February and March staff engagement workshops

Throughout February and March, we hosted a series of workshops for NCL CCG colleagues. In total 8 sessions were held with CCG colleagues, facilitated by Traverse. These sessions provided an opportunity for colleagues to share thoughts about the upcoming transition.

Feedback from these sessions has been collated and in May and June a further 8 sessions will be held for staff to find out more about the areas of work that were frequently raised. In addition, some of the feedback related to practical areas of work and we will continue to share information via staff briefings, staff newsletters and via the intranet. We will also host some local sessions about particular areas that were frequently raised.

There was rich discussion at each of these and we have several outputs to share.

On this page you will find a summary of the concerns, opportunities, ideas and suggestions that were shared in each session, as well as links to the mural boards.

FAQs

A wide range of questions were raised during these sessions which have all been captured. These are now listed on our dedicated Transition FAQs page. Whilst some can’t be addressed just yet, we will continue to answer these through existing channels including staff briefings and staff newsletters, and the Transition FAQs page will be updated weekly.

Upcoming sessions

Based on themes arising at the first sessions, a second series of workshops will be held in May and June. Colleagues are invited to attend as many of these sessions that are of interest. You can find out dates and times of these workshops and read more about each session here.

Workshop 1: Setting of Strategy and/or delivery of transformational activity (7 February 2022)

What we heard. . .

Concerns

  • Working with ambiguity is a challenge and change has been ongoing over a long time.There needs to be an acknowledgement of the amount of change that has happened and the time it takes to adjust. Specific concern around challenges of having a high proportion of interim staff.
  • Recognition that staff have had to deal with multiple priorities over the last few years and that this level of workload is not sustainable.
  • Lots of information but lack of transparency.
  • Concern about governance arrangementsand lack of clarity or accountability.

 

Opportunities

  • Working has improved with partners in the past two years and staff want to build on these good foundations to allow partners to collaborate across the system at a population health level.
  • Staff want to see that what is being said in these workshops is being taken forward and having an impact.

 

Your ideas and suggestions

  • Drop-in sessions to provide practical tools on how to cope with change.
  • A way to find out what is going on at NCL level – a directory of different leads and teams, who is responsible for what and how people can work together going forward.
  • Long-term support for long-term impacts of the change, not just support in the lead up to it. 
  • More accessible and visual information about the new structure and new language.

Link to Mural Board for this session

Workshop 2: Commissioning health care services (9 February 2022)

What we heard. . .

Concerns

  • Being ‘lifted and shifted’ is making the process feel very ‘top down’.
  • Concerns over the impact on job roles, families and descriptions.
  • Fears that this won’t be the last of the changes; is there going to be another restructure and are people at risk?
  • Partner organisations aren’t on the journey at the same pace – feels like not everyone is being brought into the change at the same time.

 

Opportunities

  • Due to Covid-19 people have already been working in collaborative ways and building the relationships that will be required in the ICB.
  • Staff will be more excited about the change when it becomes clear to them but for now, they only have the capacity to focus on getting their jobs done.
  • Becoming integrated will allow for more equitable access to services.

 

Your ideas and suggestions

  • Seeing case studies of other areas where the transition has already happened – would help us to understand what practical, tangible impact it is having.
  • A working definition of commissioning and what this would mean in the ICB – could staff co-create this rather than just being given it? This would help the teams in more positive and informed way.
  • Clarity as to where commission partners fit into this – focus on the bigger providers is sensible but would be nice to hear if this is the strategy and where small providers fit in.
  • Welcome parties as if we are joining a new organisation and meeting people in person so they can get to know the people they are working with.
  • FAQs on how to talk to providers or frameworks for different types of projects.

Link to Mural Board for this session

Workshop 3: Commissioning health care services (14 February 2022)

What we heard. . .

Concerns

  • ‘Change fatigue’ – this is the second or third major restructure, and because these take a lot of time to embed, it feels like a difficult process.
  • There is a sense that staff are unable to implement and drive these changes themselves.
  • Staff want more information about how their day job will look and feel different.

 

Opportunities

  • Excitement about meeting new people across departments – “Knowledge is power, and new people bring new knowledge.”
  • There is a hopefulness about this opportunity to do things at larger scale and implement new processes, reducing fighting and competition.
  • Having a larger footprint could address inequality.
  • Recruitment and secondment across a larger area could benefit staff if there are collaborative approaches to resourcing.

 

Your ideas and suggestions

  • More time and space dedicated to making the changes needed and for embedding the changes after 1
  • Fewer long emails and Word documents and more visual representations such as flow charts and organigrams.
  • Sessions on working for for-profit organisations versus non-profit organisations to understand different motivations and strategies.
  • Induction processes to understand who to approach for things and who you can collaborate with.
  • Creating time and space for people to build trust and relationships with those they will be collaborating with.
  • Information about what actually changes as a result of the feedback we gave.
  • Considering a particular example or case study could help focus minds and gain more engagement from teams.

Link to Mural Board for this session

Workshop 4: Setting of strategy and/or delivery of transformational activity (16 February 2022)

What we heard. . .

Concerns

  • Concerns around job losses and restructures, especially linked to the previous process which was really hard and not wanting that repeated.
  • This consultation has felt particularly difficult due to remote working and less opportunity for reflection with colleagues.
  • There are lots of delays to decision making and it is hard for staff to know who to go to if they need to escalate things.
  • Some staff feel that information is shared only if you ‘know the right people’.
  • Risk of not bringing forward existing knowledge and creating new things on top where processes and knowledge already exist.
  • Need to understand key internal relationships and what they mean in practice.

 

Opportunities

  • Excitement about collaboration rather than competition allowing providers to enable better experience for patients.
  • Hopes for interoperable IT and back-office functions to allow genuine collaborative working.
  • Lots of exciting opportunities and programmes but fears that these won’t be well-resourced moving forward and good work will be lost.

 

Your ideas and suggestions

  • A timeline about when restructuring will be happening and assistance with preparation if people are moving roles.
  • More clarity on structure and where people fit.
  • Training beyond what current learning hubs have to offer especially around culture change and new ways of working.
  • A crib sheet or script of key messages about the transition that can be used to have conversations with partners.
  • Visibility about what’s happening elsewhere in the system.
  • Emotional support during the transition period and afterwards, acknowledging the difficulties staff have been dealing with.
  • Focused work session on pharmacy and medicines optimisation.
  • Governance and decision-making structures for future state; detail on the roles and responsibilities of ICB (what is staying the same, what will be different – and what will ”doing this in collaboration” really look like).
  • Knowledge transfer options.

Link to Mural Board for this session

Workshop 5: Provision of technical, analytical or performance improvement work (21 February 2022)

What we heard. . .

Concerns

  • There’s uncertainty about whether this is the end of the process or just another change in an ongoing process. Restructuring going on for a long time and is leading to anxiety.
  • Some people are going through a double transition, from London Shared Services to the CCG, and now to an ICS.
  • There’s a feeling that a lot of these transitions are being done to us and are not engaging with us.
  • Uncertainty about grades between roles, reassurances always feel temporary, so it’s hard to engage in the process.
  • Need for transparency. We’re being drip-fed information and only if they’re in the right meeting. If execs know information, it needs to be shared to everyone at the same time.

 

Opportunities

  • The positives are that there will be more system efficiencies from looking at data in a system level, although local authorities will still have their own focus.
  • Opportunity to think differently as a system. Might offer clearer management structures.
  • It will be good to work with analysts and providers, supporting each other across the whole system, and there is opportunities for training.
  • More information to share could enable analysts to gain better insights.
  • There’s an excitement about unlocking access to data in the system and the outcomes in terms of population health for residents, but does require behavioural change that recognises colleagues are part of a wider system.

 

Your ideas and suggestions

  • Would still be helpful to have three tangible things that will be different and an understanding of what is in the control of the management team.
  • A plea to engage with service leads to co-produce the design of the restructure. We want timely, direct answers to questions that go to the right person to answer.
  • We want to know what the vision is for the organisation and want to know the structure of the ICB and whether job functions will be unnecessary.

Link to Mural Board for this session

Workshop 6: Provision of clinical services, quality or safeguarding support (23 February 2022)

What we heard. . .

Concerns

  • Partners don’t feel engaged – partners ask for an update and we don’t have much info for them.
  • Concern over people coming to this integrated new system with different priorities / values / organisational context.
  • Concern about the position of interim staff. There are whole teams where staff are on contracts, leaving them feeling very uncertain.
  • This transition feels far more radical than previous transitions.
  • Frontline staff and primary care staff have low awareness of what an ICS
  • Discussions needed on budget.
  • Where will oversight and accountability lie?
  • An acknowledgement needed that change will take months or years to take effect.
  • Worry about restructures – will we lose people with experience?
  • Concerns on whether social care colleagues are being included properly.
  • Is it a real meaningful change or is it just relabelling CCG? 
  • Clinicians and frontline colleagues not having time to think about change and how it will affect them and their patients – feel as if being done to you.
  • Hard to visualise what services in new system will look like.
  • People feel not enough consultation – fear of unknown as a result.
  • Rocky transition makes people feel displaced.
  • How key partners and stakeholders will be brought along in process – for instance local authorities may not understand what the change process will mean in future or patients may not understand the change.
  • This transition is layering on top of a change already imposed on system around Covid – one change after another.
  • Concern as getting to know people/ building relationships feels like luxury – would be easier if we had time and space to enable these relationships to be built.
  • People at ground level need to be involved in setting the vision and value of the new system rather than just receiving it.
  • Senior leaders need to think – the last transition was in office now it’s at home – people feel isolated – they cannot just talk to colleagues in the corridor – how to have these meaningful conversations over Teams.
  • Some colleagues are five weeks away from the end of their contract – so they are applying for other jobs – resulting in us losing expertise.
  • Hard to attract people to job when contracts only run to September.
  • Concerns the transition will slow down decision-making – adding to bureaucracy rather than removing it.
  • Concerns over safeguarding and on statutory requirements.

 

Opportunities

  • Positive opportunity to all work together cohesively – rather that gatekeeping.
  • Positive that we are building on the innovative, collaborative experience of pandemic.
  • Behaviour of colleagues changed during integrated working due to Covid-19, showing us that when everyone’s on same team we can deliver better service.
  • An integrated and standardised process is an exciting proposition.
  • Reducing historical barriers and discrepancies across boroughs is exciting.Integration also means unified work across boroughs. 
  • Positive aspect – the financial commissioning decisions will be based on outcomes – this is best for the population.
  • We already have lots of experience as Covid-19 demonstrated the rich rewards of integrated working.
  • Patient experience is improved – hopefully better experience of care and better outcomes for patients.
  • Excitement – collaborative resourcing and collaborative staffing – could staff move across boroughs.

 

Your ideas and suggestions

  • Workshops needed – to engage with partners – allow us to see / understand the challenges/ priorities in their world.
  • Timing – senior leadership roles are currently out in adverts – would be good to meet again when we know the leaders to further talk about the future landscape.
  • More workshops needed – to allow us to be able to make practical applications of these various changes.
  • The process of change needs a multi-disciplinary approach – having conversations with teams and external partners.
  • Could more of a vision be shared – e.g. a video message on how things will be different or case studies on how people/ patients have gone through the system and how it will work for them.
  • If we have more detail at that point it would be good to talk about change management for staff and how they fit into the system/vision etc.
  • It would be good to get feedback from the strategic team regards any issues and comments raised in this session prior the next session. This may help to inform what needs to be covered in the next session.
  • Reassurance in terms of results of previous transitions/restructures where posts were earmarked to be disestablished.
  • Greater clarity and details on what roles will look like in new structure. It is important to see all new roles in the structure before discussing implementation. Would give a sense of ownership.
  • Inclusive change process is essential – involving all internal and external stakeholders.
  • Implementing ‘champions’ who will be placed in teams and relay info to operational level from higher level and vice versa.

Link to Mural Board for this session

Workshop 7: Provision of corporate services (28 February 2022)

What we heard. . .

Concerns

  • Concern and frustration at the lack of more detailed information, especially regarding what structures will look like and thus jobs for individuals. How will working with partners pan out? 
  • Concerns about money and budgets in the future. 
  • So much change in previous years that people are just rolling with it. 
  • Issues of consultation fatigue and the feeling of perpetual change. This is particularly difficult in the context of the pandemic. We don’t fully understand the rationale for change and some of the key messages around it, which also made it difficult to communicate the rationale to the public. 
  • Some noted this transition felt different to previous ones because they are at home, it feels like it has been going for longer, and it feels more opaque and complex. 
  • Concerns around consolidating staff and job losses – what will that look like?
  • Might not be enough time to embed the good practice before the next restructure.  
  • Difficult to think about concerns and opportunities looking forward, will be easier in retrospect.  
  • Change being the norm: people are feeling a bit cautious/uninvolved, going with the flow on the basis there have been so many changes no point in becoming too actively worried about it. 
  • The updates have been useful, but it is not clear how much we can influence the process. 
  • The change is complex. 
  • Sometimes those that are meant to communicate or deliver the change are also impacted by the change (for instance HR), sometimes it’s not clear that this is recognised by everyone. I hope people can be more mindful of this – don’t shoot the messenger. 
  • Concerns about any further postponing of dates and the unknown extending.
  • Who you know, where you have previously worked and how significant your reputation is known by an Exec Director are deciding factors on who gets a job as opposed to individual qualifications, strengths and abilities. We have no talent management programme.

 

Opportunities

  • Opportunities to learn what worked well from previous transitions. It would be good to hear from the patient perspective. 
  • Learning from the last transition – ensuring this time it is much more transparent and fair. There are opportunities in the new system, but these might not be open to everyone. People are currently working to outdated job descriptions rather than their competencies. Concerns about people not receiving the same information as other people at the same time; drip feed of information based on who you know.
  • From previous transitions, clear we need to be flexible. 
  • Career opportunities, excited to work with new people. 
  • From the patient point of view, it will enable a better grip in dealing with variation and health inequality.  
  • The idea of closer integration resonated, and anything that could bring health and social care closer together would be good for patients. 
  • The pandemic has shown the power of collaboration and people have really welcomed working with council colleagues in different areas, excitement about developing that going forwards. Opportunities to improve digitalisation (and catch up with other sectors in this regard!). 
  • It will offer opportunities for staff development for example through secondment. This will allow staff to really get to know the system. 
  • Efficiencies could free up funding for patient care. 

 

Your ideas and suggestions

  • Plea for information. Difficulty of not having knowledge about structure, job losses – that information isn’t there yet but recognise that it is deeply unsettling to not have it.
  • Organisation charts, what social media accounts will be used, documents on the overall vision.
  • It would be useful to tidy up from the previous realignment exercise and ensure things like roles and job descriptions are set in place.
  • More opportunities to attend training, especially as working has become more flexible so opportunities to attend at different time and dates.
  • An opportunity for staff to get mentoring and a list of possible mentors, and staff that have already gone through change to provide insight and coping strategies about transition.
  • A big conference to give us an overall picture of how each directorate will be working in the new system.
  • There is enough information, but it is not as clear as it should be. Perhaps visual aids could help people pick out the priorities for their team. EMT session questions could be submitted in advance so they could know in advance whether it was likely to be relevant to them before they set the time aside to attend one. It is useful to hear what other people are thinking and realising that you aren’t alone in having particular concerns.
  • We need to name, call out and confront the discontent among a large proportion of staff regarding the fairness of previous reorganisations and the 2021 realignment process. This lingering discontent comes out in every session, it is acknowledged in its politically correct form but no solution is presented to stop this behaviour continuing. It’s the same people (Exec Directors and Directors), what is stopping this happening all over again? This high level of mistrust is not going away and must be addressed.
  • Some answers to the issues that were highlighted in the first session. A you said, we did document.

Link to Mural Board for this session

Workshop 8: Provision of support to primary care services (2 March 2022)

What we heard. . .

Concerns

  • Anxiety due to absence of detailed information.
  • Although the channels are good, the information isn’t there.
  • Need headspace to think about these issues – but already busy with day job.
  • Can we learn from previous experiences – worry that feedback not listened to.
  • Each borough has a different demographic and needs – not one size fits all.
  • Questions and feelings not taken into account last time.
  • FAQs need to have real information – not watered down and generic.
  • Overwhelming to new starters especially as they don’t know what the change will mean.
  • Clarity and consistency required.
  • Previously when people had questions, they felt talked down to. Need to properly listen and engage with staff.
  • Clarity very important – need clarity on vision and direction of travel.
  • Being able to describe what will happen (e.g. to practices) is important – especially because they need to be able to describe the change to patients – vision at top needs to be cascaded at local level.
  • People are keen to be involved in helping to clarify purpose and how it relates to their role.

 

Opportunities

  • More opportunity to meet with people from other organisations to make sure clarity of understanding is emerging from all parts of system.
  • Gap between thinkers and doers – strategic thinking taken directly to the provider environment while not involving doers.
  • Value of training opportunities to keep people motivated – not just training about the change but training related to current jobs and training on the ability to influence change.

 

Your ideas and suggestions

  • Need a workshop where they all come together to talk about how it will affect them rather than all the decisions being made from above.
  • Senior managers should be better represented at meetings – more presence and direction from them – to allow staff to pin down what is certain rather than senior managers not telling people anything as it isn’t 100% certain.
  • Integration needs to go beyond health and adult social care and cover children’s social care and other key partners. How do we shape a clear vision for children and young people in every ICS? We don’t have any answers to this as far as I can see at this current time.
  • Would be good to see feedback from other groups/sessions – and to keep us updated on how what we said informs (or doesn’t inform) next steps.
  • Next time, please can our second breakout rooms be a fresh group of people as this will help get more discussions flowing.
  • Is there an opportunity for facilitators to play back to group before plenary – in the case of any queries?
  • Need a timeline – when will we be engaged on what.

Link to Mural Board for this session