 Hynny'n rhoi gwybod, o dyfu'r gwybod! Fydd ddim osb ynghylch. I曲wydd yn agon nhw, mae'r gwybod nifer o gweithio sydd yn y 12 o'r gweithio yng nghyrch. Fyndd gwybod! Fyrdd yna! Beth fod yn regu, byddwn ni'n edrych yndog neu yng Nghyrch morhau. Rwy'n meddwl hynny'n edrych Mae'n tu'n gweithio'r gweithreibeth yma, mae'n gweithio'r gweithreibeth políticau gwasanaeth, dwy o'r gweithreibeth morherau, ac ymddwch yn ymddangos llynllun o'r gweithreibethau. Mae'n gweithreibeth oherwydd mae'n gweithreibeth eich ddif creatively. Ond, oedd ydych chi'n brytyn yw ym Y Brytynion, mae'r Brytynion yw'r dynion yw. I just want to big up the NHS staff at A&E in Brighton this morning because they said when they heard that I was speaking here today they said we're going to put you back together again so that you can go and do your presentation so thank you very much and thank you for the invitation for today as well. So as Jenny said I'm going to be sharing my story today about the NHS and the work that I do and I've been in the NHS for 35 years, this is my 35th year, I know I started when I was 6 and this is me when I was 21 years old. Now I don't look that radical do I? But that's me full of hope, full of expectation as any 21 year olds. Does anybody have a 21 year old in the audience? I've got two who are beyond 21 and one who thinks she's 21 but she's only 15. But you know what it's like when you're 21, you have plans to change the world and you really think that you can change the world and I'm just going to kind of move away and hope that people can still hear me can they? Yeah great, okay so you think that you can change the world and this was my plan, just like anybody else you know. Oh yeah that would be great actually I'm really struggling with just standing behind the lectern especially when I'm talking about bureaucracy and hierarchy and then you stand behind the lectern and there's nothing like your kids who can kind of bring you back down to earth. When I was telling my eldest about the work that I do in hierarchy and that she says mom you run this family like a business so please. I like to think that I don't like hierarchy but you know this is what the universe really has in store for you and this is what the NHS has in store for you as well. You can see all those kind of pits and troughs and you know stormy days and really difficult challenges and you know for anybody who works in the NHS or who works in a large corporate organisation and I'll tell you a little bit about the numbers for NHS. This is how it can feel you know NHS blue is you know somebody said the world is changing blue well in the NHS everything is blue and when you start in the NHS you come with kind of all your ideas and being innovative and all of a sudden there's you know and it can happen in a really really short space of time. You feel that you become part of the kind of the system and you kind of become part of the sea of blue. Is there anybody here from the NHS? Yeah a few people from the NHS so you can testify born you know with me that actually it's quite hard to kind of sometimes maintain your individuality. And some frontline staff this is what they describe to me that one I was talking to recently said you know it was only six months when I came I saw there was different ways I could do things and I'd challenge everything and she says before I knew it six months in I felt like I was part of the system. Fantastic. I'm free. My 22 minutes has only just started. Okay I'm not sure whether you are hearing me or are you? No. Okay so keep going. So as I've said I'm part of the NHS. We are the fifth largest employer in the world. When I used to do this presentation 10 years ago we were actually the third largest organisation in the world. But Mac Donalds and Walmart have taken over. Now there is a correlation I think between healthcare and those two organisations who have taken over but we'll see no more about that at the moment. So we have 1.7 million people who are employed in the NHS. Every 36 hours we see 1 million people myself included in the last 24 hours and we do some fantastic work. But we are also extremely you know where the fifth largest organisation so you can imagine we are the fifth largest kind of bureaucratic and hierarchical organisation and our predominant leadership style and this is not you know I think it's well acknowledged that it's very top down in the NHS. And as I said I've been part of the NHS for 35 years and if you do the Mac that means that every 3 years we do this kind of reorganisation. I've probably been through 10 major reorganisations. And so as I said it's really difficult to create change within the NHS and many of you will be familiar with this picture which other nation in the world celebrates its health service in the Olympic Games. Absolutely fantastic. And we had, I belong to a small team called the horizons team, we're working at the edge of current thinking and practice and we have the audacity to think that we could mobilise the 1.7 million people within the NHS and do something better together which was called NHS Change Day. Can I just see how many people know of or have heard of NHS Change Day? Yeah quite a few people and when I went down to A&E this morning even though my pain score was 8 I said have you heard about Change Day and they said yeah I said oh well I'm going to go and talk about it. You know we had the audacity to think that we could mobilise this vast group or vast amount of people across the NHS do something better together was our motto and it was possibly the largest sort of improvement initiative that's ever been undertaken in the NHS. So when we talk about social change we're talking about engaging the human spirit, when we talk about social change we've got to talk about movement and when we talk about movement we're talking about grassroots people, we're talking about being able to make a difference, we're talking about harnessing the imagination and the people who have come to the NHS because they want to make a difference, they get up every morning and they want to make a difference, they want to make a change. And when we talk about movement we also talk about power and when we talk about power it's not the type of power that's about technology or about money or about those hard things but it's the type of power that we talk about when we talk about relationships and community and being able to make a difference, being able to hold each other to account and when we talk about power we've also got to talk about hope because that's why we're here, that's why I joined the NHS, that's why I do what I do, that's why I get up every morning and I feel excited about coming to work. And sometimes for some people we've got to hold their hope and hold their hope until we're ready to give it back to them. So this is what change day was all about, change that was in our hands. And so in the summer of 2013 a group of young clinicians and management trainees and people who did not have an awful lot of power in the system came together with us as improvement leaders and said we want to put on this thing called NHS Change Day. One day of the year where people pledge to make a difference wherever they are, you don't have to be in health care, you can be anywhere. So these are some of the things that we did, we had a shared purpose, we set a goal of 65,000 pledges. Now we only had one strategy meeting as our first speaker said we had one meeting and we set our goal. Now I am positive we came out of that meeting and it was six and a half thousand pledges but actually somewhere along the line. It was 65, I think we were mad to think that we could do 65,000 pledges but actually that year it was the 65th birthday of the NHS so it meant something to people. So our theory of change was all about mobilising and organising, it was all about social movement thinking, we learnt a lot from Marshall Gantz, I don't know if people know Marshall Gantz but he was the Barack Obama's first year campaign leader. The first meeting that I had with this, that's another two minutes on my time please, and he said you know what shall we do, shall we choose something that is a big national target or shall we just let people do whatever they want to do and I said absolutely we've just got to let people choose whatever pledge they wanted. We used lots of social media, we took risks, we broke lots of rules, we had no budget, we had no mandate, it wasn't in our business plan but we said hey ho let's we're going to go with this. My managing director said this is cheerleading, a lot of people didn't believe in it but actually when you're doing something like this you have to believe in it and I believed in it. In fact actually I wasn't supposed to be the person who was leading at that time but I went and tapped on somebody's shoulder and said do you know what I want to do this. We had to have courage and belief, belief that actually we could make a difference and most of all we kept it simple and these two people on the side really kind of represented what this was really about. It wasn't about have to, it was about want to and that comes from the John Cotter kind of network versus hierarchy and we had to activate the volunteers and the radicals. This was about leaders everywhere so the people who are in this picture here, they're not people who have power or have any formal power. They're students, they're second year students, they are young nurses, they're frontline staff, they're cleaners, they're management trainees but these are the people that we worked with. And during that time of change day in 2013 for those of you who were in the NHS you will remember what a terrible time that was for us especially in the press. It was the year of midstaff's report so midstaffiture was a hospital in midstaffiture where thousands of patients had their care was compromised, it was an awful sort of shameful sort of period when some patients died unnecessarily as well. And I'd been asked to go and work after the health care commission report to go and work with midstaffiture to help them with their with their improvements and they had 107 key priorities, 107 key priorities. And one of the things I could tell you a lot about my experience there after a year but one of the things that I recall was that the staff did not feel that they had the permission to make the smallest change. That was one of my big takeaways and how I term this is that staff are checked out. I've been one of those staff where you've checked out and that means that productivity goes down. That means that you're not giving your full motivation or commitment to what you're doing and it says two things, this whole kind of thing about permission. Can I really make the change? Do I believe that actually I can make the change? And then on the other side it is will the hierarchy allow me to make the change? And so there is this kind of permission thing that's going on and I commissioned this cartoon after the first change day because as leaders this is what we've got to do. We need to enable and give people the permission to make the changes and so it's about shifting the positional power to a more relational power and being able to give away some of that power and that's really hard for us to do. And it wasn't just about a grassroots movement it was also getting the support from a top-down approach and these are just some of our very senior leaders. But what happened was the floodgates of change opened and we had people all over the country making pledges. And for the first change day that 65,000 pledges turned into 181,000 pledges and at the end of that week we had 189,000 pledges. It was phenomenal, we just could not believe the impact that it was having. And change day 2014 we set very foolishly set ourselves 65,000 was nothing, let's set ourselves half a million pledges. We were just crazy but we got 800,000 pledges, pledges of action of people where some people just wanted to smile. We then also set up the school for health and care radicals which was really to just help frontline staff and anybody to cope with resilience and change. And over 6,500 people have taken part in that, over 40 countries have joined in. 2015 was our biggest change day ever. My pledge was not to let hierarchy get in the way of patient care, you might expect that but remembering my daughter in mind. So what I did was I worked with the senior leaders just to ensure that actually I was saying that I was seeking their support but actually with the explicit understanding that it was a grassroots movement. And these are just some of the pledges that people made that ones that kind of really touched me. So these are two nurses in Nottingham who put on a fun day for children. There was a little boy who had a stoma. He didn't know anybody else who had a stoma so he used to go around the playground looking for other children who had a stoma and he couldn't find anybody. So they put on a fun day for him and invited all the children who had stomas. You can imagine what kind of day he had that day, it was fantastic. And then they set up a support group for the families. It didn't cost them anything. Another pledge was Ashley Brooks, he set up a guardian service and their staff survey showed a 30% improvement in the question would you feel confident if your hospital would address concerns. I'm going to rush through these now. A second year student nurse who set up a mock ward and changed her university curriculum. Damian who was one of the first doctors who tasted some children's medicine and a member of the public actually whose brother had got knocked over and she just came in and sang to the staff. But it wasn't only happening in the UK, people were watching all over the world and we received a couple of awards and the picture in the right hand side is actually in the White House. I got the opportunity to go to the White House and they'd heard about Change Day and they wanted to get involved as well. So this is what happened across the world. NHS is undergoing a huge period of transformation. At the moment in the NHS we have a generation of people who have seen how the NHS has worked well but also seen how it's not worked always for patient benefit. So this is an opportunity for people to really get together and think about the changes they want to make and quite often they're not allowed to make. We're the people that had the initial Twitter conversation and then phone call that led to the establishment of NHS Change Day and it's kind of led to this. Change Day is about grassroots movement that's engaging people to make change happen at a local level. Choosing their intrinsic motivation to change in terms of choosing a pledge or something that they want to create to make change happen and putting that into action. I pledge to my poor, my patients, to feel welcome. My pledge is to start every meeting of the patient's story. My pledge is to improve my patient's journey from the ward to the operating department. My pledge is to read the story to one of the children. I pledge to deliver the best care possible and to make the patient at the centre of all my activities. We've got on a fantastic journey in an amazingly short period of time. If you're connecting our workforce back to their own values and the reasons why they came into healthcare, 98% of the activity is voluntary. People are doing it like you say because they want to not because they have to. People with inspiring and energetic movement encourages each of us to believe that we can make a difference in helping. Improve every day. Change Day, Sweden. Change Day has inspired us to work together. Connect healthcare professionals. Try Change Day in Saskatchewan. Share the responsibility of patient safety. I can make a difference. We certainly completely support the NHS Change Day initiative. What's the day call again? The radicals and the heretics because without them the storyline never changes. And you can from the top support but actually you can't control and lead a movement. And there's a massive untapped reservoir of energy and talent out there and the potential is outstanding. And the biggest challenge that we had was actually letting go. Letting go is the fear of letting go. So power divided is power shared. And when you do let go, you let come what is wanting to be born. Thank you.