappointing, so resist the change we think we want to see.

Integrated care of course depends for its success on getting past that fear of failure and that doubt about the other person. Integrated care must be an act of trust. Because patients and their families have complex needs, we can only act in teams. And teamwork relies on that trust. Yet it starts with each of us as individuals, being prepared to change and to develop, ourselves.

That act of trust is what connects us and our patients. Any care involves believing that someone else’s expertise can help you. To the migrant mother, with no legal recourse, on the estate in Bearwood, involving someone else in looking after her baby daughter, in a temporary hostel room, the third in a few days, is an act of trust many of us, myself included, find hard to begin to imagine. To a degree, we vouch for that expertise in employing someone and in asking them to look after you, to visit that room.

As the Chief Executive with my name on the CQC license, I very much see that process as a personal promise. In my role, I cannot really change the dynamic of the consulting room or someone’s living room. What I can do is to try and help create an environment where everyone who works for us, and with us, understands that their expertise is trusted, that they must operate as part of a network of care with our patient and their carers, and that ceding control to the patient is the vital ingredient in integrating care. I am learning how to do that.