Liam Palmer: The Interview

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Tara Humphrey interviews Liam Palmer about his outlook on managing Care Homes and hears about the “Five Layers Of Technology.”

Tara Humphrey:

Hi, my name's Tara Humphrey and welcome back to the Business of Healthcare podcast, where I will be sharing interviews and insights from the field of healthcare. The Business of Healthcare podcast is brought to you by THC Primary Care, where we provide operations and project management to primary care networks. If you are a clinical director or a practice manager and your to-do list is growing by the minute and you could do with an extra pair of hands to support you to roll out your network-based contracts and projects, I would love to help you. We also provide consultancy and coaching advice to healthcare business owners and clinical leads looking to take the next step in their career for their business. Come and check us out at www.THCprimarycare.co.uk.

Hi, and welcome back to the Business of Healthcare podcast. I hope you guys are doing well. On this episode, I had the absolute pleasure of speaking with Liam Palmer. Liam is a registered care home manager, he's an author, he is a podcast host, he is a tech advocate and he is such a nice guy. I wanted him on the podcast and you'll hear a funny story of how he finally agreed to come on. In this interview, Liam introduces us to his five layers of technology when supporting care homes and transforming them. We talk about the impact of COVID on him personally and how he manages when everything feels urgent. We talked about his career journey and where he is now and where he hopes to go and how he plans to leverage his experiences. And we had a really good chat around COVID and infection control and the impact of the early days when things were a little bit uncertain and how Liam was making decisions that had huge consequences if he made the wrong call.

I absolutely loved it. I really, really, really enjoyed it. I know I say this a lot. I'm so lucky to have the opportunity to speak to my podcast guests and learn. I'm just, I'm buzzing. I'm on cloud nine. Enjoy this episode.

Hi Liam, thank you so much for joining me on the Business of Healthcare podcast. How are you doing?

Liam Palmer:

Really good, Tara. Lovely to join you on this podcast today.

Tara Humphrey:

We have to start with the story around how you came to be on the podcast after my initial rejection.

Liam Palmer:

Oh, that is so mean. Why would you do that?

Tara Humphrey:

I reached out very bravely through a very experienced, well known podcaster, somebody I've seen their stuff online, really respected. Plucked up the courage and was like, "Liam, would you kindly come on my podcast to share with wonderful listeners your expertise?" He's like, no. He's like, "I'm busy." Then it turns out... You listen to Katrina Sheikh's podcast.

Liam Palmer:

That's true, yeah.

Tara Humphrey:

And quite liked it. Then, so he was like, "Oh, actually Tara, I would like to come on." And then he said to me, "I didn't think you'd very nice to talk to."

Liam Palmer:

Tara, how you relay this is just so completely mean and-

Tara Humphrey:

True?

Liam Palmer:

Dismissing. You throw me in the hot water straightaway, that is so unfair. As I recall it, you did reach out. I was very grateful for that and I'm grateful to join you today. Yeah. In my mind, I wasn't sure whether I really fitted the profile of what you were doing, being social care versus more, I don't know how you explain it, this sort of hospital PTT stuff. So I'm not sure if there's a strong fit there.

I do work to death running a Nursing home and writing and podcasting, et cetera, et cetera, so I wasn't sure if it was an obvious fit. Where you say... What was it you just very meanly said there? Assassinated me at the beginning of the intro, which is hilarious. Oh, that's right. That you wouldn't be nice to speak to. No. I didn't mean that at all. No, what I meant was I was slightly, not intimidated, but I wasn't sure we'd get on. I wasn't sure we'd get on. I thought I might be a little bit casual and colloquial for you because you seem very impressive in lots of ways. So I thought that might not work too well.

Tara Humphrey:

Then we spoke and then he was like, oh.

Liam Palmer:

You know, we all make loads of quick decisions, don't we, based on half information and stuff like that. So it was only based on reading your profile, and that was based on looking at the words you used. They were just quite straight, structured. So it was about me not feeling that I might meet your standards. So, it was the other way around.

Tara Humphrey:

It's really good feedback, actually. I definitely take that on board because I think I'm casual and informal and if that's the image I am portraying, I will look at that. All feedback is welcome, but it did make me laugh and we had a really good chat initially, and here we are.

Could you share with our listeners a little bit about who you are and what you do?

Liam Palmer:

Yeah, thanks so much. Just to wrap that up, when I did hear you, as I said to you, didn't I, just to redeem myself slightly, when I did hear you interview Katrina, I gave you all that glowing feedback.

Tara Humphrey:

You did. He was very nice.

Liam Palmer:

About how especially good you were and how you drew out Dr. Katrina, et cetera, et cetera. So I really saw you, so hearing you, I got you. You were excellent. So thank you for giving me another chance.

Tara Humphrey:

Of course.

Liam Palmer:

Thank you. Lovely. Yeah. So thanks so much. I've been in healthcare for about nine years. Prior to that, I was an operations manager, project manager, in distribution, and so across with quite a good understanding about customer service, about how different processes fit together to deliver an outcome. When I first came across, I started a private hospital and I found it very transferable with industry having studied management and various bits. Good standards in industry did transition across the healthcare. Then I moved across to managed care homes for some of the large groups and ended up doing a mixture of interim roles, regional roles for profit and nonprofit retirement villages. It's been good. It's been eye opening.

Right from the beginning when I understood what the families wanted and when I looked at how some of the operations in care homes was a couple of decades behind the best in industry, and so that gave me motivation to eventually start writing a little bit about how we could improve homes a little bit. So, here we are.

Tara Humphrey:

What are you currently working on?

Liam Palmer:

I'm running a 69-bed home in the West Midlands, a well established home, and I'm working on bringing that up to best in class. Best in class is about a fantastic environment.

It's about five layers of technology. It's about great management structures, great HR. It's about a sort of coaching style, high levels of quality. It's the whole... Everything, all the best practice that I've picked up and people that I know that can help me, and basically throwing it at this service in the West Midland. That's my job.

I also write. I've done two or three books and I have a podcast on care quality. In between that, I have some [inaudible 00:09:02] entrepreneurial interests around social care. I obviously have no life whatsoever, but whatever. It works for me.

Tara Humphrey:

You mentioned the five layers of technology. What are those five layers?

Liam Palmer:

In a former life, I was a project manager for 10 years, overseeing a programmer and very interested in how you can use information to connect the dots, connect silos, connect the processes, connect departments, all those things. So I had an interest I suppose, and an understanding of how technology can speed everything up. Obviously, it's got to be the right technology. So yeah, I'm defining how there's lots of great technology out there in social care now and it's not as well known as it might be, which is a pet interest. So I'm defining what those steps are. What we've done is we've put in a layer of tech around the finance. Finance for residents, payroll, managing that well, because obviously that's your financial platform for the business, for the service. Managing that well makes complete sense. It's the first thing that should be looked after because that's about viability and all those important things.

Second part was a nurse call system. We had one, but it was old so we invested significantly to get a best-in-class one which interacts with other pieces of software, which we'll come back to. That's the second piece.The third layer is going to be care monitoring with the use of PDAs, kind of like next-generation care monitoring. There's some fantastic suppliers out there and one I've used a few times, which is really very good. That's coming in in about two months, then we're going to have EMR.

Then level five, six, it could be acoustic monitoring, which is about falls management or it could be a piece of compliance software. Software that tracks your attentions against the CQC, KLOE. There's really some fun you can have with technology, but the trick is to work out a bit of a roadmap because obviously you've got to take... Apology to the users of cliches there, but yeah, you've got to take the team with you and often they're not particularly used to technology and leveraging technology. It's like putting in or two pieces at a time, bedding that in, getting people to understand it, embrace it, become our new customer practice, and then adding a new layer and then another layer and another layer. That's what we're doing.

Tara Humphrey:

When you're introducing this technology and just all of the elements and the foundations to improve your clients' care homes, when does the topic of budget come up? They hire you and then you say, "Well, okay, if we're going to, this is and next stage, this is and next stage." My probably naivety makes me feel like care homes don't have lots of funds who invest in these areas, but clearly you're working with some big, big names.

Liam Palmer:

I'd probably reframe that slightly. Well, reframe it. It's just really to give a slightly broader context there. You're right, yeah, for different reasons. First of all, most of the key, or a lot of the key technologies are a pay a regular monthly fee. It's not a 50 grand or 100, or spend 200 grand. It's not like that. If you imaging that a full-time carer is approximately 1,300 to 1,700 a month, depending on what hours they do, something like that. So if you've got a big home and it costs 800 a month, well actually it's less than one full-time carer. So actually, they're not as expensive as you'd think.

Tara Humphrey:

Okay.

Liam Palmer:

Yeah. It's real money, but then with your business hat on, it's all about, what will that mean to the service? You've got several levels, haven't you? You've got running the service in a way that's compliant with the CQC and with high-quality standards, that means you maintain your good rating or beyond, so that helps the business to be viable. That's about compliance, but then also if you run the service better because you're not running around with bits of paper, which is very common in care homes, then arguably the management, the admin, your senior carers, your nurses, whatever, can focus more on the residents, on the lived experience and all the good stuff. So actually, the argument is that if it's right technology, if it's implemented intelligently, it'll improve your service and ultimately improve the financial position of the service indirectly, because it becomes a whole lot easier to run the service, basically.

Tara Humphrey:

Definitely.

Liam Palmer:

Yeah.

Tara Humphrey:

I agree. I think in my world, in primary care, we're always trying to bring new technologies in and I think sometimes it is felt that there's so much technology and every new... Sometimes where we are introducing new roles. So, we're currently talking to a company that provides first contact physio, they've got their platform. Social prescribing have got their platform. There's so much technology, but the right technology, yes, implemented intelligently is amazing, but it does take time. It takes time to get it right.

Liam Palmer:

Yeah. Massively. A couple of peers and I have done a little bit of work about exploring the idea of an online sort of guide in a way to chunk down the different categories of software and to see whether we can help put that together, because it's very, very difficult to A, work out which technologies are out there because of the proliferation and the speed of it, and then to work out within that who is actually good at it.

At the moment, the primary marketing of these technologies is by the suppliers themselves saying, "This is the best technology," which is brilliant. "I honestly believe it. I honestly believe mine is the best." Well, that's great. It's an evolving sector, I suppose you could say. It's not mature yet. The brands aren't well established really, and also the technologies aren't that well established. You've got things like someone with a care monitoring solution will then add a bit of acoustic monitoring, so it's like blended solutions that draw upon two or three different things.

It's quite complex and it's quite difficult for anybody to actually research what's there and to make an objective, qualified decision on what to buy. I think that's partly why prior to COVID and stuff that social care has been a bit slow to take up technology as well. It is speeding up now which is good, but there isn't an agreement on, like I was saying, my take on the five or six layers. There isn't an agreement on where to start, on which of the best technologies. But I guess that's just part of something being new.

Tara Humphrey:

Do you think, given your credibility in this sector, like you've written books, do people look to you? When you released your thought leadership and given the work that you have done, when you put out, "This is my take on the five layers of technology," people listen. Yeah?

Liam Palmer:

I would say it's a bit more nuanced than that. That might be just me. This is highly possible. On the, "Isn't this going great?" spectrum of anecdotes, here's a glowing anecdote and then I'll give you the one that paints me in a far less successful light. On the, "Isn't it going great?" Side, a friend of mine who's a professional social care trainer, Master's degree, fantastically qualified, brilliant, brilliant guy, he's doing an infection control diploma and on his course, he came across my work. He's studying my work as part of his infection control diploma at a reasonably high level, I guess. That's really interesting.

Tara Humphrey:

Yeah. That's so cool.

Liam Palmer:

I'm beating myself up a bit on that one. That felt good. It was a 14-hour article. It took me 14 hours to write. I co-wrote it with... Well, with input from Umesh Prabhu, the NHS director, with an ex-healthcare lawyer and also Josie Winter who's a friend and peer, an infection control specialist. I did an episode with her. So yeah, it was an informed view and it was at the beginning when the outbreak was getting serious and where I was working at the time weren't making good decisions on it and I knew they weren't because I understood about transmission because of the contacts I had. So I wrote that piece.

I didn't enjoy writing because it needed to be accurate. It needed to be clear, so that's why it took so long, but I was really pleased to hear that a year on that's being referred to. So that was really pleasing. Yeah. Quite a lot of the articles I write, some are published through nurses.co.uk, which is a job board and a friend called Matt runs that, and I get some quite good responses on that.

I feel a bit like a sort of recording artist in terms of, you can have a big back catalog and there's some stuff that people like, and then there's loads of stuff that's reasonably average. I kind of see it that way. But if you keep going, sometimes you hit the spot, so that's how I kind of see it.

I wrote those three books. The first two, one's strategy and values. People liked the first book. [inaudible 00:19:39] the second and then the third is about how to do the job, which was what some people told me they wanted to know, so that was moving away from strategy and tell me the fundamental. So, that was a market need that I wrote for. Whereas the first two, I was sharing these quite interesting stories that I wanted to share. The third one was about meeting the market need.

I don't take an influence, the status or anything like that. I don't really do that. I try to create content that will stand the test of time so I don't put out regular... I told you, I'm a little bit of a Luddite with social media. A self-confessed Luddite. Not because I'm not happy with social media, but some articles I've written, I spend a year on one article because I'm trying to tease out what I think the truth is. I'm trying to take those complexities and make them clear. So, some articles have taken me a year and it's only 600 words.

I've accepted that's me. When I put stuff out, I try to make sure it's good. It's well thought through, it's worthy of the viewer or listener's attention. That's my way versus regular tweets and this is what I'm doing, or this is who I am, or this is my cat or this is my dinner for today, or here's my witty quip or something. Nothing wrong with that. Lots of people doing really well. It's nice, it's not being isolated. It's meeting people. That works for loads of people and I'm very supportive of that. It's just not my way. I've just kind of accepted, well, this is my way. So when I do release something, often people will look at it because they know a lot of thought's gone into it. That seems to work for me. But yeah, I don't take that influence or status. I try to give some good material where I can.

Tara Humphrey:

Would you say your career is very well thought out? Given that you've got your books, you've got the podcast, you've got your own business, are you quite strategic in what you do?

Liam Palmer:

Yes, I am, but the outworking of it is like the earlier answer. A bit nuanced. Possibly a bit like you, I'm very driven. I've always been very driven. It's an internal sense of drive about purpose, meaning, contribution, and that sort thing. About doing my best, doing my bit sort of thing. Saying I'm bit intuitive sounds pretentious. I just can't think of a different word, so forgive me. But I tend to have a sense about moving in a particular direction, so that's what I tend to have and then I tend to go that way. After a while, when I look back there's a sense to it, but the sense is not there at the beginning.

Tara Humphrey:

What direction are you currently moving in now?

Liam Palmer:

I think it's leveraging some of the experiences I've had with people I've met with the podcast, some of the experiences running residential services, looking at what the gaps are. Two entrepreneurial interests are creating some qualifications to fill the gaps for registered managers. That's an interest I've had for a couple of years. Done some work on to develop. The other one is to help care providers find out about the great tech that's out there, because that's another way of helping them to create better quality, and quality is what I'm really, really interested in because it's better outcomes for the people that use care services. So that means something to me personally.

I seem to be converging towards those two. The podcasting and writing seems to be blending into one, sort of taking me towards that destination, because it's useful being a registered manager, looking at software or looking at qualifications because you are from within the sector. You get it. So although it's causing me to overwork, I bring a useful perspective to these projects. Not a genius perspective and not a particularly clever perspective, but a useful one.

Tara Humphrey:

Would you ever, or do you see a time when you are not a registered manager, but being a PCN manager? Being a primary care networks manager. At the moment, I have got a three-year vision, but at the moment it is very important to me because there's nothing wrong with advising people or not doing it, but it is important at the moment for me to do it. For me to really understand what it's like on the ground and not give theoretical answers, but there will come a time when I won't do that, but I think I wrestle with, do I need the status? Do I need the title of being the person that actually does it or can I just advise?

Liam Palmer:

Yeah. I totally get that. It's similar to my quandary. I think that the closer you are to the reality of the dynamics involved in running a, managing a service in some way, the more relevant your input is, so that's the bit that we don't want to change because otherwise the brain is such that what we learnt four years ago, unless we've updated it, we assume things are the same and therefore we would assume that our insights are valid, but they're valid based on information from four years ago. So, quite how one stays abreast of that, it could be through... Yeah. You know.

Tara Humphrey:

It's routine, isn't it? You grow your team.

Liam Palmer:

Yeah. I think it's possible, but I'm with you. I'm interested in learning and the bigger picture about how things fit together and stuff like that. I enjoy taking a service and doing something special with it. I see it as almost like art in a way, trying to take a team and really direct. I enjoy that, but actually if I step back from it, I'd make a bigger contribution to the sector by doing it at a slightly bigger level. Bigger in terms of to be able to impact more, rather than putting all my energy into one service. I think it's a natural outworking, isn't it? It's kind of, this is good, but how can I contribute more, type of thing.

Tara Humphrey:

This is like all in good time. There'll be a client or something will happen where you think this is going to be my last, and then move on to the next.

Liam Palmer:

Completely. I think to answer your question directly, yeah. I've done a regional role before and running multiple services is something that beckons within my current role, but yeah. I think being a register manager is good, but you are effectively on call 365 days. I'll even think about, I'm not a big drinker and never have been, but I would think about having more than one drink on any one day, just in case the phone rings and I've got to go in. There's all this, the brain never really switches off because at any one point you've got to get involved.

I have various WhatsApp groups with my layers of managers and heads of departments and stuff like that so I see an input into those seven days because that's part of good communication for me. I don't want do that all the time. I'm happy to put all my energy into the service of what I'm doing because it's just me. It's not a big lot of people at home. There's no kids to look after, et cetera, et cetera. I'm good with that, but yeah. I'd like to at some point have a bit more space for non-work.

Tara Humphrey:

You mentioned you have a client not making good decisions about infection control when COVID first, when the [crosstalk 00:28:27] first happened.

Liam Palmer:

That's true. That's true.

Tara Humphrey:

What is going through your mind and how do you try to influence your client to make better decisions when the consequence is so serious?

Liam Palmer:

This was a very delicate and difficult matter. This is where being a registered manager, sometimes you've got to follow conscience and you've got to step up and be the bigger person and really weigh risks to the residents, to yourself, to the service, and really look where it's all going to go and take a qualified view. This was really difficult with a particular organization whose forte was not care homes. Good people, decent people, well-meaning people. They were struggling to... I mean, they were following the government advice, but the government in those early days we all know in retrospect didn't know what they were doing because they didn't really understand about transmission. I did only because I had some people advising me who were nurses and clinicians, so I was really fortunate to understand what the real issues were because it wasn't what was going out in the media.

So I understood that and so we had this difficulty where I was a couple of layers below the chief decision maker. The decision maker was actually making wrong decisions based on transmission because they didn't really understand it, but they were following the government.

Tara Humphrey:

Okay.

Liam Palmer:

So, we're in this difficult place. What it came down to, it came down to someone who was suspected of having COVID who worked in the service I was overseeing. She was on shift, she went home and appeared to have COVID symptoms. So the question was, did she potentially transmit that to the staff she worked with during the shift? And if she did, then those people should be isolated, which is what happens now [crosstalk 00:30:33]. But at the time, that bit wasn't clear. So what the employer was saying is, "Whoa! You can't take those off. What about my bill? What about the agency? What about this? What about that?" But obviously, the transmission doesn't care about such things.

Tara Humphrey:

Yeah.

Liam Palmer:

We had all these vulnerable older people at this service and it was a kind of, within an hour I needed to take a view as to, do I follow the client and staying with them and follow their instructions and XYZ, but then wait a minute. If I don't follow them and it goes wrong... So I played it through in my head. I also talked to this nurse I was working with and I played it through. So I thought, well, if we get it wrong, if there has been transmission, we don't isolate those people, there's a risk that an older person in the service could die because of COVID. So, what will happen there?

This is based on using your imagination to play it forward, right? That happens. A year or two later, it's in a court. Why did that go wrong? Why did that happen? X, Y, Z. The main things that would be discussed would be the organization saying, "You don't need to do that." But then if it goes in front of a judge, the judge could say, "Well okay, the organization said that, but they're not specialists in care. Liam. You are. I can see you are because you've got books on it. You've worked in lots of services."

So in this instance, the authority and the expert was you and not the employer. So if the employer didn't know what they were doing, they asked you to do this, why did you go along with it? Why did you not do what was safe, according to what you understand with your level five, dah dah dah dah?

I thought if we played that one out, I did know. So why did I follow the client rather than what I know? So I thought it's just not going to end well. Who's going to be blamed at the end? The employer could say, "Well, we didn't say that," or, "Actually, we're not the experts." So I just thought in the end, I might get blamed for it, basically, and I could have the death of a person on my hands and a court case in two years' time to explain what happened in that hour. Which way are you going to go? So I thought, do you know what? I'm going to do the right thing, according to good clinical practice.

The Nurses were 100% clear. That what you do is you lock it down and anyone who was in contact with them, you bring out of the picture. That is an established and understood protocol. So, I decided follow the wisdom of the clinicians and to not follow the employer. We had a bit of a difference, let's say. Some months later, obviously the government agreed to pay for people going off, and then they said, "Oh, we didn't mind." But at the time they really did mind because it was like, I had sent people home without authorization.

Tara Humphrey:

Okay.

Liam Palmer:

But at the end of the day it's my reputation. I don't want to cause harm to anybody in my care career that was preventable and so that was the decision I took, but it was a tough one. Yeah. That's why I wrote that article, because it was really hard to work out what was right and wrong with this COVID. Legally, you need to follow the government, but what if the government is behind the curve on good practice, which in retrospect it was. So in the end, I think my responsibility was to follow good practice, which was over and above the government's guidelines.

Tara Humphrey:

This may sound like a silly question and you don't have to be an expert in something to set up the business, but it's interesting that you've mentioned your employer or the employers will say, "Yes, I own the care home, but I'm not the specialist." What backgrounds do your clients come from? I know you can't speak for them, but is setting up a care home really, really profitable? Why would somebody go into it if they didn't have that expertise?

Liam Palmer:

It's a complex question. I think in the old days... Not in the old days, but going back five, 10, 15 years, certainly 10 years, care homes a bit of a cash cow, basically. Now that some national minimum wage has gone up, which is really positive for all the people who are recipients to that, but from a cost control perspective, it's really put up staff costs massively without the accompanying fee increases. So, what was a cash cow for a simple care home to have local authority, funded residents, people could make quite good money out of that. The owners could. But now that the minimum wage has gone up so much without accompanying fee increases, it's not easy to make money from it. Also, the CQC is a lot stricter in how it's supplying the KLOEs.

In lots of ways, running care homes is not an amateurs game anymore, I would say, or it's becoming that way. Nevertheless, there's a sort of romantic appeal I think for organizations and individuals to run a care home. I mean, certainly from my perspective, I have chosen to spend my time working with older people in care homes. They're obviously a very big market. It's especially rewarding. There's something, it's a cliche, something magic about it, something special about it. Being with people in their last few years and being able to be part of that as a job, despite a complex compliance environment and various things, it's still pretty good. It's something nice, something special, especially if you get it right. I understand the appeal. If someone's owned a care home, they like it and want to own a few more. There's also this belief that they're a rock solid investment.

I think with those cost differences, not necessarily. Nurses, for example, the wages gone up from 11, 12 pounds an hour to 18, 19, 20 pounds an hour. So if you've got a nursing home, your wage bill has gone up massively. So there's lots of things that compound it that make it less attractive. However, it's a very, very popular asset class. Lots of people still want to get into them. Still want to buy them, still want to run them. It's still considered to be very attractive.

Tara Humphrey:

Interesting. You mentioned obviously, you like to work, very ambitious. COVID has been tremendous for everybody. How have you personally manage being on call all of the time? Everyone's had to manage things they've never managed before and a question that keeps coming up is, how do you cope when everything seems urgent? The scenario you just walked us through around the infection control, it's like the decision has such big consequences.

Liam Palmer:

Yeah. It's true.

Tara Humphrey:

How have you personally managed that responsibility?

Liam Palmer:

I feel fortunate that I had input from clinicians at the beginning. This was the missing link. The people who are experts in infection control are the ones who really understand about transmissions, and COVID is a type of virus which follows the rules of transmission. If you understand that part, you can work out how to protect yourself from COVID. Those people already understood how to frame this problem, but for various reasons, they weren't involved very much in the media and stuff like that, actually advising people. I was really lucky that I found some people to give me some input in the beginning, so that helped.

In those early days, Jan to March and beyond, yeah. For the last year or so, I've been going into a service every day so the whole kind of lockdown blues of working from home and all that hasn't really been my bag. I haven't lacked human contact. I haven't had that difficulty, I suppose. But yeah, in the early days I felt sick with worry every day I was going in. Especially in the earlier part, it was all a bit unpredictable. Just living with that fear of, if I get a decision wrong and someone dies, how am I going to live with it? You know?

Similarly I felt the same responsibility for my staff. I felt very committed and very, my decisions could be make-or-break life or death for them. So, a lot of time talking about that and managing risks, but then again, having studied risks before, which is part of what you do for health and safety and various things, it's really the same principles, but I just spent a lot more time on it.

Yeah, personally I was very worried. A lot of anxiety. At times I felt a bit put upon. Like, how come I've got to go to a service every day and the inspectors don't and the senior managers don't? They're kind of, "Yeah. We believe in you," rah rah from the sidelines, "We're sitting comfortably at home. Good for you, yeah. Rah rah! Oh, I'm not putting myself at risk. Don't be silly!"

That was how it felt at the time. It's just how it felt, really. At the time, there's these very senior people in the organization, creating fireside videos of what they're doing and how their week's been and all that, and I just thought, ridiculous. Why can't you just come to the car park and see how we are? Make sure we've got enough PPEs. For me, where's the leaders? I don't mean about breaching government guidelines or anything like that, but if people really wanted to, they could have provided a bit more support. But then, "Oh, no. Nope. Government says stay at home. I'm staying at home." Nevermind there's all these people going to the services every day.

I felt that was a bit unfair. I think that was my anxiety and fear. You know what I mean? There was that. I think in the last, how long, eight or nine months, yeah. Obviously there's lots of tests every day. I have a morning meeting with my team and we talk infection control every single day and we talk about the controls that are working and not, and reminders. It's just putting a high priority on it and what can we do to make it better, to make it safer. Using separate entrances, more signs, more bins. I kind of look at it as, if you really want to pass a test and the pass mark is 70, you need to aim for 90. Do you know what I mean?Infection control, it follows a set of principles, a set of ways things are. So basically, once you learn what those are, the trick is, how can you ramp up the levels of safety in your service? I've put my focus on that because otherwise I'd be gripped with fear. You know what I mean? So that's my way of coping with the fear and anxiety is to be a doer, be pragmatic and every day, see what I can do to reduce the risk.

Tara Humphrey:

Do you get approached by lots of general managers who want to forge a similar career to you? Do people say to you, "Liam, how have you done it? How do you win business? How have you written these books? How did you get published in X, Y and Z journals?"

Liam Palmer:

I haven't, actually. I think possibly because I've come a different way, because I've not spent my whole career in social care. I've just rocked up and appeared somewhere. Like, who the hell are you? You know? I remember telling you bit this story before we talked one or two times in the prep for the interview. When I wrote the first one or two books, which was stories weaving in about person-centered, empathy, effective leadership, listening, all the good stuff of management I think, and applying it to social care and some of the obvious challenges and limitations within social care. I naively thought, well, these are the gaps, these are some of the problems, these are some of the things social care doesn't do particularly well. Here's some alternative ways of defining that problem and actually overcoming it.

I naively thought that people would actually want that in the higher levels of social care, or some organizations. Put it that way. Whilst some senior-level people agreed with my findings, and I met the CTC head of inspection and my findings were the same as hers, it was [Andrea Sutcliffe 00:44:27] at the time, wonderful lady. So I knew I was on the right track but my naive was thinking that some of these senior people would be looking for that answer. Would be, "Do you know what? We're missing something, we need an answer here." And then secondly, that they'd be willing to listen to little old Liam Palmer who's been in social care for 20 minutes, type of thing. That was a little bit naive on my part because some people worked in social care 20, 30 years, it's kind of, "I know it all so I don't need to listen to you. I've don't it all. I've done every [crosstalk 00:45:08]."

I didn't quite appreciate that. So that's where, as I said, the third book was about meeting the needs of the market. And then with the podcast that I've got, it was not about me and my experiences, which would obviously be a bit potentially egotistic or self-centered, I suppose you could say. It was about learning from people who've who made a significant contribution in leadership or innovation. It's literally me asking, like you're doing, Tara. It's asking some questions and then me shutting up and trying to chunk down the wisdom that they've got.

So yeah, I have some people that admire me and then I have some people that kind of ignore me. Something like that [crosstalk 00:45:58].

Tara Humphrey:

Wow. I thought you were going to say there are some people that hate me.

Liam Palmer:

[crosstalk 00:46:03] cover them as well.

Tara Humphrey:

What does a good day look like for you at work? What needs to align for you to leave work and think, "That was excellent. I love my job"?

Liam Palmer:

I'm fortunate that I've got a nice anecdote for that this week that probably covers that off. A sweet spot, if you will. Yeah. I talked about how we're doing this in the building. I try to bring bit of London style because I'm from the southeast, I lived in London for some time and it's just a star capital, isn't it really? So I wanted to bring a bit of London style and I've done that by trying to bring some cool colors into the care home, to be a bit unexpected. It's not quite what you'd expect. I'm trying to making it like a quirky hotel, a bit interesting, and going against the corporate idea of everything needs to look the same, trying to give it a bit character sort of thing. Following that theme and putting lots and lots of work into choosing colors and all sorts of little details to try and make this a beautiful place to live.

We put a lot of work into turning this bathroom into a hair and beauty salon because in some of the stronger... Well, how can I put it? Some of the private home care groups, they do this magnificently, you know what I mean? So I wanted to bring in some of those ideas into this service here. We did quite a nice job. Again, like a piece of art. We wanted to create something really lovely. On the back wall, we've got this big photograph of Blackpool, which you can buy. You can buy these photos and then they turn it into a little [inaudible 00:47:53], that sort thing. It looks really striking and the lighting's really nice and we've got proper professional hairdresser chairs and the mirrors, the whole thing. It looks very nice.

We had the local media in to come and do an article on us, which is a sense of pride for me, showing the local community what we're doing with this home. The photographer was just blown away with what we were doing, the ethos, because it wasn't what he expected. He was expecting something a bit dour, a bit miserable, a bit, "Oh god, here we go." There's a lot of energy there and positivity and a very high respect for older people. How can we make their life better, their day better? How can we serve them better? That sort of thing. Anyway, the key point was that there was a photo opportunity.

We got one of the beautiful ladies that lives here. We got her in one of the hairdresser chairs, gave her a little magazine to read, and then there's a photo against the backdrop and the caption's going to be, "Waiting for the hair salon to open," which is a couple of weeks away from where it formally opens. What was lovely was that this lady, I think she was 90, she was enjoying all the attention the photographer was giving her and trying out different smiles. It was almost like a modeling shoot and it was really funny. It was so sweet and she came to life. She's had a whole life, she's done everything. Hasn't she?I loved the respect we were giving her that we were... It sounds pretentious, but that valuing the person, put it that way. I was just seeing it.

I've employed a couple of decorators to help me with this vision and one of them is a young chap, about 18, 19, and he doesn't understand the big picture about social care. He's come to help decorate. I pulled him aside and I got him to see it and I said, "Look, can you see what's going on here? This is what it's all about. It's not about the paint and everything. It's all about creating a lovely environment so that these people can have a wonderful time and feel good about living here. That's what everything I'm doing, it's all about this. This is what it's about." That was just a sweet moment.

The photographer got it. I showed him some of the new bedrooms we're doing, which are decent level of hotel type standard. He saw the old ones and then he saw the new ones and he was literally taken aback they were so nice. I thought, great. If someone who's not into social care comes to the building and has that sort of response to what we're doing, then that suggests we're on the right track. Despite the problems of running a care home in a pandemic, and there are significant challenges in the last year, that validated the stress and the strain of the last yeah.

Tara Humphrey:

I love that. Liam, if people want to connect with you, where is the best place to find you?

Liam Palmer:

Probably LinkedIn. Yeah. We've talked about that briefly in as much as I say things I like and things that I don't like, because I'm doing a full-time job. I haven't got time to speak to everyone about their new idea or a new project, but if it's something relevant that I'm working on, then I'm happy to find a bit of time. Always appreciate comments and feedback, and people reaching out, if their work touches what I'm doing.

Tara Humphrey:

Thank you. Thank you so much for joining us. If you like what you hear, I would absolutely love it if you left us an iTunes rating and five-star review. I know many of you give us a shout out on social media, which is lovely to see you guys listening to the podcast. Please come and find us on Twitter at THC Primary Care, on Instagram at THC Primary Care and on LinkedIn, just look for Tara Humphrey. And if you're not subscribed to our newsletter, please do. It's really, really funny. You'll get to hear more insights, more confessions, some tips and tools and a roundup of our activity over the week. So click on it, join the newsletter in the show notes, and I will see you in the next episode.