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to accompany the
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Funded by

South Lakes Registered Managers Network

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Acknowledgements
The idea for this development came about after
seeing the excellent Bedside Manners Play and
Workbook that was created by Suzanne Gordon,
Lisa Hayes and Scott Reeves. They recognised a

Let’s talk
need to develop a tool that focused on enhancing
inter-professional teamwork, particularly ,but not
exclusively between Doctors and Nurses in an acute
hospital setting in the United States. As well as
acknowledging that strong inter-professional working
would have a positive impact on the wellbeing of
staff, they also saw it as a vital component in the
delivery of safe care in a complex health system.

They felt it was important to address what was

potentially a sensitive subject in a way that was
engaging, non-threatening and fun. Therefore they
chose to use a ‘readers style’ theatre approach and
it worked extremely well with great feedback.
We decided that the same approach could
successfully be used to get people talking about the
health and social care integration agenda here in
the UK. Suzanne, Lisa and Scott please accept our
thanks for your great work, without which we would
never have developed our project.

Additionally we would like to thank the individuals

from across health and social care who provided us
with examples of good and bad practice which we
Let
were able to include in our script. We would also like
to thank those who read and commented on the
script. These included members of the South Lakes
Registered Managers Learning Network, a GP,
social worker, nurse/district nurse and care worker.

Finally we also want to thank the individuals that

appeared in our film. 5 are members of
The Silverdale Players – a local amateur

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dramatic group and the other 5 are from

Let’s talkLet’s talkLet’s

the health and social care sector.
s talkLet
Let’s
Let’s
Let’s

2
Introduction
Following the inquiries into the abuse and neglect Once we recognise our similarities we can start to
at Winterbourne View and the Mid-Staffordshire break down barriers and develop trust. The ‘Let’s
NHS Foundation Trust there has been concern Talk’ project therefore aims to promote discussion
about how best to ensure quality and safety across in relation to:
both health and social care. Research suggests
that most care is of a high quality, but that even l Building relationships
within the same organisation there can be both l Developing understanding and empathy for
‘bright’ and ‘dark spots.’1 ‘Bright spots’ include others
teams and individuals who demonstrate caring, l Understanding the impact of our behaviours
compassion, cooperation and civility and and communication
commitment to learning and innovation. ‘Dark l Delivering true person centred care
spots’ are where staff and teams are harried or l Highlighting the need to raise concerns about
distracted, preoccupied with bureaucracy or safety
engage in ‘turf wars’ rather than effective team
working. It is well known that there are significant ‘Let’s Talk’ involves a 30 minute play about team-
challenges for team working and communication work and communication. It incorporates scenarios
at the boundaries between services, for example that most of us will recognise from our day to day
when supporting someone home from hospital. encounters at work. Some demonstrate the impact
‘Let’s Talk’ is designed to support organisations to that a power imbalance can have on professional
work in an integrated way, to prevent ‘dark spots’ relationships and ultimately the quality of care that
from occurring at these key transition points and is delivered. Some show how easy it is to fall into
to know what to do where they occur so that they the trap of thinking that we know what is the best
quickly become ‘bright spots’. thing for the patient/client/service user and
dismissing what they themselves or other
‘Let’s Talk’ brings together workers from different professionals have to say.
agencies and professions and uses theatre and
discussion to provide a safe space for learning However, we also see that everyone, no matter
and reflection on these sensitive and complex what their role, is motivated by their ability to make
issues. It is a ‘relational tool’ which recognises a difference and positively improve the situation for
that working successfully in an integrated way individuals. Conversely we also learn that they
across teams means developing our understanding experience very similar stressors – the main one
of others and fostering empathy. When we do this being not enough time to fit everything in.
we are likely to learn that we have much more in
common that we realised previously. For example Therefore ‘Let’s Talk’ enables us to step in to the
many of the things that motivate us will be very shoes of our colleagues for a short period and
similar – we were all drawn to the caring profession begin to think about what needs to change for us
because we do indeed care and we want the very to successfully work together in the future. It does
best for our patients, clients or service users. this in a non-threatening manner and by viewing,
Equally we will discover that many of the issues discussing and analysing the play we hope to
that frustrate us whilst carrying out our own role, help people gain a deeper understanding of what
are likely to be present for our colleagues in other is required if inter-professional teamwork is to be
disciplines – and hinder them just as much. successful.

1 See Mary Dixon-Woods et al. (2013) Culture and

behaviour in the English NHS: overview of lessons
from a large multi-method study. BMJ Quality and
safety, doi:101136/bmjqs-2013-001947 (early online)

3
1. How To Use Let’s Talk 2. Physical Setting
‘Let’s Talk’ can be used If the audience comprises of a mix of people from
in a number of different ways health and social care make sure that you mix
them up in order to reflect the inter-professional
nature of the group. When people enter a room
1. Across health and social care by bringing
they automatically prefer to sit with people that they
teams/individual together to use the film as a
know and often they do the same job. This will
tool to promote discussion about shared
impact on how they perceive the performance and
understanding of each others roles and
engage in the discussions and therefore it is better
communication.
to direct people to where you want them to sit. One
way to do this is to give out numbers when people
2. Within individual teams by using the film to
register. These could be table numbers or row
develop understanding of the impact of
numbers and mean that friends/colleagues can be
behaviours and communication
separated by directing them to sit in different
locations.
3. By performing the play to achieve either of the
above. The script, together with guidance on
Also consider the equipment that you require for
putting on the play are included as part of this
the session and where it will be placed. For
workbook. example you will require a flipchart. If you are
showing the film you will also need a laptop,
projector and speakers and it is worth checking
that the room has suitable blinds or curtains to
block out sunlight which can impact on the viewing
experience.

If you are putting on the play make sure that the

venue is suitable. You don’t need a stage but do
need to check that the audience will have a good
view from wherever they are sitting.

4
3. Putting on the Play
Please watch the video through to see how it is If you have a female playing the part of a male
staged and use this as a guide. The film uses 10 or vice versa, make sure that you change the
actors however you may chose to use as few as 5 pronouns in the script. For example the GP in the
or as many as 15. Five of the actors were from an film and script is a female but you may make
amateur dramatic group and the others worked in choose to them male.
health and social care. If you are putting on the
play for a conference it may be worth asking a local Someone will need to act as the Director. Their role
drama group to support you. We paid them a is likely to involve casting, and staging. They will
donation and they were very grateful. You may also also arrange the rehearsal and will need to make
consider getting volunteers from the audience and sure that the actors deliver the dialogue with the
asking them to portray someone who is not from appropriate amount of feeling and emotion. Also
their particular profession – for example casting a that they speak loudly enough to be heard.
care worker as a district nurse or a doctor as a
care home manager. For the staging they need to get the right people
and the name labels to the music stand for the
You may find that a number of the audience start of each scene. Make sure there are enough
participate in amateur dramatics and are therefore seats behind the music stands for the actors to sit
very willing to get involved. There will also be on when they are not performing. If you are putting
others who will love the opportunity to get up on the play in a large venue with a large audience
on stage. However you will need to find your you need to consider using microphones. No
volunteers before hand, as it’s important to do special lighting is required.
at least one rehearsal before the performance.
The time commitment for this isn’t excessive -
about an hour is generally sufficient.
4. Facilitator
Once the actors are chosen give them copies of
the script as far in advance of the performance as The success of the session will be determined by
possible and ask them to read their parts out loud the skills of the person facilitating the event. They
several times so that they can read them need to be comfortable working with groups and
convincingly during the performance. They don’t have the ability to help all members of the
need to memorise them. When rehearsing remind audience understand the session objectives.
the actors they will be acting, not just reading and Their aim will be to support everyone to do their
that they will need to convey the feelings of the best thinking, encourage them to participate in
characters they are playing. Get the actors to look discussions and assist them to make plans for
up at the audience while they are reading and future action. They also keep activities on track,
avoid keeping their heads glued to the script. ensure discussions remain relevant and the event
runs to time. Also see the Facilitator Background
Reading on page 18 which may be helpful as it
includes brief information about teams and team
intelligence as well as the stages of team
development.

5
 5. Introducing the 6. Using the Play to
Session Facilitate Discussion
When you’ve got your audience together it’s If you are showing the film or putting on the play,
important that the facilitator explains what is going the facilitator will need to decide if it will be seen
to happen during the session and sets the context all the way through first and then replayed scene
for the film or play. We suggest that you use our by scene with facilitated discussions. We suggest
introduction as the basis for this. that you watch the film through in its entirety to
help you decide. If showing the whole film/play,
At this point before the session gets started once it has finished open the discussion by asking
properly and depending on numbers attending the audience members to turn to a person next to
the event, ask individuals to briefly introduce them or form small groups and discuss the
themselves to each other by sharing their name following questions:
and job role. This may be to the whole group or
to their table or row. It’s worth giving out name 1. Was there a moment in the play that made
badges with the individual’s job roles on too. you think of an experience of your own?
What was it?
Next ask people to complete the first section of the
evaluation. At the close of the session you’ll ask 2. Was there a moment in the play that you felt
them to answer the same questions again. This will helped you understand someone else’s
enable you to see any movement in thinking as a experience? What was it?
result of the discussions that take place.
After the audience have had a few minutes to
discuss their responses ask them to share them

Let’s talk
Let’s

with the whole group. This will give the audience

an appreciation of what everyone else has
experienced. You may choose to use a flip chart
talk

to record comments.
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6
7. Scene Titles with Characters

Scene No Overview of Scenes Characters Appearing in Scene

Prologue We’re More Similar Than You Think Social Worker

GP
Domiciliary Care Worker
District Nurse

Scene 1 Why Don’t They Talk? Louise

Scene 2 Louise Falls And Is Admitted Louise

To And Discharged From Hospital Hospital Doctor
Nurse 1
On Call Manager – Domiciliary Care Agency

Scene 3 Louise Falls Again Louise

Scene 4 Why I Became A Nurse Nurse 1 and Nurse 2

Scene 5 Physio Hurts Louise

Physiotherapist
Consultant
Ward Sister

Scene 6 We need to discuss Louise Ward Sister

Physiotherapist
Social Worker
Louise

Scene 7 Louise & Residential Care Louise

Care Home Manager
Resident 1
District Nurse

Scene 8 Telephone Call Care Home Manager

Senior Carer
Dr Hoyle

Scene 9 The Missing Pink Cardigan Louise

Care Worker 1 and Care Worker 2

Scene 10 Learning From Airline Safety Social Worker

Dr Hoyle

Scene 11 Louise Researches The Integration Louise

Question

Scene 12 Let’s Start Talking GP

District Nurse
Domiciliary Care Manager
Social Worker

7
8. Overview of the Scenes with
Questions for Group Discussion

After each scene use the questions in section Group Discussion

8 of the workbook to promote discussion.

Prologue -
We’re More Similar Than You Think
The prologue explores experiences that all four
individuals have in common such as why they
joined the caring profession, as well similarities Prologue
relating to the impact of exhaustion and stress. Group Discussion

It also highlights friction between the professionals 1 What similarities do the four individuals
and captures common thoughts about the have?
introduction of integrated care. 2 What issues does this scene raise?

Scene 1 – Why Don’t They Talk? Scene 1

Louise, the narrator sets the scene. She got polio Group Discussion
as a child and has been involved with health ever
since. Now she needs social care as well. She 1 What issues does this scene raise?
experiences lots of duplication and very little 2 Have you or any of your family/friends
working together. received an on-going health and social care
service? How was it and did it have any
impact on the way you carry out your role
now?

8
Scene 2 - Louise Falls And Is Admitted To, Scene 2
And Discharged From Hospital Group Discussion

1 What issues does this scene raise?

2 How does stress/fatigue affect your ability
or willingness for joint working and effective
communication?

Louise is admitted to hospital after a fall and

discharged at 2am due to a shortage of beds.
The hospital doctor asks a domiciliary care
service to have someone meet Louise at home
to support her and gets a negative response.
This scene is based on a real life situation.

Scene 3 – Louise Falls Again Scene 3

Group Discussion

1 What issues does this scene raise?

Following another fall Louise is back in hospital

with a broken hip. She voices concern because
she can’t understand what’s leading to the falls.
She also reflects on her hospital discharge last
time and the assumption the doctor made that
she needed someone with her on her arrival at
home. She asks a passing nurse if her daughter
has rung and is curtly put in her place.

Scene 4 – Why I Became A Nurse Scene 4

Group discussion

1 Think about a conversation with a

patient/client/service user that you wish you
had handled differently? What happened
and how would you change things if you
were in the same situation again?
2 Have you ever felt humiliated by a colleague
The nurse who interacted with Louise in the last or knowingly or unknowingly humiliated a
scene is despondent – she acknowledges her colleague? What happened?
behaviour towards Louise was inappropriate but
3 What other issues does this scene raise?
suggests she was reacting to pressure and the
humiliation she felt due to a doctor telling her off
in front of a patient. She reflects on why she
became a nurse.

9
 Scene 5 – Physio Hurts Scene 5
Louise is working with the physiotherapist when Group discussion
she learns from
her consultant that 1 What issues does this scene raise?
she has diabetes
which has been a
contributing factor
to her recent falls.

Scene 6 - We Need To Discuss Louise Scene 6

A conversation about what is going to happen to Group discussion
Louise takes place between the Sister, Social
Worker and Physiotherapist. They don’t involve 1 What issues does this scene raise?
her until they have decided what’s best – a short 2 Were the professionals taking part in the
term move to a residential home until her conversation functioning as a working
daughter can fly in to be with her at home. The group/team? How could they have arrived
sister and social worker side with each other and at a shared aim/outcome?
consider the work-
load and expense
should she have
another fall. Louise
questions if her
wellbeing is at the
heart of the decision.

Scene 7 - Louise And Residential Care Scene 7

Louise has moved to a residential home while Group discussion
she awaits her daughter’s return from America.
1 What challenges are highlighted in this
Whilst there she witnesses another resident
scene?
being called away from her lunch to have a
dressing changed by a District Nurse. She asks 2 What are the implications for the delivery of
the manager why she let this happen and learns person-centred care?
that she doesn’t believe she has the power to
challenge the situation. Louise also finds out that
there is a conflict in the requirements of different
inspecting/auditing organisations who want the
same thing managed
differently. Louise
considers integration
and it’s implication for
people receiving
services.

Scene 8 – Telephone Call Scene 8 - Group discussion

The manager of the residential home takes a call
1 How does perceived status affect the way
from a GP. The GP is abrupt and has a negative
professional teams communicate?
impact on the manager who having given up
smoking, has a ciga- 2 If a different approach had been used, what
rette to help her deal might have been the outcome?
with the stress.
3 What are the public health messages in this
scene?

10
Scene 9 – The Missing Pink Cardigan Scene 9
Louise considers that integration will supposedly Group discussion
smooth out and improve the lot for individuals
receiving care but highlights an immediate need 1 What issues does this scene raise?
for better person centred care. She gives the 2 What does true person-centred care look
example of her missing pink cardigan, which she like?
discovers another resident wearing. The staff are
apologetic but blasé and 3 Will integration make the situation better or
view personal clothing worse? Explain.
going missing as an
inevitable part of group
living.

Scene 10 – Learning From Airline Safety Scene 10

A social worker talks about the need to enable Group discussion
team members to speak out, without
1 How is the story from aviation applicable to
repercussions, if they think something is wrong.
health and social care?
If they don’t then they comment that people
could ultimately die.
Dr Hoyle considers
how the model used
in airline safety could
be used in health and
social care.

Scene 11 - Louise Researches The Scene 11

Integration Question Group discussion
Louise considers the integration question and
comments that as the number of people with 1 How can we talk to each other and listen
complex needs grows they will require both more effectively?
health and social care services. She remarks that 2 What can be done to improve the trust
these don’t always work well together. She says between professional teams?
she has heard of a number of different strategic
initiatives and asks how vulnerable people will 3 How can we all ensure that the needs of
understand all the changes and jargon. She the person requiring the care is at the
believes a difficult situation centre of all our decision making?
will be compounded if
health and social care don’t
start listening and talking to
each other and working
more effectively together.

Scene 12 – Let’s Start Talking Scene 12 - For discussion

The GP, District Nurse, Domiciliary Care 1 What insights about building relationships
Manager and social Worker come together and across teams have you gained from the play?
agree that they need to put their own agendas
aside and start listening 2 Given the complexity of all the issues raised,
and trusting each other, what’s the most important change that needs
as well as talking. to happen for successful integration between
health & social care? (The facilitator can ask
people to give a 1 word or short phrase answer).

11
 9. Audience Sketches 10. Action Planning
If you have enough time invite members of the We hope that the session will inspire audience
audience to work in small groups and create a members to commit to working towards positive
short scene of their own. This can be an engaging change. Therefore it’s important that they are given
way to deal with the issues raised in the play. the opportunity to consider how they will do this.
Groups of 4 to 6 are an ideal number for this
exercise. Make sure that if the audience consists Copy ‘The Reflection of Team Goal’s Sheet’ and
of individuals from both health and social care, the give one to each audience member. Ask them to
groups comprise of members from each. Give complete it individually. This will enable them to
them 20 minutes and ask them to: consider how well they have seen the goals listed
being demonstrated over the previous 4 weeks.
Create a sketch that illustrates poor communication Give them 10 minutes approximately to do this.
and teamwork and is no longer than 3 minutes Move them into small groups and ask them to
when read out. share their findings with each other. It will be
interesting to see if patterns emerge.
It should have:
Next ask them to complete the ‘My Personal
l A beginning, middle and end Behaviours’ Sheet. Make sure they understand that
l Involve characters from 3 different health and this is a personal document and there is no need to
social care areas share it. It has been included as a tool to help them
l Involve a made up situation in which reflect on their on own behaviours.
communication and teamwork breaks down
and has a damaging impact on an individual Once they have finished this, copy the Circles of
receiving care Impact/Influence on page 16 on to a flipchart. This
has been adapted from The Seven Habits of Highly
They should then rewrite it so that it provides a Effective People by Stephen R. Covey,. Simon &
solution that improves communication and Schuster 1992. Explain that you want them to use
teamwork. the model to focus on elements of the team goals
that they are able to have some control or influence
The groups will then be asked to read out both over in the future, as well as consider how they can
sketches to the larger audience. This exercise do this. The model also helps them to recognise
should help them absorb some of the lessons that there will be issues that they can neither
illustrated in the play – and have fun whilst doing it. impact nor influence, and therefore they should not

Let’s ta
spend time getting hung up on these.

Let’s talkLet’s talkLet’s talkLet’s

Let’s talkLet’s talkLet’s talkLet’s
Let’s talkLet’s talkLet’s talkLet’s
12
 It’s worth giving some examples. They could be:

Impact Neither impact nor influence

The group tells you they feel cold. You immediately You hate that individuals can only access
turn the heating up thereby having a direct impact financial assistance for social care if they are
on the situation. deemed in the critical category. You may think
Influence that the integration concept is a bad one but
The group tells you that they feel cold. However government policy means it will happen.
there is a ruling that the heating cannot go above Focusing your time and energy on moaning
22 degrees and therefore you are unable to turn it about issues that are out of your control will
up. Instead you feedback to management that 22 only make you feel frustrated so focus it on
degrees isn’t sufficient in very cold weather and areas where you can potentially have a positive
the ruling is changed to 24 degrees. You have impact.
influenced that decision.

Whilst the exercise is underway visit each group to

Impact see if they need some assistance. Additionally use
Dr Hoyle is rude to you. You have no direct impact this time to challenge their reasoning if they believe
as the situation as has already happened. that they are unable to impact or influence.
Influence
Dr Hoyle is rude to you. You decide to take a risk When they have completed this task, ask the
and calmly and politely point out that when he groups to share one or two things from each circle
speaks to you in that way it has a detrimental with the whole group and invite comments etc.
impact as he can be seen as rude and arrogant.
This may influence how he speaks to you and The final part of the Action Planning involves
others in the future. everyone completing a ‘Personal Action Plan.’ This
asks them to consider what they will do more of
and less of in the future and invites them to think
of ways that they can support themselves to make
their plan a reality.

alk
Once individuals have completed their action plan
bring the session to a close by recapping on the
main points that have come out of the discussions
and thanking everyone for their contribution. Your
final activity is to invite everyone to complete the
session evaluation and repeat the questions that
they answered at the start.

Let’s
s talk
Let’s
s talkLet’s
s talkLet’s
talkLet

13
Reflection of Team Goals 4 Photocopiable

The following statements describes goals that are desirable if teams, both internal
and multi-disciplinary, are to work effectively to ensure the experience of the
individual receiving health and social care is a positive one.
Think about your experience of team working over the past month
(both internal and multi-disciplinary) and consider how well you think each goal was met.

Team Goals I always I occasionally I very rarely What evidence do

experience this experience this experience this you have for this?

Everyone’s views
are listened to
(including the
care receiver)

Everyone feels
respected

Information
sharing is
common and of
high quality

Contributions
from all parties
are valued and
carefully
considered

Trust is high
amongst all team
members

Decision making
is shared

Solutions to
problems are
sought as a team

14
My Personal Behaviours 4
Photocopiable

Now think about your own behaviour in relation to each of the goals.
How well do you embrace and practice them?
Please be honest. No one else will see this sheet.

Goal 1 The well-being of the individual receiving care is at the heart

o l always embrace and practice this
o I try to embrace and practice this
o I very rarely embrace and practice this

Goal 2 Everyone’s views are listened to (including the care receiver)

o I always embrace and practice this
o I try to embrace and practice this
o I very rarely embrace and practice this

Goal 3 Everyone feels respected

o I always embrace and practice this
o I try to embrace and practice this
o I very rarely embrace and practice this

Goal 4 Information sharing is common and of high quality

o I always embrace and practice this
o I try to embrace and practice this
o I very rarely embrace and practice this

Goal 5 Contributions from all parties are valued & carefully considered
o I always embrace and practice this
o I try to embrace and practice this
o I very rarely embrace and practice this

Goal 6 Trust is high amongst all team members

o I always embrace and practice this
o I try to embrace and practice this
o I very rarely embrace and practice this

Goal 7 Decision making is shared

o I always embrace and practice this
o I try to embrace and practice this
o I very rarely embrace and practice this

Goal 8 Solutions to problems are sought as a team

o I always embrace and practice this
o I try to embrace and practice this
o I very rarely embrace and practice this

15
 Can Neither Impact
Nor Influence

Can Influence
But Not Directly Affect

Can
Directly
Impact

Circles of impact / influence

16
“
My Personal Plan

In order to play MY part in

improving the experience for people
4
“Photocopiable

receiving health and social care services

I’m going to do more:

And I’m going to do less:

People often find it useful to support themselves in making their plan a reality.
Some ideas that have worked for others are:
l The setting of diary dates to review your plan
l Asking a trusted colleague to review it with you
l Shrinking and copying the plan and putting it in your wallet or purse and using it as a
aide memoire

What will you do to support yourself to make your plan a reality?

17
 FACILITATOR BACKGROUND READING

Teams and The Stages of Group

Team Intelligence Development
As health and social care integration ultimately Bruce Tuckman’s (1965) theory of team
involves individuals and teams from both sectors development and behaviour is helpful in helping
working together in a harmonious and effective way individuals to understand the four stages they work
it’s worth considering the notion of teams and what through in order to become an effective team. The
they involve. This is equally useful for discreet theory can also relate to closer working relationships
teams within either sector. A true ‘team’ is a group due to integration.
of people who work together to achieve a common
goal. 1. Forming: (clarifying roles and establishing
relationships).
In the Bedside Manners workbook Suzanne Gordon Team members will:
discusses ‘team intelligence’ which she says l be introducing themselves and getting to know
produces not only action but also effective each other
interaction and collaboration. l trying to establish their individual identities
l discussing the team’s purpose
She believes that an effective team in this context l exploring the scope of the task
displays the following characteristics:
They may also be avoiding serious topics/feelings.
l A sense of identity, shared language, shared
assumptions about purpose and priorities 2. Storming: (resolving any tensions and disputes).
l A willingness to share information, cooperate This stage may involve:
and coach all members, regardless of level in l team members competing with one another
the hierarchy l conflicting interests between team members
l An appetite to solicit and take account of all arising, as the group becomes more focused on
members input, regardless of level tasks
l An understanding of each others roles and l bending ideas, attitudes and beliefs to suit the
work imperatives, so that common goals team organisation
l questioning about who is responsible for what
She states it has the following requisites: l discussing structure
l conflicting views about structure, leadership,
l Team members must develop a shared team power and authority
identity that allows them to articulate a shared
mental model, shared language and shared 3. Norming: (starting to build the team identity).
assumptions At this stage there will be:
l Team members must be willing and able to l more cohesive inter-professional relations
share information, cross monitor and coach all l a higher level of trust between inter-professional
members of the team, as well as to solicit and team members
take into account their input, no matter their l a greater focus on tasks
position in the occupational hierarchy l a creative flow of information.
l Team members must understand one
another’s roles and work imperatives and how 4. Performing: (the team has a shared vision, and
these mesh so that common goals can best be it knows clearly what it is doing and achieves its
accomplished goals).
l Team members must help and support one At this stage:
another so that each individual member can l team members show a high level of
perform his or her job efficiently and effectively. dependence on one another
l there are deeper relationships between people
l the team becomes good at problem-solving and
there is more experimentation
l individual team members become more self-
confident
l the team is at its most productive
18
“
Let’s talk Let
Let’s talkLet’s talkLet’s talkLet’s

Let’s tal
Let’s talk
Let’s talkLet’s Let’s tal
Let’s talkLet’s Let’s tal

Script
Let’s talkLet’s talk
Let’s talkLet
Let’s talkLet’s talk

19
Prologue

We’re More Similar Than You Think

4 actors enter and stand in a line down stage of so to the care worker but she was really defensive
the four music stands. They speak directly to and thought I was blaming her. I wasn’t of course; I
the audience. Think of the prologue as a series was just doing my job.
of musical phrases.
GP: I wanted an update on a patient but could I get
Social Worker: Helping people, it’s all I ever hold of that social worker. They’re either part time,
wanted to do. on holiday or off sick. I was on call as the duty
doctor yesterday and every single minute of the
GP: Making people better, what a great feeling. day was filled. I absolutely didn’t have time to ring
again.
Dom Care Worker: Helping people stay at home,
it’s so rewarding Social Worker: Would you credit it. I’ve been out
all day at case conferences, I get back and get a
District Nurse: Working in the community gives disgruntled message from a GP demanding that I
me a real buzz. give her an update. It’s interesting that when I try to
get hold of her, it’s like asking for the crown jewels.
All: Going home at the end of the day, knowing
you’ve made a difference, you can’t beat it. Dom Care Worker: For the last 3 days, as well as
doing my own shift I’ve been covering a colleague’s
Dom Care Worker: Integrated care – just learnt who’s off sick. I took the call asking me if I’d work
what it is. They must be joking. When was the last on my day off at 6am and was out the door by 7.
time a health person asked for my opinion and My husband says I’m mad but I think of the people
didn’t blame me when something went wrong? needing help. I’m so tired though – mentally as
well as physically .
District Nurse: Integrated care – could be good –
as long as it means no extra work. I can only just Social Worker: If I had a pound for every time I
cope now. hear a care provider say I haven’t got the staff to
take on that package of care, I’d be a really rich.
GP: Integrated care – that’s a fantastic idea – but Where have all the carers gone? It’s so exhausting
we’ve had so many changes which are never and mentally frustrating trying to sort out care these
funded properly and it brings a whole new meaning days.
to one stop shop.
District Nurse: They want to keep people out of
Social Worker: Integrated care. Does that mean hospital, has anybody stopped to think what that
we’re going to have to talk to health? actually means. District nurses are rushed off their
feet.
Care Worker: I’ve been going into Mrs Jones for
the last 6 months. She’s been struggling to eat GP: What’s the worst part of my job?
recently and it’s been well recorded by my
manager and the surgery. A new district nurse All: STRESS !!
came yesterday and practically accused me of
starving her. I felt so belittled and upset.
The dialogue from here until the end of the
District Nurse: Yesterday I started work as a prologue should build in intensity with the
district nurse and visited my first patients on this crescendo coming on the word ‘chocolate.
patch. I had such a full case load I could only skim
the notes. I went in to one house and the lady
looked malnourished. It was really worrying. I said

20
 Scene 1

Why Don’t They Talk?

Dom Care worker: You want to know about stress Facilitator: Standing in front of all music stands.
District Nurse: Don’t get me started
GP: Stress it’s my life Louise Jones is the narrator of the story. She’s
Social Worker: Don’t take your work home with 65 and had polio as a child, which has left her
you they say. If only! with poor mobility that’s getting worse.

District Nurse: I drive 5 miles to change a Louise: I got polio when I was 7 and ever since
dressing, then another 5 to give an insulin injection then I’ve had health people in my life. Individually
but end up staying much longer than I should everyone’s been pretty good, but the systems oh
because the patient needed to talk. Then I hit traffic dear those systems – they’re enough to drive a
and have 3 more patients to see so I’m well behind person crazy. And now because my mobility’s got
my list. Then I take a call from the surgery who worse and I’m on my own, my husband died a few
want me to fit in another patient and still be back in years ago, I need help from social care too. Started
time for a meeting. with a social worker and with a personal budget
I’ve arranged for care workers from an agency to
Dom Care Worker: I’ve needed the loo for the come in every morning. But the systems oh dear
past 3 hours, its 4 pm and I haven’t eaten since the systems, now there’s even more of them. And
breakfast. The last service user got us all in a panic do you know what, all these people looking after
when she wouldn’t open the door but it turned out me just don’t seem to talk to each other because
that she’d gone out with her daughter. And if I don’t I’m asked similar questions from all of them – there
get my time sheets into the office in the next 10 is so much duplication. Why don’t they talk to each
minutes I probably won’t get paid. other or understand each other’s role?

Social Worker: And as for the phone: I was a teacher, an English teacher. I think I was
probably quite a good teacher. Team work was
All: It never stops ringing. always important, after all ‘Every Child Really did
Matter’. When I was working if we weren’t working
Social Worker: Is it any wonder that I can’t give up together it made life so much tougher for everyone
red wine! and the kids lost out. I liken this now to health and
social care, surely their jobs must be tougher if they
District Nurse: Cake! don’t work together. And where does that leave me!
Care Worker: Cigarettes!
GP: Caffeine!

Let’s talk
ALL: Chocolate!!

Let’s talkLet’s talkLet’s

21
Scene 2
Louise Falls And Is Admitted To And Discharged
From Hospital
Louise is at her music stand on the left and On Call Manager: Well may I suggest that you go
three actors playing a hospital doctor, a nurse and speak to Mrs Jones and if she’s fine going
and On Call Dom Care Manager are at stands home on her own, tell her that we’ll see her at 8am
on the right. in the morning as usual.

Louise: I’ve just had a fall getting ready for bed. I On Call Manager (to audience): It’s 2 am, I’ve
ended up in hospital and they kept me in for 24 been in bed for 2 hours following a frantic day and
hours just to be on the safe side. But thankfully I’m I’m facing another one today. I need to be up at 6,
OK - and this is what happened. how am I going to get back to sleep now? Don’t
these doctors understand anything about how we
Hospital Doctor to Nurse: They’re stacking up in work? And what about poor Louise being sent
A&E. We need two beds. Looking at the notes home at this time of the morning. It must have
Louise Jones’ obs are fine so let’s send her home. some effect on her. I’ll pop in and see her later.
Can you let her know and arrange the transport? I
notice she has carers so I’ll inform the care agency
that she’s on her way.

(Doctor to Audience): What a night. They think

we can just magic up beds. No one told me that I’d
need to wake patients up at 2 am to send them on
their way. Would I like that? Of course not. Where’s
the dignity?

On Call Manager Dom Care Agency: (really

drowsily) Hello, ABC Care can I help?

Hospital Doctor: Hello I’m Doctor Wilson at the

General Hospital. Louise Jones one of your
patients is on her way home, can someone be
there to make sure she’s comfortable.

On Call Manager: I’m sorry do you know

what time it is? This is an on-call service for
emergencies only and we don’t have carers at this
time of the morning available to go out to a service
users home. We’re not 24 hours in that sense.

Hospital Doctor: How preposterous, are you

telling me nobody can be there?

On Call Manager: Yes that’s exactly right. Have

you asked Mrs Jones if she needs anybody there?
She’s quite an independent lady you know.

Hospital Doctor: Well she’s actually not my

patient and I’ve not spoken to her, I just assumed
she would need some assistance.

22
 Scene 3 Scene 4
Louise Falls Again Why I Became A Nurse

Louise at her music stand, addressing Louise is at her stand observing and listening
audience. in. Two actors playing nurses together with one
playing a ‘know it all’ doctor are at music
Louise: Would you believe it I’ve had another fall stands on the right.
and broken my hip this time so I’m back in hospital.
I just can’t understand what’s wrong with me. I Nurse 1: You look a bit down in the dumps what’s
know my mobility’s poor but I’ve never fallen the matter?
before, until this week. I can’t believe that Dr
phoned the care agency at 2 in the morning. Why Nurse 2: I’ve just had a patient ask me why I
on earth didn’t he come and speak to me. I’d have became a nurse. She’s been quite nice up until
told him I didn’t need anyone. Goodness, I certainly now and I suppose I was a bit abrupt with her. But
don’t want to become a burden to others. Sounds she’s definitely made me think. I didn’t mean to be
like the care manager put him in his place though!! uncaring but you know what it’s like. I was in the
middle of 3 jobs and that new know it all doctor
The pain killers were wearing off and I was a bit from the surgical ward had just shown me up in
out of sorts. I happened to ask a passing nurse front of a patient;-
if my daughter had rung from America and she
Surgical ward doctor: why are you using that
very curtly put me in my place and said
cream on the patient, it’s totally wrong.
someone would have told me if she had. I was
disappointed by her attitude so asked her why
Nurse 2: (to audience) the team had used a range
she’d become a nurse. I think I must have hit a
of creams and through trial and error that was the
nerve as she flounced off.
most effective. But that stupid doctor just didn’t take
the time to ask about it instead taking the ‘I’m the
et’s talkLet’s talkLet’s

doctor’, you’re only a nurse stance. I felt so

humiliated! Then poor Mrs Jones asked about her
daughter phoning and got my curt reply and I feel
awful now.
et’s talk

Nurse 1: Yes I know exactly what it’s like, I feel like

I’m about to implode with all the pressure. Anyway
why did you come into nursing?

Nurse 2: It’s such a long time ago but nursing was

all I ever wanted to do. Sounds corny now but
doing something else wasn’t ever on the cards. I
wanted to be needed.

Nurse 1: So what’s changed?

Nurse 2: Everything – more paperwork, more

technology and less time to actually care. What do
Let’s talk Let’s talk Let’s talk Let’s talk Let’s you think?
Let’s talk Let’s talk Let’s talk Let’s talk Let’s
Nurse 1: Oh I agree it’s really pressured but I still
love connecting with the patients.

Nurse 2: Yes I suppose you’re right. Maybe I

should go and have a chat with Mrs Jones later.
Now tell me how was your date last night?

23
Scene 5 Scene 6
Physio Hurts We Need To
Discuss Louise

Louise is at her stand. One actor playing the Louise to left and 3 actors playing physio,
physio, is at a music stands on the right. social worker and ward sister are at stands on
Two more actors stand a few feet behind. the right.

Ward Sister: We need to discuss what’s going to

Louise: Do I really have to walk now – I’m so tired. happen to Louise, because I think in order to avoid
another admission she needs rehabilitation in a
Physio: Yes come on, once down the corridor and care home just for a couple of weeks, until her
twice round the block. daughter flies in from the States and can be with
her at home for a bit.
Louise: Ha Ha, very funny but yes I’ll have a go.
Physio: Louise would hate it, I’ve only known her a
Physio: There you go – that’s what I like - positive short while but she’s so independent.
mental attitude. There’s nothing more gratifying
than seeing patients on the road to recovery. Social Worker: I agree with Sister, I’m definitely
siding with her. If she goes home she’ll inevitably
The two actors playing the Doctor and Sister fall again and think of the workload that will create
who have been standing behind approach the for us all – let alone the expense.
music stands.
Physio: But what about her, what about what she
Consultant: Hello Mrs Jones how are you feeling wants? Why do our conversations always have to
today? We’ve been a bit concerned by your two degenerate into whose side you’re on? Shouldn’t
falls in close succession so have carried out some we all be on the patient’s side?
investigations and I’m afraid you’ve got Diabetes.

Louise to audience: Well that came as a bit of a Louise: I’ve just been told that the best thing for
shock and it’s definitely going to have an impact me is to go into a residential home for a couple of
on my life. Especially as I have to have insulin weeks until my daughter can fly in to be with me. I
injections. The consultant and sister were really feel so down. I would have liked to have been
lovely about it though and incredibly helpful in included in the conversations. I suppose I
telling me about what it would mean for me in the understand why they think it’s the best thing for me
long term. but it’s all come as such a shock. First breaking my
hip, then finding out that I’ve got diabetes and now
To Louise and Physio this – a move in to a home!
Consultant: how are you getting on with your
physio? I’ve noticed some really good teamwork but its not
consistent. Makes you wonder who’s at the heart of
(in unison) their decisions. I’ve got a voice but I really worry
Physio: Really well. about those patients who can’t speak up for
Louise: Badly – it’s exhausting themselves.

Sister: Ah ha - normal scenario.

Consultant: Keep working at it, as soon as we

can get you mobile we can get you home.

24
 Let’s tal
Scene 7
Louise

Let’s talk
And Residential Care
Louise to left and 3 actors playing a resident, manager and
district nurse are at music stands on the right. (The manager
speaks to Mary, a resident but no actor is required for that
part).

Louise: I’m now in the residential care home and I’m too young
for this. I’m turning into an advocate for some of the residents.
Let me tell you what happened earlier today:

Manager: Mary – the district nurse is here to change your

dressing. (The actor turns as if talking to Mary)

Resident (Joan): But she’s eating her lunch.

Manager: Sorry Mary, you’ll have to come now. (The actor turns
as if talking to Mary)

District Nurse (having heard the conversation): Mary I’ve only

got a few minutes. If you want your dressing changed you need
to come now because I’ve got a long list of calls this afternoon.

Residents and District Nurse stand back from the music stands.

Louise to Manager: Would you like to have your lunch disturbed

in this way?

Manager: No of course not.

Louise: Well why on earth didn’t you speak up and tell the

Let’s talkLet’s talk

district nurse to come back after lunch then.
Let’s talkLet
Manager: It’s so difficult to do that. They come when they come
and the care that the residents receive is on their terms. I can’t
et’s talkLet’s talk
ever see it being any different. And it doesn’t end there – we
have to answer to CQC, GP’s, Adult Social Care auditors.
Healthwatch and the list goes on! Sometimes it’s so difficult to
know who to listen to when one says to do one thing and then
another tells you that’s wrong and do it a different way! What’s
more the language used by these governing bodies when they
make press statements can be really damming and damaging to
health and care as a whole. It seems were all tarred with the
same brush and a very small minority mar it for everyone.

Louise to audience: There’s talk of integration happening soon

but a starting point for me must be that we, the patients or
whatever it is that you want to call us, must be at the heart of it.
It will take deep understanding, real teamwork and a major
commitment to ensure true person centred care.

25
Scene 8
Telephone Call

Louise to left and 3 actors playing a care home Dr Hoyle: Joan Smith
manager, senior carer and GP are at music Care Home Manager: So I said sorry who’s calling
stands on the right. and she said Dr Hoyle and then she just said Joan
Smith again.
Care Home Manager: I’m so cross I’ve had to
have a cigarette and it’s such a shame because I’d Senior Carer: (Laughing ) I’ve had a very similar
gone 96 days without one. Honestly this job is conversation with him too.
definitely ruining my health. If I get lung cancer I’m
going to make sure that Dr Hoyle knows that her Care home Manager: So I said ‘Are you Joan
rudeness contributed directly to it. I tell my kids not Smith, Do you want to speak to Joan Smith or do
to smoke or do drugs and only to drink in you want to talk about Joan Smith?’ It turns out she
moderation, but I’m a terrible role model. As soon just wanted to check up on her medication but I
as I get home, I’m generally so wound up I either ask you, what an arrogant attitude.
open a bottle of wine or comfort eat. Look at me
I’ve ballooned recently, I just can’t leave the Senior Carer: I know she does it all the time. She
sherbet lemons alone. Who knew they went so treats us like nothing, don’t take it to heart. But with
well with chardonnay? I’m so angry, 96 days and regards to the smoking just see it as a little blip,
now I’ve blown it. you know you can do it. Only last week you said
how much healthier you were feeling. 96 days
Senior Carer: Calm down, breath slowly – that’s brilliant. If you start again right now you’ll
remember our mindfulness course. Now tell me crack it forever.
what happened.
Care home manager and senior carer step back
Care Home Manager: Well the phone rang so I from music stands
answered it and all the voice on the other end said
was Dr Hoyle – to the audience: I think I hit a nerve
there, I didn’t mean to sound rude but they have
Dr Hoyle: Joan Smith no idea how busy my day is and how many phone
calls I have to make before I do home visits.
Care Home Manager: So I said pardon and she Perhaps I need to retire, I just don’t have the
said: energy for niceties anymore, or for trying to
understand what everybody does, which
supposedly is vital for this integration malarkey!

26
Scene 9
The Missing Pink Cardigan

Louise to left and 2 actors playing two care Louise: I want to wear my pink cardigan.
workers at music stands on the right.
Care worker 1: But you look so nice in the purple
cardigan you’ve got on. I love purple it’s my
Louise to audience: The bigger picture of health favourite colour.
and social care integration will supposedly improve
and smooth things out to improve everything for us Louise: Well that’s lovely but I want to wear my
but actually there’s still an awful lot that needs to pink cardigan today.
be done on the ground relating to person centred
care and everyday interactions. Care worker 2: I’ve looked in your wardrobe and
can’t find it. Sorry.
Here’s an example that left me feeling insignificant,
invisible and a bit sad. Louise: So reluctantly I agreed to wear the purple.
Later on at breakfast imagine my delight (said
Care worker 1: Morning Louise, we’ve come to get sarcastically) to see a lady on the next table
you up and dressed. How are you this morning? wearing my missing pink cardigan!

Care worker 2: Did you sleep all right? You’ve probably gathered by now that I’m no
wallflower and I managed to get through breakfast
Louise: I had a bit of an unsettled night but never before tackling the senior carer. She was very
mind, I’m sure I’ll be fine. apologetic but a bit blasé and said personal
clothing goes missing all the time. She implied it
Care worker 1: That’s a shame but we’ll soon get was inevitable. Well you can imagine how I felt
you sorted and feeling a lot better. about that!!

Louise to audience: They then proceeded to get The term person centred care is banded about so
me up, washed me, chose what they thought I’d much these days but I wonder if it’s true meaning
like to wear and put me back in my chair. I was so has been lost.
incensed I felt that if I said something it would be
so inappropriate I’d better keep quiet. I might have
poor mobility but I can wash myself and choose
what I want to wear. Which brings me on to the
purple cardigan!

27
Scene 10 Scene 11
Learning from Louise Researches The
Airline Safety Integration Question
Louise at stand on left and two actors playing a Louise at stand on left
social worker and doctor at music stand on left. Louise to audience:

Social Worker: We talk a lot about mutual support Since leaving the care home and becoming more
in team work across health and social care. We can mobile again, I’ve had time to reflect on my
have a really positive impact on people’s lives. But experiences over the past few months.
when the full team doesn’t work well and they don’t
allow people to speak out if they think something is I’ve been researching the integration question and
wrong, then ultimately people could die. Even if it basically the number of people who have health
turns out that they got it wrong, people have to problems requiring health and social care is
know they can voice their concerns without increasing. So that’s more people with complex
repercussions. health needs requiring a combination of health and
social care services and as we are aware, these
Dr Hoyle: I’ve been reflecting on that phone call services don’t always work well together. For
to that residential home ……. I’ve heard recently example people are sent to hospital when it would
about airline safety, where pilots go through special have been better if they’d got care at home.
training called ‘Crew Resource Management’ to Sometimes people get the same care twice from
improve safety by improving communication and both NHS and social care organisations, or an
team work. Apparently a lot of crashes were important part of their care is missing, leaving them
happening because staff were too intimidated to tell at an increased risk of harm. I realise that care is
the captain something was wrong. The whole idea changing and being driven by Governments,
is that leadership means using all your available because people are living longer and therefore
resources – which means people, not just there’s less money in the pot but are we the public
technology. able to keep up with these changes? In the last few
months I’ve heard of ‘Care Closer to Home’, ‘Better
They keep this blue card which has Care Together’, Individual Service Funds, Care
recommendations for effective communication and Navigators, to name just a few and then there is the
it also suggests asking questions like ‘what would Care Act being implemented with even more
you feel comfortable with’. An example was given changes to come! How on earth are vulnerable
when on a flight a co-pilot was worried they didn’t people going to understand all these changes and
have enough fuel on board. The captain thought the jargon that goes with them. Especially if health
they had plenty and knew that if they stopped to and social care services aren’t working together as
refuel it would cost an extra £5000 per hour delay. they need to, or talking or listening effectively and to
Instead of saying I’m the Captain and we’ll do what I each other!
say, he talked through the options with the co-pilot
and asked ‘what would you be comfortable with’. I think I was lucky as I did see some empathy and
They agreed to keep close track of the fuel and if it compassion. Perhaps I even saw signs that
looked like they needed more they would stop to integration is starting to work. But there’s still a very
refuel. That was fine with the co-pilot as he got to be long way to go. To begin with professionals from
part of the decision making process. both sides have to understand each other’s roles,
and be committed to working together to make the
I keep wondering why we’re not doing this sort of situation better for everyone, including themselves.
training in health and social care. If I were to be They mustn’t ever forget though that the perspective
receiving services I’d feel a lot better if I had of the person needing the care or the service has to
confidence that all individuals across teams would be the organising principle, or an opportunity to
speak up if an error was noticed, wherever that may make things better will have been lost and it will all
be. Why don’t they teach us how to work together have been in vain.
properly, why does it have to be so hard?
As I’m so much better now I thought I might go and
do a talk around this integration issue to some of the
local WI’s – that will stir it up a bit and hopefully get
health and social care talking!!
28
Scene 12
Let’s Start Talking

Dom care manager and social worker move

forward to a microphone and GP and district
nurse move forward to another microphone.

GP (to district nurse): I’ve had a terrible day

today – on top of an unusually high number of
patients to see, I also had a disagreement with a
local domiciliary care manager about a patient. We
both thought we were right and the problem could
have been totally avoided if we had just talked to
each other before it got to tempers flaring!

District nurse: Oh dear not good! The other thing

of course is also listening to each other. I may be
getting a bit philosophical here, but when trying to
put the patient at the centre, we all tend to think we
are in the right and so stop listening!

Dom care manager (to social worker): Do you

know what I’ve learnt today after a right barny with
a GP? That integration is just not going to work
unless we talk to each other!

Social worker: You’re right. We also need to trust

each other more and try to understand that we all
care for our clients but just need to care together!

ALL: SO LET’S START TALKING!!!!!!!!

29
“
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Funded by

Produced by Dignity in Dementia for

South Lakes Registered Manager’s Network

www.dignityindementia.org
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