Latest / Rad Chat / Bonus Episode: Heather McClean - Macmillan Cancer Support Neighbourhood Health Strategy
Transcript
- Naman Julka-Anderson (00:00) Hello everyone and welcome to Rad Chat, founded by me, Naman Julka- Anderson. Jo McNamara Rad Chat Host (00:04) and me, Jo McNamara. So Rad Chat is a forward thinking global knowledge hub where healthcare professionals can advance their expertise in radiotherapy and oncology. Unlike traditional academic resources, we blend real world experience, expert insights, best practice, and of course, most importantly, patient perspectives. Naman Julka-Anderson (00:23) We make advanced knowledge engaging and accessible, supporting continuous learning and professional development without compromising patient care or personal time. By providing insights into both technical skills and career development, helping you progress confidently in your field and shape your professional future. Jo McNamara Rad Chat Host (00:39) Just to let you know, our episodes may contain sensitive and difficult topics that you may find distressing or triggering. Naman (00:46) So this is a bonus episode where we will be hearing from our guest Heather McLean about Macmillan Cancer Support Charities' Neighbourhood Health Strategy. Hi Heather, how are you? Heather (00:56) And good thank you, it's very warm and close today, so really happy to be here. Naman (01:13) Thanks for being here on brand as well in green. Would you mind just starting and telling our listeners who you are and what your current role is, please? Heather (01:22) Always. Yep, so my name is Heather McLean, my pronouns are she/her and I'm the Director of Community and System Partnerships at Macmillan Cancer Support, and that also includes being the lead for neighbourhood health. Naman (01:23) How did you get to where you are now? Heather (01:26) What a good question. I've had a bit of an eclectic career across health and the voluntary sector all of it has been driven, which feels like a bit of a culmination ⁓ in the neighbourhood health work, really about ⁓ being a voice for people with lived experience and particularly from communities who've been most underserved. I've seen time and time again. That inequity gap growing, but also when care is designed around people, it's much better. Everyone gets a better experience and we deliver better services. So I've had various roles from kind of local involvement networks, working with community organisations, and doing kind of system leadership roles with the British Heart Foundation and kind of pinched myself a little bit when I got my first job at Macmillan to be honest and I'm still here, they've still not kicked me out nearly five years later. So hopefully I'm doing something right. Jo - Rad Chat (02:19) They're very lucky to have you, Heather, you're very modest. Tell us a little bit about what neighbourhood health actually is. You know, for the general public out there who thinks, well, I know what a neighbourhood is and I know what health is, what is it when you put them together? Heather (02:29) Yeah. Yeah. Yep. So I think the bit that's missing in there, which is actually what it's about, is about the person and about communities. So neighbourhood health for me really is about, in this case, people living with cancer, but actually anyone getting joined up care that's personalised to them, where they don't fall through millions of cracks, they don't need to navigate 20 million different MDTs and pathways. It's care that's really built and designed around them. And the neighbourhood element is really about it being as close to them as possible. So not over relying on acute or hospital services when we don't need to. So it's that sense of really personalised care, really joined up, as close to the person as possible. That's that's what neighbourhood health really means and for me and for for others I think. Naman (03:27) Why has it become an importance for Macmillan or I suppose just in general within the UK? Heather (03:33) So so there's a few things, right? So for Macmillan actually, like this has been important to us for well over a decade and arguably for kind of the the entire time that Macmillan's been around because from Douglas Macmillan kind of delivering coal looking after people, it's it's about their wider needs, it's recognising that if you've got cancer diagnosis, the cancer diagnosis is only one part of it. It's how you going to pay your bills, it's your emotional needs, how are you gonna support your family all of those things that make us make us a human being and and that matter to us. And Macmillan's been in that space for for decades and we've been talking personalised care for over 10 years. And so it might sound a bit cheeky but we felt actually like kind of governments were catching up with us a little bit when we we saw policies coming out of the neighbourhood health because we've been talking about personalised care, joined up care, thinking about the whole person for a really long time now. So it's it's kind of pretty exciting that ⁓ that actually that the the whole system is now starting to talk in this space and that's giving us some really amazing opportunities to to think really quite differently about how do we centre people and communities in really designing and shaping services that that work for them. Jo - Rad Chat (04:53) How do you get to find out what specific communities need? Heather (04:57) So that's an amazing question, Jo. So I'm gonna we could probably do a whole other podcast on what is good co-design and what is really not good co-design. ⁓ What it isn't is a bit of a tick box consultation exercise. That's that's not it. What it's not is one person on a patient panel who might have been there for years and is there to try and represent everybody with a cancer diagnosis. It starts with ⁓ insight and data, so knowing who your community is, and that's different in the Highlands of Scotland to the South West to Inner City London to kind of West Hertfordshire, which we may well talk about to Birmingham, all really different communities. So it's got to start with, well, who is your community? I who are the people who live in your area and what are their needs. And then it really is then about building really strong trusted relationships with people who already have those relationships. Heather (05:54) So it's really about so you get that insight, you really understand who your communities are. And we've got this tendency as kind of big charities in the NHS that will often swoop in and think we know best, but actually the people who often... know their communities best are some of those grassroots organisations, faith-based organisations, community networks, and going directly to people living with cancer. So there's a whole host of different approaches. Part of what we've been doing is playing a really kind of important convening role and bringing people together and trying to resource and support community organisations so that they're more enabled and empowered to be part of the conversations and to really shape and design services that work for them. Naman (06:43) How do you decide who is the trusting or trusted person in a community? Heather (06:49) It's an amazing question and it's not an easy answer, right? So I've been around the block a bit in community engagement and I looked back kind of 15 years ago, 20 years ago and shudder a little bit at what I kind of thought was great community engagement and I would, you'd go to the kind of the big loud voices, some of the kind of bigger networks. Sometimes you need to get a bit more creative. So some of that is kind of reaching into kind of pre-existing networks. There's some amazing kind of community foundations, some amazing VCSE networks that exist already. And it's also about kind of looking at the kind of relationships we've already got. So if I think about this, some amazing organisations that can survive in Manchester, who pretty much sprung up from the fact that we hadn't always done a particularly brilliant job as a big charity or in the NHS they've been really building and designing services to meet the needs of the black and ethnic minority population in kind of some of the boroughs around Manchester and their figures and their impact speaks for itself. So we can pretty much say that they're a trusted community partner. But it's also those ones that when you go, when you turn up and you're in a community centre with some of those organisations and you see them live and active, when you go to the Domino Club, when we go to kind of Croydon, we see those those kind of relationships build and people keep going back and when they're reaching people that we've historically not done a particularly good job, or when I say we, mean, kind of bigger charities in the wider health system, we see them engaging with those communities. We know that they're getting something right. But sometimes that is a risk. So when we're thinking about who we partner with and who we fund, we've sometimes been a bit nervous, kind of, well, they're a really new organisation. Do they know what they're doing? That means that we all in the system need to think a little bit differently about what's a good community organisation. Jo - Rad Chat (08:50) Heather, when you're partnering with communities, how do you go about maybe dispelling any myths or stereotypes or building a relationship where you don't go in and correct them? Because absolutely, we recognise that communities have their own faiths, their own beliefs, their own values. And sometimes that really does kind of cause a bit of a kind of opposition to maybe... westernised healthcare and that in itself can sometimes be really difficult I would imagine when you're supporting a community and they don't necessarily align with facts or scientific evidence base and yet it's still really important to them. How do you kind of forge enough of a relationship to maybe challenge some of those beliefs or values without ruining a trusted relationship? Heather (09:22) ⁓ man. That's such a good question and it's a live one, right? So whether we're thinking about trusted community organisations or we're thinking about the ease of AI, good quality information for people with cancer really matters, right? We don't want people to have unsafe advice and information. But also I think if, for any of us, if people kind of came in and suddenly started going, like how you've been brought up with things that really matter to you and you believe in are wrong, and there's a way of having those conversations or not. One of the things that we've seen work really well that we've been investing in and partnering in over the last couple of years, our Cancer Champions programmes right across the UK. So what we've done here is partnered with, we've described them as anchor organisations, but it's basically well-established, trusted organisations that probably got lovely spider web relationships with other smaller organisations. And we've worked with them to train up volunteers and some staff members around what great quality cancer information looks like, what pathways look like, so that they've got a really great understanding of the system, where to go for kind good information, good quality information, but not in a way that is doing the kind of Macmillan or the NHS no best and you must all be wrong, that really awful paternalistic patronising way, but what we've seen in those communities is kind of greater uptake of screening, greater confidence of getting kind of signs and symptoms checked out, people getting diagnosed earlier, people feeling more confident to engage in the NHS system that they might not have had that confidence or trust in before, but that's not an overnight thing. You're not going to achieve that by going in and going, you're wrong. That really is about going in with a sense of humility and curiosity and building those strong relationships up. But what we've seen is whether that's the fisherman's mission in North Shields, whether it's the farming community, whether it's the lovely Calderdale Cancer Aware team who I adore and they've just won the Macmillan Award, who are going into a whole host of marginalised communities. What they've been doing is they've got really great insight and information. They've got the trusted relationships to have those conversations around this is kind good quality, evidence-based information that people then trust in their language, sound like them, look like them, go to the same schools. Naman (12:22) How does it work with the NHS workforce then or Macmillan professionals to buy into the strategy and the ideas? Heather (12:29) That's a really great question. So a big part of our strategy that we've been looking at well beyond neighbourhood health and it's been looking at kind of what's Macmillan's role around health inequity. And one of the things that we've been looking at is what's our role around cultural responsiveness. And this is really that sense of Macmillan, we've got this amazing reach, right, with Macmillan professionals. So 11 and a half thousand and growing after I launched the membership offer hoping to have kind of 40,000 through the affiliate program. That gives us amazing reach and amazing influence through Macmillan professionals. So we're gradually over time now doing a whole host of work through communities of practice through Macmillan's own podcasts to actually start having those conversations around actually this is what it's like for certain communities. This is kind of how you can, what good culturally appropriate, culturally responsive care looks like. Again, it's not an overnight thing is it? It's, that's kind of a slow, deliberate piece of work, but I think as Macmillan we see, again, we can't go in and necessarily preach, but we've got a really important role to play in terms of both modelling, what that looks like, and we're on our own journey there. We haven't always got that right and we still have missteps, we've still got a way to go. But also through our reach with Macmillan professionals, kind of shaping that conversation and it's been really kind of really exciting and warming to see that level of engagement and responsiveness from professionals. People want to get this right, they don't turn up to work to do a bad job and there might be a whole host of systemic issues that need tackling but we've got an amazing role to be able to play to shift some of that conversation. Jo - Rad Chat (14:24) Heather, you mentioned a few projects. For people out there who don't know a lot about maybe some of the projects you mentioned or Macmillan, what are some of those neighbourhood community projects that you've been part of? Heather (14:38) Yeah, so I talked a little bit about we've been kind of building our personalised care work and our work with communities. So that Cancer Champions model is this really lovely work with a kind of substantial kind of community organisation that's really well trusted and have this volunteer model that's really deeply connected. But we've had some really fantastic examples in the last couple of years where we're looking at kind of a much bigger scale. Two in particular where we've got a project in Dorset where they've been really growing and shaping their integrated neighbourhood health teams, working alongside community organisations to be able to really build responsive well-designed services. And then in West Hertfordshire, there's been this really interesting model where they're looking at essentially proactive anticipatory care. So how do they think about preventing people falling into crisis or preventing unnecessary admissions or reducing the amount of time that somebody's going to need to be in hospital by getting as much of a left shift as possible. So we're not always going to stop people deteriorating as they get older or if they've got a little health, but if we can keep people home longer, if we can give them better support, meet their wider needs. So that's better for the person and it's better for the system. One of the really lovely things that we've got in the West Hertfordshire model, and this is where we've been using social investment through our neighbourhood transformation funds. We've also got the centre, and I'm trying not to get all techy, but I get a bit excited, but at the centre of it we've got this community interest company, and what this is about is about really centering the voluntary and community sector right at the heart of it. So we provide a grant, so in the wider system we essentially provide, it's almost like repayable finance if people meet certain outcomes. But at the heart of it, we've got this grant that goes into the VCSE sector. So it's a couple of million pounds. It's not small fry. But what enables them to do is as they achieve what they think will be great outcomes and savings in the system, so great for patients, great for the system, but it also means you can recycle money into the voluntary and community sector. So great for the voluntary and community sector as well. So what we're really trying to do at Macmillan is really think about that kind of commitment to care close to home, services being designed by communities and with kind of the needs of people at the heart of it. But doing that in a way that really recognises that we've got great ideas out in the system. And when people come together, they can design something truly brilliant. But often you need different types of funding. You need different opportunities to innovate and you need different opportunities to come together. So, so much of our work now is in the space of what's our role as helping innovation, helping convening and helping kind of put communities at the heart of it. Naman (17:38) I think one of my favourites is the farming community one, to Alex and the team, having met them in person. Even in Northern Ireland there's a therapeutic radiographer part of the team, very important as well, but it really talks about building relationships and taking care away from hospitals to them. Heather (17:43) Yeah. Yeah, it's just gorgeous, right? ⁓ I of, I got to go and see the team at the Fisherman's Mission. So really like different community, different audience, but like some really similar things. So this kind of quite stoic approach to their health, but also like huge pressures in terms of can you get to your appointments if you're out at sea for days and weeks? if you've got a farm to run and farmers like this, there's a bit of an impression that they're all kind of really wealthy things. Actually people who work in rural communities are under huge pressure, work huge hours. Both are at risk of certain types of cancer. And what we've really tried to do is rather than us going and go, right, we know best with fishermen or with kind of rural communities is really lean on like amazing organizations like Fisherman's Mission and the farming community and they're having real impact, right? And at scale, it's really, really exciting work and it gives us an opportunity to think very differently about the sort of care people can experience. Jo - Rad Chat (19:03) Some of the projects you've mentioned, I would envisage that from a qualitative perspective, it's really easy and anecdotally, it's really easy to measure the impact. But how do you go, especially when you're donating such significant large amounts of money, how do you actually compute financially the health economics around that? Because I would imagine that's a real challenge. And especially if you're partnering with communities that maybe have never had to do that. Heather (19:32) Yep. Jo - Rad Chat (19:32) When you go right, can you tell me what the impact is? I'd imagine sometimes that's really nerve wracking. Heather (19:38) Yeah, it is and it isn't, right? So, and I kind of say this, I've got a million grassroots organisations on my shoulder now, like that I can just hear and they've all got 20 million different opinions. Like evaluation and measurement is a really hot topic. So yes and no. So actually, community organisations are pretty fantastic at measuring outputs and measuring their impact. It's not always done in a way that is like fits into a nice neat box that a health secretary or a commissioner is going to want, but they can definitely demonstrate impact. And it is so much more than qualitative. And these are organisations that sometimes might have one paid member of staff. So that's literally the person who's putting the bins out, training the volunteers, doing the evaluation and delivering services. And I've been that person. So kind of like it is literally do everything and sort the toilets out as well. And so these are amazing people doing brilliant work and actually are often great at doing this, but also they're hugely pressured, right? So like with the Cancer Champions, we very deliberately wrapped evaluation around that. And we love support and major programmes where we can help that kind of, that insight. And it's one of the reasons why we really encourage every health system to really think differently about their insight, what are they measuring? So I think there is quite a lot there that's there already and we do need to think really differently about what's good quality evidence in those spaces because so many of those organisations will have had countless pilot programmes to prove efficacy, prove that something works. Short-term funding, they've gone, well we've shown it works but nobody will pick up the funding. So sometimes it just needs a little bit of bravery. However, I would also say that particularly in the social investment world, this is part of the absolute gorgeous element of the model is it's really focused on the analytics and going, what is the outcome you can measure? So if we go back to when we first did social investments of pre-neighbourhood health, we started in the end of life care space. And this was looking at, OK, what are the things that we can measure that matters to a person? And also is kind of like a measurable, trackable data point in the system. So we were looking at bed days in the last year of life. So we basically invested sums of money at scale in systems for them to be able to test new models. So double running, so taking that innovation headache away. And then when they could show that they were achieving a saving, that's when the money came back. And actually each of those sites have done incredibly well. There's been 86,000 bed days have been saved from that project. So that is phenomenal. And on average, think it's, I always get the numbers wrong, it's either 11 or 14 on average bed days saved for a person in their last year of life that they get to be at home with their family rather than being in hospital. And that's such an amazing impact, but it's also something you can measure and it's also something that you can see has an impact in the system. that is essentially, and sorry, I'm getting really excited now, but that's essentially at the heart of what we're trying to do with neighbourhood transformation funds is go, what's the thing you want to measure? And we're not saying what it needs to be. We will work with systems to go, what is the thing you want to measure? So they might be looking at a population that is thinking about cancer and long-term conditions. It might be leaning towards more frailty might be leaning towards more younger people. But it might be that they go, the thing we want to track and measure is emergency admissions or A&E attendances, or it could be bad days. So let's look at a thing that we can track and then go, if we do this thing, the hypothesis is this has an impact. And that's absolutely the space that we want to be in. But at Macmillan, we are always going to come from a space, not from a health economic space, we are always going to come from a space of what is good for people. And we think that left shift for neighbourhood health is really about strengthening communities. It's definitely about that kind of wider health and societal resilience. It's great for people living with cancer and other long-term conditions. And it's great for the wider system and enables us to innovate and transform things for the future. Jo - Rad Chat (24:17) It's so reassuring to hear that because if I have to do one more business plan that just focuses on bed savings, I'm going to scream because, you know, it's so hard to actually formulate that. And it's like the only thing that the NHS seems to recognise. It's so frustrating. So it's amazing that you kind of. Yeah, so it's lovely that you're really taking it as a community project in the sensible. What outputs do you think you could look at? So, it's brilliant from that perspective. Heather (24:29) Isn't it right? Yeah, I said I wasn't going to swear, but yeah, I agree. Jo - Rad Chat (24:46) sounds really great. What's been your biggest learning Heather from kind of being in this role and supporting neighbourhood communities? Heather (25:02) Oh, like how long have we got? So the learning is there's so many tensions, right? So some of the tensions that I'm like holding on a daily basis still now is the tension of some of this work takes time. Like you don't build trust overnight. And when we were at Confed someone was describing how change operates at the speed of trust. And if you're doing it right and you're building in and with communities, that's not overnight, that takes time. But equally, we're really impatient. There's never really been a moment quite like now where things are really aligning. So we want to get some pace and we want to be doing the work to demonstrate the impact and what can happen and the benefits of that. So that balance of like taking our time, but also some pace. then we've got, I might talk a little bit in a moment around an amazing new trailblazers programme that we're doing in partnership with the Office for Impact Economy. Those sorts of partnership that come centrally and with other partners do not happen very often. So us being able to capitalise on that and go where the momentum is and go where the energy is, but also going, takes time to build trust and do this well. That's kind of a learning and a real tension. I think there is also something around really thinking about how we design from the margins. So it was so brilliant to hear at NHS Confed, ⁓ we were there recently, where you could hear so many more conversations where people were talking about inequities, talking about bringing in lived experience, talking about communities, and that's great. But When pace hits and people need to deliver, you very quickly, and I've been burnt on this so many times, people will very quickly go from really great quality co-design, and I've been guilty of it too, to then doing it a little bit more tokenistic and just going, right, that's good enough. And if we really want to use opportunities like neighborhood health to really shift the dial on health inequities. We have to design from the margins. So we have to think about who is getting the worst experiences. And that might look different in each place and that's okay. But we have to start extrapolating the data we've already got. We've got to speak to people and we've got to design it around their needs. And you can't do that in a tokenistic way. And ultimately it ends up more expensive and you end up making the same mistakes. But they're probably my biggies. I'd probably tell you a million more over a couple of glasses of wine. Naman (27:46) It's a really good point around the co-production. I think still in the NHS world, in academia, people are saying in the titles of their journal articles and fancy journals that, we we co-produced this, but you haven't, you know, having them at the end or just having a PPI group that's looked over your findings. It's not co-production and actually good co-production, like you said, takes ages and it should do. It's not supposed to be quick. Heather (28:08) Yeah. Naman (28:09) You know, like that's Heather (28:09) Yeah. Naman (28:10) the point of it is that you've got more challenges, but you're doing it right from the beginning for the people who need it the most. I was quite lucky to do a talk at ESTRO this year, talking about some of the stuff that we've done at Macmillan and actually like the co-producing the Macmillan open house is always one of my favourite stories that it was designed for brown and black people, maybe a bit more leaning towards a black community, but at the same time, the lunch was about the South Asian community. So I was happy with that. Heather (28:15) Yeah. Yeah. Naman (28:35) But it just meant in the room, everyone was comfortable to talk about things because it was the environment they trusted and liked and there was the right smells, whatever it was. But those conversations, if you took it out of that room, it never would have happened again. And that's the point. But even to set that up, it took lots of money, time, you know, and there's still so many more learnings, even though it was such an incredible event. But that's the kind of stuff that think NHS colleagues and academia don't always get to see because we don't have time. Heather (28:49) Yeah. Yeah. Naman (29:03) And actually to do things quickly you have to otherwise you lose the funding or you know can't roll it over to the next year and stuff like that but yeah it's just a good point to get across. Heather (29:05) Yeah. Yeah. Yeah, definitely. And I would just say as well, there's something about just being really honest as well, that there are times when we should all be, and we are, I really hate using the word journey, but I think this is like the third time I've used it. But we are on that journey, for really embedding kind of co-production and co-design. And I would love us to see at that stage where it's real community mobilization, where people are setting the agenda and they're driving the change. We're a way off that, but at the very least, we just need to be honest about when we're not doing that. So if it isn't co-production and it's just really limited consultation, just say that, like be authentic because that also helps with the build and the trust. So if there are times when you do it, you're doing it in a way that you wouldn't want in a suboptimal way, at least be candid and honest about it because it's so extractive when you see people just swoop in, do a bit of something, come back out, call it co-production, and the outputs bear no resemblance to the conversations people have had. And again, I've seen that, I've been part of some of that in the past, I churn now when I go, did we really think that was good enough? And it's like, you've got to like we've got to do it differently and we've got this amazing opportunity with the community sector. I'm trying really hard not to get on my soapbox. They're phenomenal, right? They have real instability in funding and I know things are precarious in the NHS, but the amount that people can do with deep insight, deep knowledge and in the voluntary community sector, they have been talking about the same things for years and years and years. And yet they still engage and they still show up to the table when I know so many of them will be wanting to roll their eyes going, here we go again. like, we've got to share the power properly, right? Like, this is not just some people who are not professional. Like, they know their stuff, they know their communities, they know arguably a lot more than most kind of commissioners around like what communities need. So let's just really share the table, really share power in a ⁓ really equitable way. And when we're not doing it, be honest about it. Jo - Rad Chat (31:35) I always love it. We did a piece of work called Radiation Reveal and the biggest bit for me was when we were adamant that the patient representatives were going to be authors of the paper. Of course they should be. Why would they not be? They've contributed the entire way through. And I think kind of changing that. Heather (31:50) test. Jo - Rad Chat (31:58) that kind of ethos is so important. And I absolutely know that there are some journals that won't be except patient authors. And I just think that's such a crime really that you can't do that true co-production of research for whatever reason they deem that they're not experts when I would actually argue they're experts in their care more than anyone else. Why would you not be? So yeah, I absolutely think that's really important. Heather (32:21) today. Yeah. Jo - Rad Chat (32:33) You mentioned trailblazing so tell us a little bit about what's going next. Heather (32:35) Yeah. Yeah. So ⁓ to set a bit of context, so we think neighbourhood health and to caveat when I talk about neighbourhood health, sometimes that can sound a bit England centric because that's kind of the name that's been given kind of across England. We mean care close to home and care kind of like in that kind of community space. I can describe it a bit differently in Scotland and in Wales and sometimes in Northern Ireland. So just to of caveat that, that what we mean, neighbourhood health in the of the broadest possible sense. We think it is so important in terms of the impact it can have to really deliver kind of joined up personalised care and to really go some way to really tackle kind of fairer cancer care to kind of prevent some of this fragmentation that we are putting kind of our resources now money where our mouth is over the next few years. And that Mullen's intending to invest about 250 million pounds over the next three to five years, it's like a huge amount of money. So we are absolutely committed to really shifting the dial in this space. And we're wanting to do that through a number of different funding mechanisms. So some are still in their final bits of design at the minute. So we're looking at kind of grants that can go into systems who want to test some innovation that kind of helps the left shift. So there'll be more on that coming soon, but we're really excited by. We're looking at a partnership with QLab, who are part of NHS Alliance, around how do we kind of answer the question of what does great holistic cancer care look like at place level and to help people test and learn and bring people together differently. And there'll be some money attached to that. But then we've been funding our community care grants. an amazing kind of open call that we tested earlier this year. We were expecting maybe 20 or so applications and maybe about one in a bit million that we might spend. It was about 7 million that we've invested. We've got, I think, close to 50 new community organisation partners. It's brilliant. Our head of communities and participation, Milad. I don't know how he's still so calm. Is that swan-like? I think the guy's on a lot of chocolate. But amazing, amazing work with the team there, which is phenomenal. But then the really big flagship area that we know there is something around is social investment. we're really, know government, our health systems are really interested in the potential for social investment to enable money to go into the system. Macmillan to take that risk and to share the risk, but people to try new models of care. But what we also know is that to do that, it does need some capability building in systems for people to understand how do they look at the data? What do the analytics need to look like? What's the learning that they need to gather? How do they build the right sorts of relationships and embed co-design? So what we're doing in partnership with social finance with West Herts, which was one of our early sites, with the Office for Impact Economy and with the Strategy Unit is launching this Trailblazer program. So it will start with up to six of the 43 neighbourhood and hip sites across England, but will also be extended across the devolved nations as well, to identify a number of sites, to work with them over a number of months, to build their capability, to help them kind of really understand what it might look like to essentially get them ready for hopefully a social investment case next year. So that we would intend that we would hope those six would then be fundable or investable from our perspective next year. So really amazing. So it's 1.5 million that's come from the Office for Impact Economy, lots of partners around the table, but us really going out to the system, building the capability and getting people investable and we're also really hoping that other kind of funders of third sector organisations also might join with us in this to invest in some of these sites next year and beyond. So the Trailblazer programme will be launching end of this month, so June, so really looking forward to seeing how that goes and that's going to give us bucket loads of learning. that first kind of cohort of people along with the sites we've already invested in. We really hope there'll be some of those flagships to be those ambassadors and to help others understand how to do this really well. But these are really sizeable investments we'll be expecting to make in each year. Jo - Rad Chat (37:24) Need to bottle your enthusiasm and motivation Heather and sprinkle it round the NHS. Heather (37:29) It's just powered by chocolate, Naman (37:32) It's strange because a lot of the NHS is powered by chocolate too, so, you know... Heather (37:36) Well, obviously I have the wrong chocolate. Naman (37:46) So Heather, we're coming to the end of the episode. We always like to end with top tips for our listeners. What would you give our listeners to take away? Heather (37:46) ⁓ yeah. I did actually prepare for this. So I've got three top tips. So I've got them for different audiences. I'm hoping this is okay. So one, for people with lived experience, which is most important, right, is to be an advocate. So keep insisting that services are designed for you. If you're involved in community organisation, stay involved. Like your own voice really matters. And that's really is at the heart of what is going to make neighbourhood health come to life. If you've got opportunities to get involved, get involved. It really matters. And for people who are students or kind of learning, and you know my kind of my future son-in-law is in the kind of radiotherapy space. I've got a bit of a soft spot for people who are in the radiotherapy arena is to stay curious about the kind of the health system and beyond kind of the clinics. And it's so easy when you're you head down, want to kind of pass your course, you want to do brilliantly, but I know that we all know so much of health happens outside of hospital, right? Like 90% of a person's experience is not in a hospital. So for students, remember that amidst all of the millions of assignments, all of the expectations, remember that people live their lives outside of hospital and you will be better professionals and Heather will really approve. And for healthcare professionals is to really, it's a plea really, is to kind of, if you're a system leader, is to treat this as an opportunity to think really differently. And even if you don't see yourself as system leader, and I'd argue pretty much everyone is, is to really think about how you can work with communities as partners, not just a referral destination. Don't just assume they've got the resources to really think about, are you treating this organisation with kind of equal power? Are they fellow professionals and to really think about and challenge yourself, are you really thinking about co-design and are you really thinking about your local insight and using that to design your services? So that's millions of top tips and I think it's actually a bit of a nag, so I'm hoping that's okay. Naman (40:03) Definitely okay, and I think you apologised earlier for being too enthusiastic. Don't. Heather (40:07) You Naman (40:07) think with the geopolitical landscape at the moment, we need people like you standing up for communities and pushing for stuff. And actually it's quite nice having been a Macmillan professional for so long, and obviously working with you as well. That Macmillan is going in this direction and it's not just kind of business as usual, it's more where can we have the biggest impact with the money that we have and how we can support different communities and stuff like that. I think it's really important. And hopefully with our global reach, other people can see that and try and implement things where they are as well. Heather (40:37) And if people want to get in touch, so if there are other partners or people who are doing amazing things wherever, I want to hear about it. Let's be humble and curious together, right? Naman (40:49) Exactly. Thank you so much for coming on. It's been amazing. And thank you all for listening to our chat with me, Naman Julka-Anderson and Jo McNamara. Naman Julka-Anderson (40:59) You can use this episode as part of our free, continual professional development, accredited content, which offers flexible learning that fits your busy schedule. Just check out the show notes for the reflective questions, links to literature and resources, and a link to complete the form to receive your accredited certificate. Jo McNamara Rad Chat Host (41:15) Stay up to date with the latest radiotherapy and oncology advancements by liking and following us on social media channels and hitting subscribe wherever you get your podcasts. Naman Julka-Anderson (41:25) Join a supportive community designed by professionals who understand the unique challenges of radiotherapy and oncology. Check out our website www.radchat.co.uk. Together we're actively working to improve our profession and make a lasting positive impact on cancer care. Jo McNamara Rad Chat Host (41:41) It goes without saying that we can't achieve this alone. It takes all of us working together to create real change. That's why we value every voice and every contribution. We ask that you listen and learn, spread the word, share your story and if you need to, contact us. Naman Julka-Anderson (41:57) If you like what we're doing, buy us a coffee, keep us caffeinated, go to our website to find out more. Thank you all for listening and take care.