Permission to Try: Celebrating the Legacy of the Culture of Care Programme
In this blog, Molly Anderton reflects on her journey as a Lived Experience Advisor on the Culture of Care Programme, exploring the challenges, emotions and achievements that shaped the programme’s impact. She shares how teams moved from uncertainty and fear of change towards greater confidence, connection and courage to create meaningful improvements in care.
When my role working as a Lived Experience Advisor on The Culture of Care Programme came to an end in April, it was so easy for me to become caught up in the sadness and grief of ‘losing’ something which has felt so special to be a part of. Whilst it felt important to recognise, acknowledge and honour these feelings, I also wanted to be able to capture, look back on and celebrate just how much we have all achieved.
We have walked alongside ward teams who, when we met initially in Summer 2024, started from a place of fearing (and therefore understandably avoiding) any form of change. Many had become ‘stuck’, bogged down in processes and procedures, often still delivering care and running their wards in the same way that they had when they first started working in mental health, many years ago. Whilst these teams were keeping their patients safe, often flying under the radar of senior leadership and/or feeling somewhat ‘forgotten about’ amid other wards ‘in crisis’, they often lacked confidence in their ability to empower patients and carers to be active partners in their care. Cultures were not necessarily ‘closed,’ relationships between members of the MDT were strong and respectful, but there was a felt sense of disconnect between the humanity of staff, patients and loved ones.
Other teams joined the programme very much poised and ready to hold a position of defence. They were so used to feeling scrutinised, examined and/or criticised by everyone from regulators and inspectors to management and patients. When a Quality Improvement Coach, Leadership Coach and I visited their wards, they were probably anxious and expecting that we were about to add to that list. Conversations which were intended to be exploratory and reflective may have instead felt like a test of loyalty to colleagues and/or their organisation: asking people about how the three equity principles (anti-racism, autism-informed and trauma informed care) aligned with current practice therefore sometimes felt uncomfortable.
What I perhaps wasn’t expecting to see, hear and experience was the conversations with teams who had so little grace for their efforts to provide compassionate and relational care in such unforgiving, challenging systems. Hearing them speak so candidly about the ways in which they felt they had ‘failed’ to involve individuals and carers in care planning, were not able to give people the time and opportunity to really tell their story and feel heard, and were not meeting the cultural or access needs of patients left me feeling so emotional. They did not fear change, nor did they try to manage and create only positive first impressions, but carrying the weight of feeling personally responsible for ensuring all patients experienced the best possible care was weighing them down and trapping them in a narrative of “we should be better.”
Ultimately, every ward and organisation started and ended the programme at different stages of their journey to embedding the standards. Some had more confidence than others, but all started with their own worries and concerns: we heard that wards were scared of ‘getting it wrong’. They feared rocking the boat and changing what had ‘worked well for years’, of being judged and/or vulnerable to critique, of failing, and of not being ‘good enough’ or ‘bold enough’ in the changes they made. Despite this, and in the face of every challenge thrown their way, one thing in particular stands out to me-
The Culture of Care Programme has given people the permission and courage to start, and to try. To test out and implement change ideas, collaborate with patients, carers and those with lived experience, and strengthen positive and relational ward cultures. It has given them a safety net: one in which they have been held and supported to navigate ‘failure’. To embrace and learn from this safely but then get back up and, without judgement, try again.
As a result, so many teams have succeeded, thrived and flourished in their own, unique ways. The ward frozen in their ‘safe’ (but often outdated) ways of working became trailblazers: they committed to both listening to and acting upon the voice of patients and carers, making changes which mattered most to them. They refused to allow communication ‘barriers’ to stop them from doing this. Those who struggled to acknowledge ‘room for improvement’ have gradually learnt to sit with the discomfort of imperfection, whilst those who were unable to see their strengths began to actively celebrate the successful implementation of change ideas.
The Culture of Care Programme may have formally coming to an end, but we are hopeful that the legacy it has created will continue to live on in the hundreds of wards, and in the thousands of people, it has reached.
