Andrew Nichols-Clarke is the Head of Health and Justice Children programme for NHS England. In his role he oversees the provision of healthcare to children and young people in the secure estate.
As a pathology graduate and biomedical scientist, it isn’t an obvious path to a role working to prevent the most vulnerable young people ending up in justice or welfare placements.
But, if there’s one thing which becomes apparent quickly it’s that Andrew Nichols-Clarke wants to make people’s lives better. And he has a set of skills which place him perfectly to do that, by creating systems and processes which really work.
Starting when he was a Chief Biomedical Scientist in one of the largest labs in England diagnosing cancer. Given the chance to work on a consultancy basis with a company who had developed new tech which cut cancer diagnosis time from two days to two hours he was undaunted by the huge changes in processes, technologies, and techniques.
Here the phrase ‘reducing anxiety’ comes up for the first time. This is clearly a key passion for Andrew. By operating on a trust basis Andrew’s team know they can try new systems and be innovative, without fear holding them back. He holds the anxiety for them, to allow their work to flow.
The Health and Justice Children programme is working with young people who have often been bounced around many systems within the community. Alongside their mandated responsibility for the provision of healthcare to children and young people in the secure estate, they also have a programme to work at a preventative level with the most vulnerable young people they know would end up in justice or welfare placements.
Using psychologically led; formulation driven trauma informed care the team work to stop the upward trajectory of young people into those placements. The aim always being to support young people in a better pathway. Allowing them to thrive, both in and out of the secure estate.
Learning to Change
This is where we return to Andrew’s background story. Discovering he had an aptitude for mapping processes for improvement technologies and techniques through his cancer diagnosis work, he began to move into the sphere of service change.
From this work Andrew had the chance to spend time with a Japanese based company to do Six Sigma training. Essentially learning a set of techniques and tools for process improvement, to enable real service and culture change. The end result of these changes may be a new system, but the end difference is, again, a reduction in anxiety.
Back in the UK and working for NHS England, Andrew first began working in the stroke care network before moving into the children’s network. After undertaking work in Yorkshire and Humber on how acute care and anaesthesia works for children, then transferring his learnings into children’s mental health processes, he was seconded into the National NHS England team to lead and implement the brand-new community forensic CAMHS (Child and Adolescent Mental Health Services).
From here it was a swift and smooth transition into health and justice, which is where everything came together; the forensic mental health side of things, the service redesign and the culture change. As Andrew says; it’s all his passions wrapped into one.
Seven years into the role and Andrew is seeing real changes with the programme, especially the preventative programming in the community.
It’s easy to see why Andrew is so effective at activating change. It isn’t about being the one who came up with all the ideas, it’s about creating the space and safety for others to do so. His teams know their job is to design change. To test and try and not worry that it won’t always be right first time. In working this way he finds brilliant innovation emerges.
Every Interaction
The Health and Justice Children Programme team see every interaction with a child or young person as a chance to change the trajectory of their life.
Many miss out on CAMHS services because they don’t meet the threshold, or they simply don’t attend because they don’t have a consistent adult intervention. Often, they come from broken homes and hold a lot of trauma. They may not be attending school and are hard to reach. But, as Andrew says, potentially there is that one sports or community club they attend because they have an interest. In those places every interaction can be an intervention. The sports coach who knows and understands them could become the support they need.
Andrew believes this all comes down to looking at needs led services, and not always diagnosis led ones. Rather than looking at a young person and saying ‘you need to go to this football club’ it’s about reaching the young person who chooses to go to the club and giving them the space within that environment to be supported.
Many services may be able to deliver clinical interventions but, if that young person doesn’t feel safe, secure and supported in their environment and within their community, then the interventions may not improve things for them in the first instance. As Andrew tells us, there are 168 hours in the week and one hour a week with a specialist clinician will struggle to make an immediate difference if there isn’t support the rest of the time. What is done with the other 167 hours is crucial. In that time the young people need to build trust through consistency in their lives.
So, those spending most of the time with the young person, whether a family member, carer, schoolteacher, or someone else, are the positive influences of change. The systems used by our services need to model that, because if they don’t all they are doing is passing the young people from pillar to post.
Vulnerable young people can often find themselves working with multiple services and agencies. Each one trying to help, but often not in a joined-up way. The young person can find themselves with a tangle of plans which don’t interact or interlink in any way. A sure-fire way to lose the trust of someone is to overwhelm them with chaos when their lives are often chaotic enough already.
Evidence is in the Power of Many
And this, he says, is where the link with the Alliance of Sport comes in. Andrew is clear; the health service, education services and social care services cannot do this alone. Get Well Stay Well pools the knowledge of all these services and associated organisations, giving one voice to gather and disseminate evidence-based learning, to help inform future programmes.
At the moment Andrew feels organisations are forced to just pick at that evidence. Trying to scratch it together on their own. Get Well Stay Well is focused on the whole pathway approach. Not just looking at those already behind walls and in systems but trying to reach them on the path in – before they get behind those walls. And also reaching those coming out, people who are leaving the walls behind but at risk of reoffending. Get Well Stay Well covers both adults and children and young people. We know from listening to adults with lived experience that the access to physical activity and the positive use of this time is fundamental in their rehabilitation and wellbeing.
This sharing of knowledge, centred around a sports and activity led system, says Andrew, will eventually reduce the need for the highly specialised services. Freeing up the money from those to be fed into other areas.
More than a job
As someone whose passion for physical activity comes in the form of dance, Andrew found, during Covid, just how important it was to his own life.
Suddenly under more pressure than ever at work but unable to use dance as the outlet he normally would it struck him what a difference it made to his mental and physical wellbeing.
This led to him to supporting a big charity event for the NHS around dance which in turn formed the basis of a charity, which he was managing director for and now continues to support with the trustees.
A meeting of minds
Andrew first met James and Justin, of Alliance of Sport, on the Levelling the Playing Field project. Realising they all work in a similar way; a connection was born. Immediately they began modelling the Get Well Stay Well aims, by constantly feeding knowledge and understanding to each other. Testing what they knew and trying to figure out what they didn’t.
Once NHS England agreed to fund the piece of work around Get Well Stay Well the interaction was really able to take off. It was never about just putting in money and letting others get on with it. Through the relationship Andrew, James and Justin already have, they are able to show other services and organisations the benefits of being a part of knowledge sharing and the immense difference it can and will make.
Join the Get Well Stay Well network
Are you passionate about making a difference in the lives of children, young people, and adults involved with the welfare and justice systems? Do you believe that promoting physical activity, health, and wellbeing can create positive change?
If so, we invite you to join the Get Well Stay Well network. Collaborate with us and government leaders to drive systems change and promote healthier lives and safer communities.