Agents Assemble #2 – Season 2 – The School for Change Agents Podcast
Each week during The School for Change Agents, we make a podcast with behind-the-scenes discussion from the team who create School.
Episode 2, Season 2 of Agents Assemble The School for Change Agents is here!
In this episode, host Kerry McGinty is joined by Vin Diwakar – Medical Director for Transformation National Medical and Transformation Directorates NHS England.
Vin shares his brilliant story. The journey of his career in improvement and how The School For Change Agents helped him and his team to implement change, with wellbeing at its heart.
This transcript has been created by Sonix:
Kerry McGinty: [00:00:09] Hello and welcome to this episode of Agents Assemble. Brought to you by NHS Horizons. This podcast is where we expand and explore the teachings of the School for Change agents and seek out improvers and change agents to share their stories. Basically, we’re on a mission to share and learn together. I’m your host, Kerry McGinty. I’m a production project manager at NHS Horizons, and I’m super thrilled to be joined today by Vin Diwakar, medical Director, National Transformation and Medical Directorates in NHS England. So welcome to the podcast, Vin. How are you today?
Vin Diwakar: [00:00:43] I’m very well, thanks, Kerry. Nice to meet you.
Kerry McGinty: [00:00:46] And you, I’m so excited for us to have a bit of a chat. And as you could tell by me mucking up your title there, it’s quite a lengthy one. So for those listening at home, what does your job entail and tell us a little bit about yourself.
Vin Diwakar: [00:01:01] Yeah, great. Okay, So, well, as you know, my name’s Vin, and my job is, as you say, medical director for transformation and secondary care in the national team in NHS England. So there’s two components to the role. So one is provide the clinical leadership for day to day operations in in NHS England. So things like urgent and emergency care plans, care diagnostics, etc.. And then the second job I have is responsibility for transformation improvement and technology. So it’s quite a broad and wide ranging role, but exciting actually, because obviously everything we do in transformation and improvements got to help day to day operation of the service and supporting and benefiting patients.
Kerry McGinty: [00:01:52] Yeah, so just a few things on your to do list every day then from the sounds of your title. But no. Well really fantastic to have you. And actually a little birdie told me I think it was last year when we were doing a solving together tweet chat actually, and we had a very brief conversation as we transferred over our different time slots on the chat. And you mentioned that you had actually taken part and in the School for Change agent, So it would be great to hear how you kind of first found out about the school’s change agents and took part in your experience of it, really.
Vin Diwakar: [00:02:32] Yeah. Brilliant. Thanks, Kerry. So just a bit. I’ll start by just telling you a bit about my kind of career stories. I’m a paediatrician by background. And right at the beginning of my career, I trained in paediatrics up in the Midlands and then I became a consultant in Birmingham Children’s Hospital back in 2002. And for the last six, seven years of that, I was the medical director of the Trust. And then after that I was looking for a new challenge. So I moved down to London and started working as the medical director for Great Ormond Street. And then after I’d done that, I then moved to be the medical director of the NHS in London. And in fact, during the pandemic I was providing the medical leadership to the capital throughout the pandemic period. So I started as medical director for London in about 2016, 2017 at time. And one of the teams that was under me when I started in NHS London was the clinical networks and the clinical networks, if you like, a group where we bring together groups of clinicians and programme managers to develop firstly clinical standards with Royal colleges and taking into account the best evidence through nice and so on, and then working to implement those standards throughout the NHS in London. And so a big component of that of course was improvement. The second thing that we were trying to do is while I was there, we had this kind of bold vision that we developed with the Mayor of London, with local government, the 32 London councils, with the voluntary sector and with communities throughout London called the London Vision.
Vin Diwakar: [00:04:19] And we had this vision that we wanted to be the world’s healthiest global city. And although that sounds like a bit of a lofty ambition, actually, London is the seventh healthiest city in the world. So that felt like a doable ambition. Yeah, if you take it on a series of measures that are published by the World Health Organisation and then of course during that period we also set up integrated care systems. The role of place became increasingly important. So where you experience your health care and where you are well is not in NHS England or indeed in a hospital or in a GP surgery. It’s in your community and it’s in your neighbourhood, it’s with your friends, your family and so on. And so the role of places and the role of the health and social care and the voluntary sector in communities in place became increasingly important. So if you kind of put those three things together, what we’re seeking to do is actually to transform communities and also to transform the way that we support people’s wellbeing through the health service. And that’s quite a big transformational role. So what I found actually was that the kind of change model was we’ll get clinicians together, we’ll work with nice, we’ll develop some clinical standards and then we’ll produce lots of guidance, toolkits, implementation guides, commissioning policies and so on.
Vin Diwakar: [00:05:47] And in the best teams, they were also going out and doing clinical peer reviews, visiting clinical services and saying, look, you know, we’ve audited your service. These are the ways in which you meet the standard, these are the ways where we’ve got variation. This is how other places have improved their services and this is what we do. And that had varying degrees of success. It’s certainly a good methodology for doing things, but it isn’t the only way of doing things. So I was looking for a kind of what is the evidence based way of really transforming the way we deliver services across a city that’s bigger than about 11 European countries, but also in the multiple local communities. That is London. And that’s where I came across the sort of NHS large scale change model. So that became right, we’re all going to use this as our kind of template for how we’re going to transform the way we deliver care across London. And of course, the School for Change Agents was the the big ticket thing that was there in order to train people in how to use the large scale change model. And so that’s why I said, Right, everyone working for me, we’re going to do the School for Change agents, and that included clinicians and not just our sort of improvement managers and so on. And so that’s what we did.
Kerry McGinty: [00:07:03] It’s just fantastic. And just listening to you there, first of all, your drop, in fact, bombs all over the place really didn’t know that London was so healthy, so might need to come down a bit more often. But I think that point that you made about the communities is so poignant and like so important because it’s that thing of that everybody can make a difference. Everybody can make a change in the fact that the School of Change agents is open to everybody and the fact that you got so many people in. Involved in it. I do think it gives it these massive models that, you know, someone like me who joined the NHS two and a half years ago and at first it could be something that be quite daunting if that’s something that you’ve not come across before, but it does kind of do it in that bite size way. It kind of took me back to my GCSE, BBC, both sides vibes where it was like, Here’s some amazing information that everybody can learn from, even if it’s you take a little bit of a different bit from it. And so from the School for Change agents, you took part and your team took part as well. What was the kind of response once they’d followed through with the whole of the course, what was the reflections? How did it help you and your goals and your team’s goals?
Vin Diwakar: [00:08:20] Yeah. So, so I think firstly the feedback we got was really, really positive because people felt that they’d learnt from the program. And as I was saying, I think the original approach we adopted was quite a traditional approach. Know people come from NHS England, they’ve audit against standards that we’ve developed, they tell you where you’ve got room for improvement and they kind of guide you in what to do. And I think they found really helpful for School for Change agents was firstly that I think the way in which change happens is very different nowadays. And the thing that School for Change Agents I think does really well is talk about old power and about new power. And it talks about how you mobilise a movement for change focussed on making a difference. And that meant that. And if you think about it, that’s quite key to the way in which networks work. And so rather than taking this kind of traditional approach to a network and instead moving to a model in which you’re saying, how do we mobilise a community of leadership focussed on making a difference, that kind of opened people’s ideas to a very different way of doing things? And then from that, I think we probably started developing more partnerships at local level.
Vin Diwakar: [00:09:39] We develop more partnerships with sort of charities and with the voluntary sector. And I think where it really where we saw it work best during the pandemic actually was in the in the vaccine programme. And what happened in the vaccine programme was firstly we had a big national challenge that was affecting everybody. It’s important for health, it was important for wellbeing, it was important for the economy, it was important for the workplace, etc. So everyone gathered together to deliver this great big vaccine campaign. But of course, for entirely legitimate reasons, they were people who were concerned about having a vaccination based on previous experience or their views about the evidence base and so on. And we found that those were quite related to background and to culture. And what happened during the vaccine campaign was that actually firstly we had data because I think School for Change agents does talk about the use of data. Through the use of data you were able to see where are the areas where people have the greatest concerns about vaccination. And then thirdly, were able to go to those areas. And then what you’re able to do then is gather the local communities together, mobilise them to say, look, here’s the value of vaccination and then what will help you in order to do it? And then you kind of we developed and worked with advocates in local communities who weren’t, you know, your traditional health service people or even GP’s.
Vin Diwakar: [00:11:10] It was sort of faith leaders or community leaders and so on. And then we created ways of delivering vaccinations that were culturally competent, which might be pop ups or buses or in mosques or in churches, in schools and so on. And so what you really saw there was that I think lots of people think the vaccine campaign was kind of delivered, you know, as an NHS service. But it wasn’t. It was a genuine partnership and a genuine movement that was created between actually the politicians, local communities and the NHS and the voluntary sector. And I think we then when we went back and evaluated it, we learnt a lot of think about that illustrated the real value of School for Change agents and I think preferred. It’s an affirmation that what we’ve been doing pre-pandemic was actually the right way of going about making change happen.
Kerry McGinty: [00:11:57] Oh, it’s so fantastic to hear. And I do remember all of that work. I think the pandemic has actually kind of moved everybody to think differently and to make changes differently. And I think that the School for Change agents and the teachings in it, like all power, new power, really do help people to think in that kind of different lens and that different way of navigating these different challenges that come up. And that was one heck of a challenge that everybody faced, every single person and in the world. And I’d be interested in what for you personally about the School for Change agents? Did you kind of resonate with you? You’ve got this massive job and I think, you know, when everybody’s got a big job to do. But when you think about you personally, what were some of the things that helped you on your journey? As you mentioned earlier, it was really that school also is a real kind of champion for that well being and keeping yourself well in order to help other people get well. So was there anything in school that helped you to keep going and make sure you were doing your job as the best that you could during these tough times?
Vin Diwakar: [00:13:07] Yeah. I mean, I think well, so the first thing to say is that, you know, lots of people talks about the NHS England taking a command and control role during the pandemic and obviously a bit of command and control is important when you’re in an emergency. But I’m often fond of saying to people actually during the pandemic, I think I only actually ever gave about two or three orders, and that was usually when people said to me, Then you need to order this or else we can’t make a decision. Because actually most of the time I think what we did during that pandemic was actually to mobilise people. And if you look at the challenges, I think that the NHS is facing now, so patients are worried about access, access, access, access to emergency care, as we’ve seen over the last few weeks. Access to primary care, access to community services, access to mental health services. So it’s a big concern for the public that maybe wasn’t so present pre-pandemic. And then secondly, as you’ve seen, our staff work really hard, and I think I want to pay tribute to staff who’ve worked really hard in the NHS. They want kind of enough colleagues working with the right skills in a compassionate and inclusive culture that gives them opportunities for development.
Vin Diwakar: [00:14:17] And, you know, government wants us to deliver on the promises it’s made to the public in return for the investment that we’ve made in the health service. So I kind of see it then that we’ve got kind of four challenges. One is recovering from the impact of the pandemic. Secondly, there’s building resilience for future shocks. Thirdly, there’s reform and improving care for the future. And finally, there’s respect for our staff, patients and the wider public. And I think you can apply the principles that we teach in school for change agents to any of those challenges. And so I think the difference for me has been when I get called in to say, Well, then we’d like you to come and contribute to the workforce challenge or the challenge around urgent care or the challenge around planned care or, you know, how we look after our staff. I’m kind of often then reflecting back on what I learned through school for change agents and say, Well, actually here’s a really structured approach to change that we can take because a lot of these challenges are not going to be served solved in NHS England Central. Where they’re going to be solved is in people’s place of work and in people’s place of community.
Kerry McGinty: [00:15:21] No, I completely agree with what you were talking about there, and you can see from the comments and the replies to each module of the School for Change agents, the the the, the change agents that are already there and making change happen and taking on these challenges within their own trusts, within their own department, whether that’s in a hospital or even in the finance department. We’ve had some a cohort of change agents that took part there. Take these learnings and apply it to them. And as you say, as we go forward, this building of that kind of repertoire of like I like to think about it as a backpack for school that you used to pick for a school trip. So when you’re about to head on to the next challenge, the School for Change agents is kind of pat you full of a nice lunchbox of tools and methodologies and theories and things that you can really apply to make make your work life better, but also yourself and be more able to take on the varying challenges that come each day. And the School for Change Agents Last registration day is actually on the 22nd of January and there will be other runs throughout the year, but for this run is the 22nd of January. So for anybody that’s listening to to to our little chat and Alvin and they kind of feeling in a place where there is a lot of uncertainty, there’s a lot of change, but they want to make change happen. What advice could you give to them or what advice would you give to anybody as a person who has kind of been immersed in change for so many years?
Vin Diwakar: [00:16:57] Yeah. So I think the first thing to say is, you know, reflecting on that conversation, we’ve just had the way to maintain your well-being when you’re trying to lead, change or deliver change is actually by being effective at doing it and rewarding yourself then when you achieve things. So the program is important, I think firstly, because it teaches you a way of doing that in the new world. Second bit, I think, is that people are often a bit intimidated by power. People say to me, Well, how do I make sure that senior leaders in the NHS take what I’m trying to do seriously? And I will say to them, Look, just get started. That’s how I started in my leadership journey, was if something wasn’t going as well as I liked it, I just kind of tried to change it. Thirdly, I think so. Remember out of that actually isn’t senior leaders who hold the real power that’s old power. It’s people like you working with services, working with patients who hold the rare power. So figure out and make sure you’re confident. You hold the real power and then gather your coalition around you.
Vin Diwakar: [00:17:56] I think storytelling is really important to getting your narrative right As a result of School for Change agents, I went off and kind of read martial arts book about the power of narrative. And in fact, I’ve got a little guide as to how you write a narrative. So every time I have to give a talk, I kind of sit down and think, write, how am I going to get my narrative and my story straight? I’m motivating people. And then the final thing I’d say is, you know, find like minded folk like yourself and then mobilise your social networks. Sometimes that can be by using social media, but there’s lots of other ways I think you can tap into social networks or even more formal networks like clinical networks in order to get change to happen at scale. So, you know, kind of if there’s a core message behind that is get started. Go on school for change agents and then be the change that you want to see. If I can use a kind of old aphorism, I.
Kerry McGinty: [00:18:48] Love that to be fair, that should be our new slogan. But that was I loved that It was so I think it was so powerful and would resonate with so many people. And I’m so passionate about stories as well. That’s one of the reasons why we wanted to create this podcast, to get some more nuggets out of all of the things that we can learn from school and the change agents that work within health and care. And and I just think that was so amazing and powerful. So thank you for sharing. And I did pick up one thing just before we close. You know that that point that you made about being an effective change agent, you need to do it well, but you need to look after yourself. Well and reward yourself is, I believe what you said. So, I mean, I like to reward myself with maybe a better chocolate and maybe a Netflix episode. Is there anything that you think at the end of a long week and you’ve had a good week, then what do you reward yourself with? It could be grand or it could be like me, very basic, a bit of a few rollovers in front of their favourite Netflix program, which is Wednesday at the moment, by the way.
Vin Diwakar: [00:19:56] So yeah, I mean, I think firstly, I love spending time with my family. So spending time with my family is always a great treat and doing things with them. And I think the second thing is I quite like hitting tennis balls around. So playing tennis at the weekends or was a great treat if I don’t have to have to work. And then I think the final thing is I’m partial to a maltese.
Kerry McGinty: [00:20:17] What a stunning choice. A maltese or that is a good one. And also, who knew that you you’ve got a bit of the Federer about you. I love it.
Vin Diwakar: [00:20:25] Definitely not true.
Kerry McGinty: [00:20:27] Oh, well, Vin, just before we close off, is there anything else that you would kind of like to say to people and around the school or just anything? As we venture into 2023? We can’t believe we’re hurtling through January so quickly. But have you got any message that you would like to say to anybody listening about the the changes ahead or the years ahead and any last bits of advice?
Vin Diwakar: [00:20:51] Yeah, I mean, so firstly, I think we face some big challenges, don’t we, not just in the health service but actually as a as a country as well. The scale of the challenge means that we’ve all got to be part of the solution. So no matter what level that you work at, remember that you’re the change and you’ll be the person that will make that change happen. So, you know, join the School for change agents and and be proud of what you’re doing. Give yourself a reward.
Kerry McGinty: [00:21:18] Amazing. Thank you so much, Vin, for joining us today. It’s been a real pleasure to talk to you and it’s been fantastic. And so that’s all from us today. Thank you for listening to this episode of Agents Assembled. Thank you again to our amazing guest, Vin. I’m feeling inspired and ready and I need to get myself some Rollo’s or Maltesers after this, I think. And just a reminder, the last day to enrol and upgrade for the School for Change agents is Sunday 22nd of January and information on how to join and upgrade can be found at horizons NHS dot com forward slash school. So for now buy and. You.