People's History of the NHS


Portrait of Yvette Roach-Smith

I have mother is half-African and half-English and my dad was from Barbados. So the person that came over at the time of the Windrush was actually my grandfather. He came over to work for British Rail as it was then called, working on the railways. He did that until he retired, I think he was sixty-five, but he background was in carpentry! So he carried on working: doing his little bits of carpentry, until he was eighty.

From the time of when I was getting ready to leave school, I’d always had a little part-time job in care work. I kept doing that ‘cause I loved the interaction with people.

I went to college and actually studied fashion design, dressmaking and pattern making. So I actually had a business designing wedding dresses before I came into the NHS. I came to nursing as a mature student. At that point I was married and I had a young daughter. I came to a point in my life when my mom said to me ‘what are you going to do with the rest of your life?’ I sat and thought about it, and what I really wanted to do was midwifery! (Laughs). That was until I started my nurse training, and started to talk to some midwives, and that soon changed. I just loved nursing as a whole - my two passions at the time were theatres and district nursing.

When I qualified, way back in 2002, I was actually offered jobs in both, so that gave me a bit of a dilemma. Due to my family circumstances I decided to go down the district nursing route. And I’ve never regretted that decision.

Back in 2002 I worked as a community staff and I actually worked for what was then Solihull Primary Care Trust. Lovely team in an area of Solihull which was extreme: extreme deprivation in some areas but extreme affluence in others. That was lovely; we were a very small team who just worked for one GP (General Practitioner) who was based across the road. We had lovely relationships with all of our patients and it was in a time when you really knew your patients, you knew your patients family, you knew what was going on in their lives. In a way you were really able to support them in their journey.

At the time I always lived quite some distance away from where I worked. So there was a job that came up closed to where I lived, in Wolverhampton, as a senior staff nurse. Back in those times is was grading so that was an E grade job and not a D grade. So I took on that job as senior staff nurse in what was now a very large district nursing team: because they had brought lots of little teams together and they covered a much bigger geographic area and worked for more GP practices, so that had different challenges.

Within six months of me joining the team all of the senior nursing staff left (laughing) so there was only myself and a group of community staff nurses. We made it through! We did okay and we made sure that everyone was seen and safe and that the staff were trained and that they felt like they were really part of a team.

Then I was seconded to undertake my specialist practice in District Nursing. That required a change and a move and a totally different experience which I thoroughly enjoyed and I’m still in contact with some of the nurses who I undertook that training with now, even though it’s eleven years later, we’re still in contact.

After I had completed my training and I went back to work as a qualified district nurse, a prescribing district nurse, I then moved into management. So I was just told, when I started, by my manager; ‘you’ve got two teams, two very small teams, that don’t work well together. They are not able to evidence their KPI (key performance indicators), or what they’re doing, what’s their activity?’ So their data quality wasn’t very good. She just said to me ‘I just want you to go in there and sort it out! It’s up to you just sort it out!’ So that was a steep learning curve as you can imagine and I stayed there for quite some time, bringing the team together and just getting them to work together as one team, over quite a long period because it was out of hours and overnight, so we had the biggest time span to cover.

The team grew from twenty members of staff up to sixty by the time I’d left which was about four years later. With a much bigger caseload of people that they were seeing, many more planned visits over the evening and night time provision.

Then I thought to myself I want to know whether I can transfer everything I’d learned in that organisation somewhere else. That’s when I applied to be a locality manager in the daytime, in a totally different area, over towards Coventry and Warwickshire. They had integrated teams, integrated with therapists as well as health staff whereas it had just been health staff during my previous role in Wolverhampton. So lots of working with the team, making sure - the same things again - that they had enough staffing, that everybody was safe, that the staff was safe, the patients were safe, all of those key things. I did that for another four years.

That was the time when I moved more into the strategic direction of nursing. What could we do on a larger scale that would make things more streamlined and better for the staff and patients? So there was a lot around that, work with the GPs and work with the patients, to try and bring that change in pathway about. So I stayed there until that was planned: we’d written an operating policy around that to try and make sure that that was streamlined.

Then I moved across to Burton-on-Trent - which was lovely, I really enjoyed my time there - as an integrated services manager. So this, now, was a role where I didn’t have direct hands-on management responsibility for the front line clinicians, but they all had managers of their teams.

So that was where my portfolio really expanded: so although I had intermediate care, integrated services, and that was health and social care, I also had the hospital social work team that fell under my remit as well. I also had the in-house reablement and the difference about that organisation was - at the time - they were an integrated health and social care organisation, so all of the local authority provider services fell within that remit. So although district nurses were connected with what we were doing, I actually wasn’t managing district nurses at that time. What I was managing was the other services. I also had a service that looked after stroke rehab patients, so that had a pathway that started in the acute trust and came out to hospital.

I also had the community respiratory team, which was a regional team across the whole of Staffordshire that came under my remit. So as you can imagine I then moved on to a much more strategic role: working with the commissioners, being very clear about what we were doing, what was the way forward, what it was possible to achieve. Very much working with the acute trust looking at flow through the hospital and how that came out to communities, how we needed to be able to respond to that in communities.

Then I was asked to do a piece of work at that same acute trust looking at their complex discharge pathways. So I only stayed there for six months, because that was the timescale for the piece of work, but I worked really closely with the director of operations to very specifically look at the complex discharges. This could include people that may have been identified for continuing healthcare, requiring a big local authority package to facilitate discharge, or there may have been other complications in why they couldn’t be discharged. To look at that and to look at how the flow in the hospital is impacted by not having a really clear, smooth pathway for this and identifying where work needed to be done along that pathway.

I introduced a new role onto the wards to facilitate early detection and ensure there was somebody to keep on top of it every day as opposed to someone who might drop in to the ward, observe it and left it for a bit, so that was really interesting.

Then I moved onto the CCG! (Clinical Commissioning Group).

So within the CCG I don’t directly manage any staff, I have a big hand in hospital flow still, the delayed discharge agenda, but my main portfolio is around intermediate care and looking at the whole journey out of the acute trust, out of hospital. What services do we need to have in place? How well are they working? Are there developments that the providers need to make to those services, to make sure they meet best practice? So we can benchmark what we’re doing and so it can really fulfil the outcomes for the patients and for the local population.

… I still remember some of the people that I’ve looked after in the past. I’ve got lots of people that I keep in touch with via social media from the teams that I’ve worked in or managed previously. The nature of the work is that there are times that you see people during the worst experience in their life. I’ve always remembered, through my district nursing careers, that I’m a guest in their home and that my purpose was always to try and make their worst day more bearable. I like to be able to see and evidence that my work has made a difference not only to the patients but also to the staff I’ve worked with.

All photographs copyright of Inès Elsa Dalal © 2019 Commissioned by Sandwell and West Birmingham NHS Trust, 2018. No photographs or text may be referenced or published elsewhere, without prior permission.

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