School for Health and Care Radicals 2015 study guide

PROGRAMME STUDY GUIDE

‘Never doubt that a small group of thoughtful, committed citizens can change the world.

Indeed, it is the only thing that ever has.’ Margaret Meade

http://www.theedge.nhsiq.nhs.uk/school/

@School4Radicals #SHCR

http://www.theedge.nhsiq.nhs.uk/school/

School for Health and Care Radicals Programme Study Guide

http://www.theedge.nhsiq.nhs.uk/school/ 2

Contents

The School for Health and Care Radicals ................................................................................................................ 3

Staff and governors ............................................................................................................................................ 3

Introduction ............................................................................................................................................................ 4

What is the School for Health and Care Radicals? ............................................................................................. 4

A short history of the School .............................................................................................................................. 4

Who is it for? ...................................................................................................................................................... 5

What’s in it for me? ............................................................................................................................................ 6

How does it work? .............................................................................................................................................. 7

Programme outline ............................................................................................................................................ 8

Module 1: Being a Health and Care Radical: change starts with me ............................................................. 8

Module 2: Building alliances for change ........................................................................................................ 8

Module 3: Rolling with resistance .................................................................................................................. 9

Module 4: Making change happen ................................................................................................................ 9

Module 5: Moving beyond the edge .............................................................................................................. 9

Is there any formal recognition or qualification? ............................................................................................. 10

Masterclasses ................................................................................................................................................... 10

Introducing some Health and Care Radicals ......................................................................................................... 10

Getting the most from the School ........................................................................................................................ 12

Social learning ....................................................................................................................................................... 13

School Learning Groups.................................................................................................................................... 14

Case study: New Zealand class of the School for Health and Care Radicals .................................................... 16

Sharing your experiences ................................................................................................................................. 17

Finding support ..................................................................................................................................................... 19

Working with a mentor .................................................................................................................................... 20

Keeping a learning journal .................................................................................................................................... 20

Drawing up a learning plan ................................................................................................................................... 22

Getting to know yourself: the Johari Window ...................................................................................................... 24

The Arena ......................................................................................................................................................... 24

The blind spot ................................................................................................................................................... 24

The façade ........................................................................................................................................................ 24

The unknown .................................................................................................................................................... 25

Becoming a reflective practitioner ....................................................................................................................... 26

Theories and models of reflection ........................................................................................................................ 28

Kolb’s experiential learning cycle ..................................................................................................................... 29

Critical incident analysis ................................................................................................................................... 29

Johns’ model of structured reflection .............................................................................................................. 30

Tripp’s model of structured reflection ............................................................................................................. 31

Questions used to examine a critical incident ............................................................................................. 31

Stories and transformation ................................................................................................................................... 32

Servant leadership ....................................................................................................Error! Bookmark not defined.

Resources.............................................................................................................................................................. 34



The School for Health and Care Radicals

'If you want to build a ship do not gather men together and assign tasks.

Instead teach them the longing for the wide endless sea.’

Antoine de St Exupery

Staff and governors

Helen Bevan, Programme Director

@HelenBevan

Jackie Lynton, Head of Diversity

@jackielynton

Jodi Brown, School Governor

@JodiMOlden

Kate Pound, School Director

@KateSlater2

CJ Graham, School Director

@CJGrahamNHS

Pip Hardy, Curriculum and Learning Lead

@PilgrimPip

Paul Woodley, Head of Support Services

@Paulwoodley4

Joanna Hemming, School Editor

@joannahemming

Michael Goodeve, Communications lead

@MichaelGoodeve

The School for Health and Care Radicals is an initiative of the NHS Horizons Group, NHS Improving Quality. This Programme Study Guide was prepared for the School for Health and Care Radicals by Pip Hardy.



WELCOME!

Introduction

‘Be the change you want to see in the world.’ MK Gandhi

Welcome to the School for Health and Care Radicals. This Programme Study Guide will help you

make the most of your studies and your time. We will try to anticipate – and answer – some of your

questions, and offer some tools and suggestions that will help you translate your learning into

action.

We can imagine how busy you are, but we are pretty sure that you will find it helpful at least to skim

through this study guide before beginning your work on the first module you have chosen. As well as

explaining a bit more about the programme, we will introduce you to some other Radicals and share

with you some of their stories of change. We will also encourage you to engage with the School and

the learning in a number of different ways.

What is the School for Health and Care Radicals?

The School for Health and Care Radicals is not just another new initiative. The first seeds of the

School were sown back in 2002 and took the form of a one-day school for organisational Radicals –

that is, people who wanted to bring about constructive change in their own organisations. Over the

years, these ideas have taken root in the world of healthcare quality improvement, have been

nourished by the application of social movement thinking and have spread by means of community

organising principles and the use of public narrative.

A short history of the School

The first School for Healthcare Radicals was held in 2012, partly in

preparation for, and in support of, the first NHS Change Day in

March 2013. NHS Change Day has been hailed as ‘the largest

simultaneous improvement initiative in the history of the NHS’,

resulting in nearly 200,000 pledges from people throughout the

NHS and beyond, from people of all ages, at all levels, doing a

wide variety of jobs and extending to patients, families and carers.

It has demonstrated yet again that grassroots movements really

can make a difference and, in this case, improve care for all of us.

http://changeday.nhs.uk/

In 2014, the School was renamed The School for Health and Care

Radicals to acknowledge the close relationship between health

and social care and to reinforce the idea that anyone, whoever

they are, can participate in the School and contribute to bringing

about positive changes in care. Once again, the School ran during the lead-up to Change Day 2014

and participants were encouraged to link their work in the School with their Change Day pledges.

http://changeday.nhs.uk/



In keeping with the founding principles of the NHS, the School for Health and Care Radicals is also

free at the point access, non-hierarchical and open to all. People working at every level in the NHS,

together with patients and carers, have been joined by people from around the world, united by

their common goal is to improve the quality of care for everyone, to share learning and support one

another in their efforts to bring about positive change.

The overarching aims of the School are to equip people across the health and care system with the

core skills to become effective change agents. Through the effective use of social media as a means

to connect, communicate, shape and share, the School works to:

equip people across the health and care system with the core skills to become change

agents

ignite people’s passion to improve services

promote a grassroots change movement

provide a robust underpinning in new ways of thinking about improvement

operate to help people implement and sustain change

promote connection and communication via many different channels

create a national and international community of practice share leading-edge change

methodology and thinking.

So, by joining the School, you will become part of its history and its future. We hope that you will

join the growing number of people who are committed to making changes –large and small – and

that you will also find support and encouragement from this community of practice and learning.

‘Beauty and the sense of belonging it evokes

introduces us to a new standard of care--a quality

of attending-- which we may extend to our sense

of stewardship in creating communities of care.

Perhaps in the future a well-lived life will involve

the shift from a focus on utility to the combined

search for signs of the beautiful.’

Michael Jones, 2004

Who is it for?

‘Dialogue is the encounter between men, mediated by the world, in order

to name the world.’ Paulo Freire

The School for Health and Care Radicals is for anyone and everyone who wants to improve the safety

and quality of health and social care. You may hold a senior post in the NHS or in another health or

social care organisation; you may be a doctor or a nurse, or a student doctor or nurse; you may work

on the frontline or behind the scenes; you may be a commissioner, an administrator or a manager;

you may be a healthcare assistant or an allied health professional, a carer, a patient or a service

user. The School for Health and Care Radicals is an opportunity for all of us to come together to pool

our ideas and our resources with the intention of making sure that care will be as good as it can

possibly be for us, our parents and families, and for the generations that follow us.



‘I’ve cared for my husband, who has dementia, for eight years. The number

of people we have to deal with can sometimes be overwhelming – it’s

certainly confusing, especially as they often don’t know what the others

have been doing. My Change Day pledge is about finding a way to co-

ordinate all those different people and different activities so that there is

one person carers can call who actually knows what’s going on – like a case

manager. In order to make that happen, I am hoping to learn more about

how to make change happen so that many other carers can be saved from

going through what I’ve had to go through.’ Carer

In 2014, around 1900 people from 66 countries took

part in the School. Around 10% of those people went

on to graduate and become Certificated Change

Agents, proudly displaying their badges in many

different ways! They connected with each other via

the weekly webinars and Tweet chats and many have

remained in contact, sharing ideas and experiences,

offering support and building a strong sense of

community and connection.

What’s in it for me?

If you’ve ever thought to yourself ‘I could do that better’ or ‘I would want to be cared for like that’ or

even ‘I’m so glad that’s not my gran in that bed’, then you probably have some great ideas for how

health and social care could be improved. But, if you are like many other people, you may then think

to yourself ‘Nobody will pay attention to me’ or ‘I wouldn’t know where to begin …’. If you have ever

wanted to make a difference to patient/service user and staff experience, and improve the

outcomes of care, then the School for Health and Care Radicals is for you.

The School for Health and Care Radicals will provide you with information and tools to help you

identify the kinds of changes you can make for the better and give you the knowledge and

confidence to go ahead and make them. You will gain skills and confidence that will enable you to

act as an effective change agent – you’ll learn how to rock the boat but stay in it!

‘The moral test of government is how that government

treats those who are in the dawn of life, the children; those

who are in the twilight of life, the elderly; and those who

are in the shadows of life - the sick, the needy and the

handicapped.’

Hubert Horatio Humphrey, US Vice President

You will also have the opportunity to meet other people, not only from

around the UK but around the world, who have been trying to make

health and social care better. Some of your fellow learners will be

experts in bringing about change and some will be people just like you

– wanting to make things better for yourself, your families and friends

and for future generations. You will join a Community of Practice –



other people who are as passionate as you are about making the world a better place – so you will

have plenty of encouragement and support to carry out your plans and accomplish your dreams.

Along the way, the School will also:

offer relevant and rewarding skills and learning opportunities

encourage learners to gain knowledge, skills, abilities and confidence

provide opportunities for active learning

offer appropriate coaching and mentoring support

provide opportunities to relate learning directly to the workplace in order increase personal

and organisational potential

acknowledge and value learners’ achievements

offer opportunities to shape and participate in the School

encourage learners to form a network of like-minded people (a community of practitioners)

and remain involved with the School as it grows.

‘There are a lot of possibilities for medical students and junior doctors to

influence the NHS and the health and social care system that we work within.

We’re often not taught to think about those things but actually we all have a

voice and I think that we are very powerful change agents. We move around the

wards, we meet people in a lot of different areas, we have a way of talking to

patients which sometimes consultants don’t have time or the inclination to do

and because of that we can sometimes understand their perspectives better.

That can be really powerful about how to get more compassion back into the

NHS.’ Medical student

How does it work?

The School consists of the following

components:

five weekly webinars

module study guides

online discussions and Tweet

chats

School Learning Groups

an international community

of learning and practice

four advanced masterclasses.



Programme outline

The Programme consists of five modules and four masterclasses.

Module 1: Being a Health and Care Radical: change starts with me

In this module, we will be exploring the differences between trouble-makers and radicals,

understanding how to rock the boat and stay in it; we’ll at how to be a great change agent and

highlight learning from around the globe

Module 1 will help you to:

understand the history of change agents and of The School

recognise your own values and passions

recognise the difference between transactional and transformational learning

consider the emerging direction for transformation and change

reflect on what it means to be an agent of change

explore some of the challenges for Health and Care Radicals

learn how to rock the boat and stay in it

build self-efficacy

recognise the importance of community

clarify your vision and your purpose.

Module 2: Building alliances for change

In this module, we will look at understanding the power of working together by exploring

communities of practice, social movements and community organising; we will also investigate some

techniques for connecting with your own and others’ values and emotions to create a call for action.


understand the need to build alliances and create communities for change

identify the characteristics of effective social movements

learn from the leaders of social movements

recognise the power of storytelling

use stories to connect with others through emotions and values

reflect on your existing networks

establish and build new networks

bridge disconnected groups utilising strong and weak ties.



Module 3: Rolling with resistance

It’s natural for people to resist change but we can actually use the energy of resistance to help bring

about the changes we want. This module will help you appreciate where people are starting from

and to see dissent, disruption and diversity as essential components of effective change.


recognise the challenge of resistance

understand some of the reasons for resistance

embrace diversity

recognise the crucial difference between impact and intent

use the Stages of Change model to help people through change

build resilience in yourself and others.

Module 4: Making change happen

In this module, we will draw together some of the themes from previous modules and examine ways

of bringing your aspirations for change to fruition. We will look at the NHS Change Model and the

energy model and consider the importance of balancing different types of energy and recognising the

need for both extrinsic and intrinsic motivation.


recognise the power of politics

understand why change efforts often fail to achieve their objectives

examine the need for extrinsic and intrinsic motivators and balance the tension between them

create shared purpose

build energy for change

plan for success

share stories of success.

Module 5: Moving beyond the edge

Change always starts at the edge and always starts with activists. This module will help you move

closer to the edge and towards sustainable change; it will help you take your learning from the

School for Health and Care Radicals forward, think about what you might do next and where else

you might get support/resources.


review what we have learned so far about the characteristic of a transformational change agent

examine Peter Fuda’s Transformation Change Agent framework: Being, Seeing, Doing

consider emerging directions for change and change agents ‘from the edge’

reflect on some of the key messages from the School

plan for the future.



Is there any formal recognition or qualification?

We hope that you will engage with the School and enjoy learning for

learning’s sake. If you do want to engage more deeply with the opportunities

provided by the School, there are various ways in which your work can be

recognised, although at the moment there is no formal qualification.

If you engage with all five modules and submit a reflective statement about

your work, you will be eligible to become a Certificated Change Agent. You

can hear from some people who gradated from the School and became Certificated Change Agents

below.

Masterclasses

The four masterclasses will be open to anyone who has participated in any of the School modules.

They are:

Transformational leadership

Advanced storytelling

Thought diversity

Rebels at work

These masterclasses will give you the opportunity to deepen your knowledge and develop specific

skills in these areas.

Introducing some Health and Care Radicals

We would like to introduce you to a few Health and Care Radicals – hopefully their stories will give

you a flavour of the great diversity of people who can be Health and Care Radicals and inspire you to

join them!

Simon Platt, Service Improvement Manager, North West Commissioning Support Unit

‘The SHCR has helped to re-energise my determination to make a difference and

also empowered me by knowing just how important our role is. When working to

embed positive change, it can sometimes feel like an uphill battle to gain the

trust/support/following of others but this School has helped me to analyse that

such challenges are a necessary evil on the journey to making our efforts a

success. Be resilient, take small steps forward on your journey and, above all else,

listen as much as you talk.’

Annemarie Tesora, Director of Quality improvement for Prevention and

Wellness, Lynn Community Health Center

‘Walking on water or drowning are not commonsense survival options. We

have to bind our boats together through strong bonds to create a supportive

platform that can withhold turbulent conditions.

Rather than rocking the boat while staying in – staying afloat together –

surviving – becomes our shared purpose.’



Molla Imaduddin Ahmed, Specialist Registrar in Paediatrics, University Hospitals of Leicester

‘The School for Health and Care Radicals course has been an eye opener for me and

has encouraged me to work towards improving patient care and encouraging

others to do so as well. I have learnt the importance of networking with like-minded

people and the power of a community to change things. As a part of the

community, I have been able to share experiences and support others and this

course gave ample networking opportunities to liaise with other change agents. The

course was extremely well conducted with excellent study materials enabling me to

learn about various aspects of being a change agent.’

Dr Sabira Mohammad, Project Manager, Urgent Care, Herts Valleys Clinical Commissioning Group

‘I found being a part of the School for Health and Care Radicals completely

life-changing. The process sent me on a journey of self-discovery and

empowerment. It was liberating to spend time learning and sharing with like-

minded people, to know that I am not alone in refusing to settle for the status

quo.

Since the SHCR, my entire approach to my role within the NHS has changed. I

get it now: if change is going to happen, it’s up to me.

So I have started to speak up, sit at the table where decisions are being made,

question when things are being done that are not in patients’ best interests.

I found a voice through the process and the confidence to undergo a career change that has taken

me from the frontline of healthcare delivery to the centre of redesigning out-of-hours services!

Change projects I am currently involved with include setting up masterclasses so tomorrow’s leaders

can learn from the leaders of today, as well as setting up paired learning between GP Trainees and

Managers in the CCG.’

Liz Hedgecock, Knowledge Development Manager, Health Education North West

‘The School for Health and Care Radicals Programme was a breath of fresh air.

I learnt so much from the webinars, finding out about new resources and

online communities. It was inspirational to hear change stories, useful to

receive advice on making and sustaining change, and wonderful to feel part of

a community of like-minded people.

Regarding my own change journey, I’m probably more of a boat-wobbler than

a boat-rocker, but I have introduced some new ways of knowledge-sharing in

my organisation and they’ve been well-received. Hopefully the ripples will

spread further!’

Dr Lynne Maher, Director of Innovation and Honorary Associate Professor of Nursing, University of

Auckland

‘The School was a wonderful way to meet and learn from lots of like-minded

people doing great work from around the world.’



Joan Pons Laplana, Proud Nurse, Derbyshire Community

Health Services NHS Foundation Trust

‘The School for Health and Care Radicals has put me in contact

with extraordinary people that I never knew existed. It has

given me an immense fount of guidance and a frame to keep

developing myself.’

Dr Maxine Craig, Head of Organisation Development, South Tees NHS Foundation Trust

‘I think the greatest impact for me was being in the community during the

School. I found it enlightening and heartening to work with so many enthusiastic

learners from all over the world. It made me proud of our NHS. It helped me

think about how we could create The Great North School of Health and Care

Radicals! It gave me energy.’

Celine Schillinger Head of Quality Innovation and Engagement for

Sanofi Pasteur

‘The School for Health and Care Radicals has been an eye-opener for me.

Unleashing the desire for change, connecting like-minded people and

equipping them with actual change skills is such a brilliant idea.

Forward-thinking content, inclusive spirit and superb logistics have made

this course an unforgettable milestone in our change journey. Long live

the SHCR, its graduates and its amazing organisation team.’

Jonathan Richards

‘This photo was taken on St Luke’s day as I was reading a poem about the patron

saint of doctors and artists.

The School has changed forever the way I work for the NHS.’

The rest of this Study Guide will suggest ways in which you might get the most out from the School –

some of these might be particularly helpful if you haven’t done any studying or learning for awhile.

Getting the most from the School

As with most things in life, the more effort you put in, the

more you are likely to benefit from your efforts. Having said

that, the School has been designed to be very flexible and

we invite you to engage with it in whatever way works best

for you. You might decide to:



dip in and out of the weekly webinars

enlist the support of a coach or mentor to support your learning

work through the reflective and other activities in the programme and module study guides

keep a learning journal

set up an Action Learning Set or a School Learning Group in your organisation to spread the

learning more widely

share your own experience of change with others, perhaps by becoming a mentor

any combination of the above.

However you engage, we encourage you to:

ask your own questions

set your own goals

plan your own time

decide what you want to learn, and how you want to learn it

become a reflective practitioner

assess your own progress

share your learning – and put it into practice – with others.

Social learning

‘All change starts when people get together and talk about the things they care

about. We move in the direction of the questions we ask.’ Margaret Wheatley

It is difficult to find your way in the darkness if you have only one candle; many candles will

illuminate even the darkest of paths. Similarly, sustainable change comes about when groups or

teams of people work together to bring about the desired change.

So, while the desire for change may begin with you, The School for Health and Care Radicals is

founded on the principle that large-scale, sustainable change happens when many people share the

desire for change; this collective energy can then be harnessed to bring about the changes you want

to see in the world. By creating a resource that can

be used flexibly but that also encourages a social

approach to learning, we hope to increase the

potential for real change and improvement.

Learning is changing as people become busier and

e-learning replaces face-to-face learning. We are

connected in myriad ways, communicating via

email, Facebook, Twitter, sharing photos, hopes,

ideas, experiences, aspirations and knowledge more

widely and more rapidly than ever before.



Certain characteristics of learning in the 21st century can be thought of as ‘social learning’. One of

the people who has clearly articulated the characteristics of social learning is Jane Hart. Here is how

she describes ‘Guided social learning’:

It is social – you are learning – not simply with others but from the shared experiences and

ideas of others – in the professional learning networks of trusted connections that you have

developed.

It is continuous – you are benefiting from a constant drip-feed or flow of information or

resources, or conversations with colleagues, all of which over time builds up into a large amount

of knowledge and shared experiences

It happens in short bursts – you tend to have short interactions with others and read bite-sized

pieces of content

It is autonomous – you are in control of what you do, the relationships you build, and how much

time you spend time on any activity – based on what value it gives you and to what extent

it meets a personal interest or professional need.

It is often serendipitous – although some of what you learn is planned, you are also learning just

by hanging out in social networks, gradually assimilating new ideas and experiences, in many

instances without even realising it (Hart 2014).

You can find a number of resources about guided social learning on Jane Hart’s website:

http://c4lpt.co.uk/

School Learning Groups

The design and delivery of the The School for Health and Care Radicals aims to nurture the

conditions that support both planned and serendipitous opportunities for learning. In seeking to

establish a community of learning and practice, the School promotes the sharing of knowledge by all

those who engage with the School. We would like to encourage you to set up or join your own local

School Learning Group where you can reflect on the ideas put forward in the School Webinars,

engage your colleagues with your hopes for

change and engage in activities designed to be

thoughtful, thought-provoking and relevant to

people’s jobs. We will support your efforts by

providing content that is generated by experts,

practitioners and users.

The philosophy of the School encourages you to

become more autonomous by providing some

choices around when you learn and how you

apply your learning at work while also providing

guidance and support for individual and

collective learning journeys.

The School will provide plenty of opportunities for you to connect with others from around the

world. We also encourage you to establish your own local School Learning Group, where you can

connect with other change agents from your own organisation. There are some suggestions and

guidelines for setting up a group in the document called ‘Starting your own School Group’.

http://c4lpt.co.uk/



ACTIVITY: SHARING YOUR PASSION FOR CHANGE

It can be a daunting prospect to think about setting up a learning group, so we would like to

encourage you to adopt a slightly more radical approach – one that has been successfully used by

the Star Wards Programme http://www.starwards.org.uk/

Star Wards has brought about great changes in mental health care, partly by appealing to people’s

passion, and harnessing the energy that prompts people to do the things they love doing.

1 Begin by thinking about something you really like to do – it doesn’t have to be work-related. Make

a note or two here.

2 Now think about how you could share your passion – whether it is for cooking, reading, running,

listening to music, repairing motorcycles, making quilts, gardening, walking dogs – whatever it is –

with others.

Try to visualize how you could bring your passion to work. Make a few notes.

3 If you are feeling really brave, make a poster, send an email, let people know that you will be

meeting at a particular time in a particular place and see what happens!

You may be surprised to find others where you work sharing your passion – whatever it is.

Some great examples include:

setting up a weekly running club

establishing a reading group

promoting healthy eating through ‘Come Dine with Me’ activities

founding a gardening group

preparing a cookery book

organising a singing group.

When people have the opportunity to share their passions, unexpected things may happen.

Undoubtedly something will change. Trust is built up, attitudes change, the energy of resistance can

http://www.starwards.org.uk/



be harnessed, diversity can be embraced and conversations can move towards other kinds of

changes that may have a more direct result on the way care is designed and delivered. You can find

some great examples of changes in care delivery on the Star Wards website:


And, if that is not enough to inspire you, please read about how one group of committed,

enthusiastic, excited and eager group of Health and Care Radicals shared and deepened their

learning from the 2014 School.

Case study: New Zealand class of the School for Health and Care Radicals

Dr. Lynne Maher Director for Innovation, Ko Awatea & Associate Honorary Professor of Nursing, The University of Auckland

Alex Nicholas Project Coordinator Community Organising, Ko Awatea

Alex Twigg Campaign Manager, Ko Awatea

Excited, enthusiastic, committed and eager. This is how ‘we’, Alex, Alex and Lynne, felt as we joined

the School for Health and Care Radicals in 2014. We are all change agents and were keen to extend

our knowledge and ability to become more effective in our roles.

New Zealand is around 11, 7682 miles (18,800 km) away from England and

it is ahead in time zones by around 12-13 hours depending on the time of

year. We worked out that most of the Web Based Learning sessions would

take place on Friday evenings our time which initially posed a challenge in

our ability to join the sessions ‘live’ without disruption to family lives. We

added the word ‘determined’ to our vocabulary and worked out a slightly

different way of participating; the ability to be autonomous in our method of

joining the School was highly successful. We were able to access recordings

and a transcription of the discussions held during the web sessions in

addition to the slide deck used, these tools provided all of the basic learning

material we needed.

By arranging to meet after each of the web teaching sessions we set

a pace for our learning which was in step with the programme and

incorporated time to reflect. At our meeting one of us would lead a

review of the learning session and each of us committed to feedback

on our individual interpretation and to provide examples and

additional learning from our own practice. This was fascinating; we

had all committed to ‘do’ something and the diversity of our

discussion brought a richness that vastly increased our

understanding and knowledge.




After each session we developed a short update to share with others in our organisation, this started

to create much interest. As the weeks progressed we turned our attention to how we might more

deeply share our learning with others, we wanted many people to have the opportunity that we had.

The three of us pledged to bring 400 other passionate change agents together and enable them to

also learn. Through eleven half-day foundation workshops we have achieved our pledge.

We know that a fundamental principle of being a Health and Care Radical means that change starts

with ‘me’. Through participating in the learning modules we have achieved the knowing. This has

now lead to doing a number of things including raising awareness through five articles shared on our

organisations newsletter (The Daily Dose) and putting into action a plan to achieve our pledge. This

has enabled others to experience our learning and has resulted in a new community of 400 change

agents. We are living the principles of being effective boat

rockers through our conviction that this will make a

difference, and creating a sense of hope as we go.

Excited, enthusiastic, committed and eager. We, together

with our 400 colleagues are now part of ‘us’ a global learning

community of change agents. Together we can radically

improve health and care around the globe; ‘we’ are starting in

Auckland, New Zealand.

Sharing your experiences

Whatever you decide to do and however you decide to do it, we would love to hear from you about

what you’ve done, how you’ve done it and what’s happened as a result.

‘I think the School for Health and Care Radicals is for everyone who wants to

make a difference and hasn’t known how to. I think it will give you the tools

to really engage with the NHS, to really impact and do those things that

you’ve always dreamt of doing.’

‘If you feel that the system is too big, too confusing, that you’re alone, I

think if you get involved with the School for Health and Care Radicals you’ll

find other people who feel like that too, but also people who have already

made change happen in whatever area you’re looking at and by networking

together and forming that community, coupled with the resources that the

School will provide, then we will be able to make some real change.’

Learner, School for Health and Care Radicals

REFLECTION: THE ONCE AND FUTURE STORY

Before going on, you might like to give a few moments’ thought to the future story you might like to

tell about your involvement in the School.

What would you like to be saying to your colleagues/friends/family by the time you have graduated

from the School?



1 It might help you to think first about what made you decide to register with the School in the first

place. Note your thoughts here. If you have a particular problem or issue that you are hoping to

change or solve, write that down too.

2 Next, consider what you hope to gain from the programme? Consider, for example, how you

would know whether you have solved your problem or answered your question.

3 Finally, what would you be doing differently in say, six months – one year’s time, to indicate to

yourself and others that the programme has been successful?

4 Now write your own ‘quotation’ summarising what you hope to gain from the programme.

If you find it difficult to visualise your own future story, you might be inspired by this digital story,

created by Helen Bevan, anticipating the change agents of the future:

https://www.youtube.com/watch?v=9WFcWgO9D5M

Helen’s story looks at The Five Enablers, which are explained in the recently published White Paper:

The new era of thinking and practice in change and transformation.

The Five Enablers are:

1. Activate disruptors, heretics, radicals and mavericks

2. Lead transformation from ‘The Edge’

3. Change your story

4. Curate rather than create knowledge

5. Build bridges to connect the disconnected

You can read more about the five enablers in the White Paper here:

http://www.nhsiq.nhs.uk/resource-search/publications/white-paper.aspx

https://www.youtube.com/watch?v=9WFcWgO9D5M

http://www.nhsiq.nhs.uk/resource-search/publications/white-paper.aspx



Finding support

‘Learning and teaching should not stand on opposite banks and just watch

the river flow by; instead, they should embark together on a journey down

the water. Through an active, reciprocal exchange, teaching can strengthen

learning how to learn.’ Loris Malaguzzi (1920-1994)

Now that you are part of the School for Health and Care Radicals, you never need to feel isolated.

We have suggested the possibility of setting up or joining a local School Learning Group, but there

are many other opportunities for support , including people involved with the School want to work

with you and support you.

Consider your needs for:

personal support

professional support

coaching support

mentoring support

practical support.

ACTIVITY: FINDING SUPPORT

You might like to note down here the names of people who may be able to support you – and the

type of support they could offer others. Be as specific as you can.



In terms of personal support, friends and family can be good sounding boards for new ideas. Tell

them about your involvement with the School and share your experiences with them – they can

encourage you and support your efforts.

Professional support comes in many forms. There will be people from your past or present who can

help you, by talking over ideas, reading your work, helping solve day-to-day problems at work. It’s

good to have the support of your manager and immediate team members. Let as many people as

possible know that you are learning with the School. Ideally your colleagues will work with you to

provide peer support and perhaps even some peer assessment. It is helpful to gain the views of your

colleagues as to what’s changing at work – they may even notice changes in you! We also encourage

you to involve your colleagues in some of the activities and to draw on their thoughts and

reflections.

Practical support can take a variety of forms. In addition to the weekly webinars and this Programme

Study Guide, there will also be a Study Guide for each module. These will contain lists of additional

resources that you can use to deepen your learning: books, articles, papers, films, blogs, videos and

so on. And, of course, you can always ask for suggestions from other learners. Remember that you

are now part of an international community of practice, where everyone is encouraged to

contribute, and everyone can learn from everyone else.

Working with a mentor

You may like to formalise this support by arranging to work with a mentor on a regular basis. You

might connect with other learners in the School or be inspired by a former Graduate of the School –

many of these people will be very happy to support you in your change efforts.

On the other hand, if you can’t or do not wish to have a mentor, that is absolutely fine. Whatever

you decide it is important, when studying at a distance, not to become isolated. There are many

ways of keeping in touch with other people and sharing some of what you are learning. You will find

others engaged in the School a great source of support and inspiration.

Keeping a learning journal

‘By three methods we may learn wisdom: First, by reflection, which is

noblest; Second, by imitation, which is easiest; and third by experience,

which is the bitterest.’ Confucius

As one of the best ways to learn is to reflect on your

experience, we strongly suggest that you keep a

learning journal to help you keep track of your work –

it can also form the basis for useful discussions

between you and your mentor or colleagues.

Research by Dr Neil Conway and Dr Rob Briner (2001)

at Birkbeck University found that keeping a journal or

diary at work can help you survive and thrive.



Not only can they be used to keep track of your time, but they can also:

keep track of both negative and positive feelings

provide insights into how people relate to one another

provide a release for things which are bothering you

encourage reflection

help you recognise changes in yourself and others

identify patterns

make you more efficient by helping with time management

offer a ‘reality check’ amidst of the mysteries of organisational culture and politics.

Source: ‘Why keeping a diary at work can help your career’ by Tola Awogbamiye in The Guardian Saturday July 28, 2001

Your learning journal will give you the opportunity to keep notes on:

what you are learning

how you are learning it

how new skills and knowledge may be interacting with your work

your thoughts and ideas for the future

questions and concerns.

In addition, you can use your learning journal as a:

critical incident or reflective diary – recording significant learning and work experiences

record of written work – published or unpublished, as well as letters, memos, reports, etc.

private diary for examining personal issues (you do not need to submit this part of the

journal unless you wish parts of it to be seen in the context of your learning)

log for future learning/training needs.

You may also like to use your learning journal like a scrap book, keeping track of letters, memos,

minutes of meetings, articles, etc. which may stimulate your thoughts and ideas about projects you

want to undertake and how you might like to undertake them.

Some people like to keep a journal in a beautiful (or handsome!) book, while others prefer to keep

an electronic journal. Whatever you do, try to get into the habit of writing in it regularly.

If you are interested in journaling, you may like to look at some of the following resources:

Progoff, I (1982) At a Journal Workshop Dialogue House

Price, D (1999) How to Make a Journal of Your Life Ten Speed Press

Senn, L (2001) The Many Faces of Journaling Pen Central Press



Drawing up a learning plan

‘To know how other people behave takes intelligence, but to know myself

takes wisdom. To manage other people’s lives takes strength, but to

manage my own life takes true power.’ Lao Tzu

Now that you have begun thinking about what you would like to get from the School, it may be

helpful for you to draw up a learning plan. If you have a mentor, a learning contract is a useful basis

for your relationship. If you are working with other colleagues or people in your team, you may like

to share and review each other’s plans. Or you may just decide that you will make an agreement

with yourself. Your learning journal may be the ideal place to keep your learning plan.

A learning plan is really just a way of clarifying your expectations:

what you hope to gain from the School

what you expect from yourself, your colleagues, your mentor

what others expect from you.

You don’t have to complete the plan all at once – it can change over time but it does put a peg in the

ground as you begin your work with the school and will help you to organise your work and your

learning in the way that is most helpful to you in your particular circumstances. Your learning plan

should start with where you are now and a realistic assessment of the things you already know and

the things you are good at.

ACTIVITY: WHERE ARE YOU NOW?

1 Give some thought to your own strengths and weaknesses. Be as honest as you can – especially in

relation to your strengths!

2 Looking back at the programme outline, you may know something about some (or many!) of the

topics already. Jot down some notes relating to the content headings and learning outcomes.

Many of us find it challenging to talk about our strengths so you may find it helpful to talk to a friend

or colleague and try to see yourself through his or her eyes. And remember that you don’t have to

do everything at once: taking the first step can sometimes be the most daunting but it is always the

most important, as this poem by David Whyte reminds us.



START CLOSE IN

Start close in, don't take the second step

or the third, start with the first

thing close in, the step

you don't want to take.

Start with the ground you know,

the pale ground beneath your feet,

your own way of starting

the conversation.

Start with your own question,

give up on other people's questions,

don't let them smother something

simple.

To find another's voice,

follow your own voice,

wait until that voice becomes a private ear

listening to another.

Start right now take a small step

you can call your own don't follow

someone else's heroics, be humble

and focused, start close in, don't mistake



that other for your own.

Start close in, don't take

the second step or the third,

start with the first thing

close in, the step

you don't want to take.

David Whyte (2012) River Flow: New and selected poems

In the rest of this Programme Study Guide, we will offer some ideas, theories, tools and techniques

that may help to deepen your learning and make your time spent on the School more fruitful. You

can pick and choose what you like and leave the rest but we hope that you will find something that

resonates with you and your particular approach to learning.

Getting to know yourself: the Johari Window

The Johari Window is a technique designed to improve your self-awareness and your understanding

of others in your group or team; it’s particularly useful for personal development, self-awareness,

improving communications and interpersonal relationships, understanding group dynamics and

inter-group relationships. in relation to behaviour, empathy, cooperation, inter-group development

and interpersonal development.

The model consists of a grid made up of four squares (like a window with four panes).

The Arena

The upper left quadrant, usually labelled open self/area; free area; public area or arena, represents

those behaviours, attitudes, feelings, emotions, knowledge, skills, experience, views, etc. that are

known to the person and to others. This is the most productive area for individuals and groups,

where there is good communication, co-operation and trust. This is obviously the area that most

teams should concentrate on developing.

The blind spot

The upper right quadrant, known as ‘blind self’, ‘blind spot’ or ‘blind area’ represents what is known

by others by unknown to the individual. The person may lack self-awareness or be deluded or may

be deliberately hiding things from others. It is helpful to gain sensitive and non-judgemental

feedback from others to reduce the size of the blind spot and increase the open area.

The façade

The lower left quadrant is known as ‘the façade’, ‘hidden self’, ‘hidden area’ or ‘avoided area’ –

these are the things that are known to an individual but are kept hidden from others. This area may

include fears, insecurities, sensitivities, hidden agendas, secrets – anything that a person does not



want others to know about. Obviously there are personal things that are private and not relevant to

work, but there are other things that could more usefully be brought into the open area for the

benefit of the individual and the team.

The unknown

The lower right quadrant, or ‘unknown self’, area of unknown activity’ or ‘unknown area’ relates to

information, feelings, abilities, aptitudes, experience, etc. that are unknown to the individual and to

the group. This area tends to be larger in younger people with less experience, but can also cover

abilities that are underestimated, perhaps through lack of confidence or training.

http://en.wikipedia.org/wiki/Johari_window

There are many opportunities for using the Johari window and it is an excellent tool for developing

skills in delivering constructive feedback as well as promoting trust in teams. All team members, but

especially leaders, should try to increase their open areas and reduce hidden and unknown areas.

Give some thought to ways you could use the Johari Window to increase understanding and self-

knowledge within your team or between teams in your organisation.

You can find more on how to use the Johari Window here:

http://www.businessballs.com/johariwindowmodel.htm

http://www.businessballs.com/johariwindowmodel.htm



Becoming a reflective practitioner

‘We learn not from experience but by reflecting on experience.’

John Dewey, 1939

There is a great deal of emphasis within the NHS and other

health and care systems on becoming a reflective

practitioner…. but it is not always clear what this means.

We hope that, by joining the School for Health and Care

Radicals, you will take the opportunity to learn from

reflecting on your experience.

Some people regard the ability to reflect as the hallmark of

a professional, as opposed to someone who simply does

their job.

Academics and theorists have written a great deal about reflection and reflective practice and we

will summarise some of these below.

In essence, the practice of reflection is not difficult, and it is quite likely that you are already doing it

in your work and in your everyday life. The fact that you have registered with the School indicates

that you have given some thought to what you do well – or at least to what you don’t do so well –

and this is the basis of reflection.

ACTIVITY: PRACTISING REFLECTION

Think of an incident which has occurred during the last few days. It doesn’t really matter whether it

was at home or at work – the main thing is to take some time to reflect on what happened.

Briefly describe the incident: what happened?

How did you feel?

What did you do in response to the incident?

What was the outcome?



If it was successful, what did you do to contribute to the success?

If not, what would you do differently next time?

Here is an example that might help to illustrate the process of reflection.

Case study: How are you?

A medical student is working with his clinical partner doing psychiatric triage. The patient is

depressed, confused, disengaged, barely responding to questions, however hard they try to engage

with him.

When the assessment is finished he goes out to the waiting room.

After a few minutes, they hear him announce that he wants to leave. The doctors are remonstrating

with him, fearing that he is at risk of self-harming or even suicide. He makes no eye contact, gives no

response to their questions.

After many minutes of fruitless attempts to engage with him, or even to get him to speak, they

threaten to section him.

Just then he looks up and asks ‘How much is the treatment going to cost?’

The man was an NHS patient, and there would be no cost.

Our medical student reflects on the conduct of the assessment.

‘If we hadn’t been so engrossed with getting all the clinical details, we might have paid more

attention to his concerns, his anxieties, especially as money worries were a huge contributing factor

in his depression.’

‘I would like to think that the next time I am assessing someone, I would ask a simple question like

“Is there anything you are concerned about?” Or even, simply “How are you?”

That would save so much anxiety for the patients and so much time for the clinical staff.’

You can watch the reflective digital story made by the medical student here:

http://www.patientvoices.org.uk/flv/0778pv384.htm

There are a number of other reflective digital stories created by medical students, which might help

you to think more deeply about the value of reflection:

http://www.patientvoices.org.uk/pkt.htm


http://www.patientvoices.org.uk/pkt.htm



Most of us go through this process many times each day, both at work and at home, and it is one of

the ways we learn best.

The key stages of the process are:

1. Identify the incident or problem. (The experience)

2. Think about what happened: who was involved, what each person did, what the outcome

was and how you felt about it. (The description and its effect on you)

3. Now consider what might have been differently to produce a different outcome. (Your

reflection and analysis of the situation – can also include your thoughts and feelings about

the knock-on effects, what led to the situation arising in the first place and what is really

going on?)

You can also use this process to help you keep track of what you are learning:

1. What have you learned?

2. How do you know you have learned it (i.e. what are you doing differently now to indicate

that there has been a change in your skills, knowledge or attitude?

3. How is this affecting your work and what might be the implications for the future?

This process is one that you can use throughout the School and beyond and it will stand you in good

stead throughout your life and career.

‘Mere activity does not constitute experience…. To learn from experience is

to make a backward and forward connection between what we do to things

and what we enjoy or suffer from things in consequence. Under such

conditions, doing because a trying: an experiment with the world to find out

what it is like: the undergoing becomes instruction – discovery of the

connection of things.’ Dewey 1916

Theories and models of reflection

Many models and techniques have been

developed to assist the reflective process.

They all have a similar aim: to provide a way of

thinking about and recording experience so

that it becomes possible to learn from that

experience. Three of these models are set out

below. They are not intended to constrain you

but to help you begin to structure your

thinking in the most effective way. All the

models described here share crucial

similarities. Feel free to mix and adapt them to

your own situation or learning style – the

important thing is that you take time to reflect upon your work and your learning and learn from

your experience.



Kolb’s experiential learning cycle

David Kolb (1983) identified four key stages in learning:

1. Concrete experience – learning begins when something happens – there must be active

involvement and felt experience. So here is where you identify the problem, situation or

incident.

2. Reflective observation – standing back and observing ore reviewing the incident. Has it

happened before? How was this time different? How did it make you feel? Why is this

aspect of your work particularly important or particularly troublesome? It can be helpful to

involve others here.

3. Abstract conceptualisation – this is when you make sense of what has happened and

involves your deeper analysis and interpretation of events. What caused a problem or what

made it work well? What are the knock-on effects? How did it arise in the first place? What

is really going on here?

4. Active experimentation – engaging in this process helps us learn from experience in a very

effective way by considering how to translate new learning into planning and doing. This is

where we set out the possibilities for change and better practice.

Kolb’s learning cycle from: http://www2.le.ac.uk/departments/gradschool/training/eresources/teaching/theories/kolb

Critical incident analysis

Critical incident analysis is another well-known way of

establishing a structure for your reflections. Critical incident

analysis as a technique originated during World War II, when the

US Army Air Force needed to select and train air crews quickly.

Instructors were asked to answer four questions about their

trainees in an attempt to discover why pilots failed the training

programme.

When was the last time you saw a trainee pilot do something effective or ineffective?

What led up to this situation?

Exactly what did the trainee do?



Why was it effective or ineffective?

The questions demanded factual answers – not intuitions or unfocused feelings about particular

individuals.

Today, critical incident analysis is used by professionals in many fields, particularly as part of the

reflective process. It can help identify the areas which professionals themselves recognise as critical.

Critical incident analysis should take into account questions like the following:

Where did the event occur: what were the relevance of the place and its impact on the situation?

When did it happen: was this an important factor?

Who was involved?

A detailed description of what happened.

Why the incident was critical or significant to you?

What you were thinking about as it was taking place?

What was most satisfying or dissatisfying?

What you might have done differently?

Why you might have done this differently?

What action, if any, you will take as a result of this learning?

Johns’ model of structured reflection

Christopher Johns (1994) devised his model of reflection for use by nurses and other health care

professionals. With slight adaptation, it is as suitable for any professional – or anyone at all – who

wishes to learn from experience.

1 Description

- Describe the incident or problem or

issue.

- What are the key issues within

this description which you need to pay

attention to?

2 Reflection

- What was I trying to achieve?

- Why did I act as I did?

- What were the consequences of my

actions?

- How did I feel about this experience when it was happening?

- How did others involved feel about it?

- How do I know how they felt about it?



3 Influencing factors

- What internal factors influenced my decision-making and actions?

- What external factors influenced my decision-making and actions?

- What sources of knowledge did or should have influenced my decision-making and actions?

- Could I have dealt better with the situation?

- What other choices did I have?

- What would be the consequences of those other choices?

4 Learning

- How can I make sense of this experience in the light of past experience and future practice?

- How do I now feel about this experience?

- Have I taken effective action to support myself and others as a result of this experience?

Source: Johns, C. (1994) ‘Nuances of reflection’ IN Journal of Clinical Nursing 3: 71-75

Tripp’s model of structured reflection

Finally, here is Tripp’s model of structured reflection.

Questions used to examine a critical incident

Kind of judgement Information required Questions asked People involved

Practical Procedural What should I do?

How?

When?

Where

For and/or with whom?

Diagnostic Descriptive

Causal

Effectual

Affectual

Semantic

Explanatory

What happened?

What made it happen?

What does it do?

What does it feel like?

What does it mean?

Why did (does) it occur?

Who was involved?

Who acted?

For whom?

For whom?

To whom?

With whom?

Reflective Personal

Evaluative

Do I like it?

Is it a good thing?

Do others like it?

For whom?

Based on Tripp, D. (1993) Critical Incidents in Teaching. London: Routledge

Despite the many different models of reflection, it is not

always clear that what we are really seeking to do in the

process of reflection is to develop a felt understanding of an

experience. This is particularly important when working in

the context of care, when those with whom we come into

contact are often ill, vulnerable and needy. We need to

understand their situation, their life experiences, as well as

our own, in order to provide care that is kind and humane as

well as clinically effective.



The creative arts offer opportunities to explore meaning, to see light and shadows and to use our

imagination, especially when trying to understand others. This kind of reflection can also deepen our

capacity for empathy and compassion.

‘Culture of the mind must be subservient to the culture of the heart.’

Mahatma Gandhi

We would like to end this section by drawing your attention to the power of stories and storytelling

as a way of engaging hearts as well as minds, and reflecting on others’ experiences as well as our

own.

Stories and transformation

‘Storytelling is the mode of description best suited to transformation in new

situations of action.’ Schön, 1988

Storytelling is one of the oldest – and most pervasive – of human activities. Stories help us make

sense of experiences – our own and those of others. It is through stories that we learn to be part of a

family, a group, a society, an organisation or a culture. Stories convey tacit knowledge – the things

we know but don’t necessarily know we know. Stories can be educational and instructive as well as

entertaining. A story is so much more than just a list of events: stories carry our values and our

passions, allowing us to encourage, motivate, inspire, celebrate, enthuse and engage – all vital when

we are trying to effect change.

‘How can I help people if I don’t know the right stories to tell them?’

Jack Cash in Walk the line

However, as Schön warns us, ‘Stories are

products of reflection, but we do not usually

hold on to them long enough to make them

objects of reflection in their own right.’

(Schön, 1988) So, if we want to use stories to

carry our dreams and aspirations into reality,

it’s necessary to find a way of preserving

them. There are many, many different ways

of sharing stories and you may be more

adept at some than others. Some people

love to tell stories, some write poetry, some

draw or paint pictures, some take photos,

some make films, some write plays, some act

in them, some throw pots, some compose music (or play it), some make quilts, knit scarves, work

with wood, decorate cakes, arrange flowers, while still others dance…

All these are ways of expressing and sharing our common human experience. So, it’s helpful not

only to the think of the stories you want to tell, but how you will tell them.

You may be thinking that you are not very creative; most of us, however, are more creative than we

think.



ACTIVITY: THINKING ABOUT STORIES AND CREATIVITY

1 How do you express your own creativity?

2 How would others – friends, family and colleagues – describe your creative gifts?

If you are able to bring your creativity into your work in such a way as to engage with others, you are

likely not only to find greater satisfaction in your work, but also to be a more effective change agent.

‘Telling this story has reminded me of how our creativity connects with part

of our soul - how wonderful it is to be part of something that does not have

measurable targets or hard matrices.’ Patient Voices storyteller

ACTIVITY: CELEBRATION

1 Think of something you have done that you are really proud of. Jot down a few notes.

2 Now turn that experience into a story – one that will engage, entertain and possibly even inspire or

motivate your audience.

You might find it interesting to watch some stories of celebration made by colleagues in the health

and care sector – they may inspire you to share your own stories of success!

The chief officer of the NHS Heart Improvement Programme wants to make a difference and with a

little help from his friends he does so.


A small voluntary organisation that provides free counselling for those who would not otherwise

have access to such a service is struggling to survive in the face of funding cuts. If the prevailing

attitude does indeed prevail what future is there for voluntary organisations in the co-production of

care?





A brief history of the Heart Improvement Programme celebrates the real improvements in services to

patients that are the result of working collaboratively and building networks of doctors nurses and

patients.


Val Leggett, Infection Control Nurse for Norfolk and Waveney Mental Health NHS Foundation Trust,

describes how lateral thinking, teamwork and use of colleagues' expertise achieved an award-

winning facility.


A chance remark made Katie determined to return to the nursing job she loved. But it wasn't until she

was sent on a Montessori for dementia patients training course that she realised the direction she

now wanted to take. Today she is really making a difference to people's lives.


As you progress through the School, you may find it helpful to pay particular attention to the

different ways in which people tell stories and how you respond to them. If you haven’t already

done so, begin to develop your own storytelling style – and you can see from the examples above

that it is possible to say a great deal in a very short space of time!

‘Narrative is radical, creating us at the very moment it is being created.’

Toni Morrison, 1994

Resources

Each module will contain a list of resources that are particularly relevant to that module.

You will also find a collection of resources at www.theedge.nhsiq.nhs.uk/school/

This collection will grow as we update it so please do check back often.

Rapid Radical Reading

We know that Radicals are busy people and don’t always have a lot of time to keep up with new

information. We want to help you with that and so we will be encouraging you to practice RRR – that

is, Rapid Radical Reading – by highlighting things that you can read or watch or listen to in just ten

or 15 minutes. Keep an eye out for the RRR symbol – R3 – next to these short but useful resources

and we hope you will enjoy updating your knowledge over a sandwich or cup of tea!

We also welcome your suggestions of resources that you have found helpful, so please do contact us

with your ideas and contribute to the growing collection. We look forward to seeing you in School –

and please keep in touch!

Email: [email protected] Telephone: +44 2476 627543

Facebook: School for health and care radicals Twitter: @School4Radicals #SHCR





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