Friday, 4 April 2014

Improving quality in challenging times

I am often asked ‘why can’t you just use your surplus to make savings and protect services?’  which is a valid question I will try to answer.

The Trust's financial surplus in simple terms is there to both keep the Trust afloat (in the black not the red) and to pay for high cost projects to improve patient care (capital investment).  Our surplus each year is around £2 million and could never cover the level of efficiencies we have to make.  It is a one off sum of money (like money in a savings account), whereas the efficiencies are against spend each and every year (like reducing your outgoings at home). 

Rather than a technical explanation, I will give examples of how the surplus has benefitted staff and patients alike over many years:
  • The excellent ward improvements in Tameside and Stockport, completed in 2013, cost around £7 million, paid for from the Trust’s surplus.
  • PARIS and the roll-out of a modern information system, improving patient information and staff working practices has been funded from the Trusts surplus.
  • We enjoy high levels of maintenance and in-year improvements to our environment funded from the Trust’s surplus.
  • In the next few years we will refit/redesign/refurbish wards in Oldham, this will be funded from the surplus
Compared to 10 years ago, the majority of staff and patients now benefit from being in high quality environments. This couldn’t have been achieved without sound financial management, which is a reason why managing money well is an integral part of delivering excellent care.


Pennine Care isn’t the only Trust making savings, all NHS Trusts have to.  All Councils are having to make savings and very significant reductions in costs.  Commissioners (who buy our services on behalf of the public) are making difficult decisions on priorities in a climate of reducing investment and increasing demand. Everyone across health and social care is working with the challenge of reduced levels of funding and increasing demands for services.

This means commissioners are increasingly concerned with the value they get for each pound they spend, more so now than ever. Providers like Pennine Care, have to make our own efficiencies, under increasing scrutiny.  We have to ask, is the care we deliver the best possible within the most efficient cost envelope?

If commissioners can’t be convinced of the value and productivity of what we provide, there is every chance they will stop buying it, or buy it from someone else. There has never been a more important time than now to be able to demonstrate that what we provide is effective and good value. Commissioners are now guided to use competition to test for value and that’s why we have so much activity around tenders for services we already operate.

Focus on patients and quality

Whilst I didn’t welcome the financial crisis, I very much welcome the patient focused debate that has been generated as a consequence of economic upheaval. Every pound spent has to buy something effective and efficient, and we have to drive out any variation or inefficiency.

I heard a patient story recently, from a daughter about her mum. Mum had had more than one stroke and lived alone, she needed a lot of care to support her. It wasn’t great to hear that the disjointed care was in part delivered by Pennine Care. What was great was how we fixed it once they raised their concerns. Their concerns? Multiple practitioners and agencies going in to provide care to mum, with no one speaking to each other. Disjointed, unproductive and at times unhelpful care. That isn’t efficient or effective.

I use that as an example of where we need to make changes and improvement. I do know that we deliver excellent care more often than not and that staff are hard working. But, in the current climate can we always demonstrate that? Do we communicate it well where we do provide excellent care? I don’t think we do sufficiently.

And that’s where the new vision and strategy will come in, when it is launched this month. It will set out what we believe everyone wants in terms of excellent care, it will describe what we think success will look like, based on what staff and stakeholders have told us.

Whole system change

It’s not just our challenge either. Rob Webster, the new Chief Executive of the NHS Confederation has recently said NHS Chief Executives need to lead outside of their organisations and lead across systems. What he meant by that is that we all now have to look beyond Pennine Care, beyond our usual NHS borders, and form new partnerships to deliver better and more efficient care.

And Pennine Care’s collective challenge in all of this? As every pound spent has to be spent well, we all need to demonstrate that what we provide works and how we deliver it is good value. I’ll write more on that in the future, but that’s why I started blogging about money to acknowledge that the current climate can make things tough. But also to set out that the reality that we must ensure we deliver evidence-based care, consistently and at the most efficient cost possible.

I think the journey we are on is one of improvement and there is the real prospect of exciting change and redesign. It will be challenging but I truly believe care will improve as we work through each step together.

With two posts on money done, next time more on our vision and strategy.


Twitter: @MichaelMcCourt1


  1. Really enjoying the blog posts, so good to see a Chief Exec speaking openly : )

    1. I have to disagree with you. I find very little open speaking in the Chief Exec blog. what exactly does he mean when he says we have to look beyond our borders? beyond the nhs? new partners? does he really mean we have to be prepared for the privatisation that will surely come? If so why did he not say this clearly? He has said nothing at all about the fact that wages for many are slowly diminishing and that many staff have been refused even a 1% pay rise.
      There is so much unsaid in this blog that people on the ground are ignoring it completely. Until chief execs, and the government start to communicate truthfully with the actual facts of what is happening in the NHS nobody will pay any attention.

    2. In agreement with latter post.

  2. I find Mr McCourt's approach to information sharing refreshing to say the least. As a practitioner with over 25 years of experience in providing health care in the community setting I have long been frustrated with the degree of partnership between Health and Social Care. As the financial cuts begin to bite into services we see as a growing trend Social services operating with an approach with directly impacts on our own services. Far from being a partnership which in my view is a figment of imagination and is paid lip service to in meetings, we on the frontline are seeing a relationships with social services decline with patients/clients falling foul of a failing system. I wonder if Mr McCourt has any plans to really address this major issue?

  3. Are you going to address the increasing privatisation?

  4. With the CEO attempting to open up lines of communication and improve readers understanding of financial change and the increasing pressure that this inflicts upon Pennine, it seems odd that there are so many 'anonymous' responses in this short space of time. A culture of openness and honest information flow to me means put your name to it. The whole management chain has to work to support these values and act upon them.. Michael Armstrong, Public Governor ,Trafford.