he report will introduce a project that explores an inclusive approach to access to health care services in England. In particular, the report places focus on the concept that some service users are “seldom heard” by health providers, and aims to challenge the more widely used judgement of “hard to reach”.

Such a concept is informed by Findings from Serious Case Reviews (NSPCC, 2016), and Domestic Homicide Reviews (Home Office, 2016) where victims were “invisible” to services.

Factors such as mental ill health, being new to country, immigration status, language barriers, being a victim of abuse, homelessness and criminality, carry associated fears that may render some mainstream health services difficult or impossible to access. This loss of credibility for health providers may be confirmed in high and recurrent nonattendance of appointments or a disproportionate use of available services, based on local population size. 

Patient Care Improvement Project 

A project was borne out of the autonomy of being a Designated Nurse for Safeguarding within a forward thinking Clinical Commissioning Group (CCG) Commissioning of health services is informed by patient experiences.

In the city of Birmingham this had to recognise the changing population demographics; increased number of births, decreased deaths, increased migration and a predicted population increase of approximately four to five thousand each year until 2028. (Demography of Birmingham, Census, 2011). These factors are pertinent to my project in recognising a potential increased pressure on health services. There is a clear requirement for services to support a migrant population, who may present with subjective physical and psychological health needs. Early intervention will minimise long term ill health, and as such, a prepared understanding from health services is crucial.

I successfully initiated a Safeguarding Commissioning for Quality Improvement and Innovation (CQUINN) for the Health Trusts in the city. The CQUINN had a requirement for health providers to review and respond to data around appointments not being attended, including making attempts to locate adults or children and establish the reason for missed appointments.

During the scholarship I was successfully recruited into the role of Head of Safeguarding in Birmingham Community Healthcare NHS Foundation Trust. The Trust had embraced the CQUINN and was proactive in delivering the requirements.

This resulted in insightful findings, with practitioners becoming aware of the life issues facing services users that make attending appointments a challenge. Factors such as multiple appointments, families with several children to cope with, reduced understanding of the importance of the appointment and unable to interpret written information were identified.

Practitioners were prompted to speak to other professionals working with families to achieve seamless care packages. As a result, changes have been made to improve patient access and experience. The learning from the CQUINN is reported regularly at the Trust safeguarding Children Subcommittee Meeting.

I was pleased to be in a position to see the positive outcomes and implementation of change from within the Trust.

Being part of the Community Trust opened more opportunity for me to influence service delivery to individuals who are seldom heard. In particular, I had interest in developing initiatives around a service for women and children who are new to the country.

Due to personal circumstances, all elements of the planned patient Improvement Project were not completed.

Learning and Development 

Leading Change and Organisational Renewal (LCOR)

This valuable residential course allowed protected time to explore myself as a leader and to establish a toolkit to support areas that need strengthening.

It was expertly led by a group of diverse facilitators who enabled a rich learning environment. It was of particular value to connect with fellow scholars and develop open and honest relationships where I was able to learn from experiences of others. The small group work was conducive to my preferred learning style allowing me to feel comfortable to discuss situations that posed a challenge to me and receive constructive feedback that I was able to apply to my professional work.

The impact of political climate on Leadership was also discussed and this raised my awareness of the requirement to horizon scan and be timely in leadership activities.

Royal Academy of Dramatic Arts (RADA) in Business 

This very enjoyable experience has left a significant personal impact. I was able to hold a mirror up to myself in a safe environment and receive supportive feedback on my personal and professional presence. This insight led me to immediately think about how I present myself to others and consider my voice projection and use of words to ensure my message is received as intended.

I was able to explore situations that I find difficult and to reflect on how I can build resilience to deal in such circumstances.

It was a privilege to receive training and facilitation from an experienced and professional actor who had an immense amount of knowledge and awareness to share. I came away from RADA with a toolkit of ideas and exercises to use within my current role.

Visit to Public Health England 

A series of connections were made within Public Health England that brought personal enrichment as a Nurse Leader as well as provided material to inform my project.


I was privileged to meet with Jamie Waterall, an inspiring Nurse Leader who expressed interest and shared my passion around my project. Jamie encouraged me to take pride in my achievements and vision and to own my position as a Nurse Leader.

Pauline Watt, Quality Lead provided insight into the measurement and demonstration of outcomes to inform future commissioning of services.

Loretta Sollars, Program Manager, Children, Young People and Families. We shared similarities in our specialities and career pathways, Loretta provided specialist advice and support around the principles of leadership.

Sarah Gaughan, Program Lead, Best start in life and beyond: Improving Public Health Outcomes for Children, Young People and Families (Public Health England, 2016). I was able to explore the investment of this program that had an intention to deliver early help and intervention to improve outcomes.

Visit to Queen’s Nursing Institute

Whilst visiting the Queen’s Nursing Institute I met David Parker-Radford, Homeless Health Project Manager. We shared a similar vision around inclusive health care for all. I was able to explore the concept of service development for individuals who are seldom heard and the importance of service user involvement in achieving credible and accessible services.

Overseas Connections

Contacts were made in USA with New York Presbyterian Hospital Group who have a successful Ambulatory Care programme offering bespoke health services based not solely on medical need, but holistically also considers social, cultural and emotional population needs. Successful implementation of such programmes requires a change of hearts and minds within health organisations.

The scholarship has enhanced my ability to influence a change in hearts and minds.


The experience of my scholarship was invaluable in encouraging self-focus. As a continuation of my personal assessments and analysis, completed with Sue Machell at the start of the scholarship, I have been able to acknowledge my areas for personal development. I have been proactive in addressing these areas to enhance my professional performance. The “imposter syndrome” Clance & Imes, 1978 was also pertinent to me and I have now learnt to claim my achievements.

Powerful transferable learning was gained as I diverted from the scheduled plan for the scholarship to provide palliative care for my father. Through this experience, vulnerability and the need for advocacy are seen from a different perspective.

I gained strength of character to ensure my father’s voice was heard and to achieve a personalised care package. I developed resilience to focus on a priority, despite suffering emotional weakness. As a leader sometimes things are out outside of your influence and do not go to plan. In such situations, review and refocus is required, which is what I had to do. The importance of self-care and kindness were also acknowledged in order to give to others.

The report includes reflections from my journey of personal and professional development and my aspirations to become an influential and confident Nurse Leader, Role Model and Advocate.

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