Friday, 1 December 2017

No more compromises on quality

Over the last few weeks I’ve been hearing some pretty strong messages coming from staff about the pressures they are under, facing increasing demands and a never ending flow of referrals.  From talking with clinical leaders and managers at the planning day last week, I heard lots of examples of where services are stretched too thinly and as a result you aren’t able to provide the safe and high quality levels of care you want to.     

We have very caring and committed staff who want to do their very best for people who use our services and I know you have been very accommodating in trying to stretch services to meet increasing demand. But it is not acceptable for our services to be stretching caseloads beyond their means without this being recognised with additional resources. This isn’t good for our staff, it certainly isn’t good for patients and it hides a fundamental problem of a mismatch between the expectations of our services and available resources. 

So what are we going to do about it? 

As a start, we need to be having a different conversation with our commissioners about what we can provide within the resources we are given, as is starting to happen at a national level about the total funding the NHS has.  We should not be trying to meet greater and greater demand, with an expectation we can continue to provide everything we currently do, if this means we are providing a lesser standard of care.  There should be no more compromises on quality. 

In order to change things, we are beginning to have this conversation with our commissioners about the quality, financing and demands of our services.  We have signaled an intent to agree some clear and fixed standards of quality for all of our services and to co-produce with staff and our commissioners a service offer that ensures we can deliver to these standards. 

This may mean not being able to provide everything we currently do. I know how difficult it is for staff to say ‘no’ when all you want to do is provide care and support to everybody who needs it.  But if it isn’t safe or affects quality, then we are going to have some difficult discussions about a different service offer and what we potentially won’t be able to do. So, agreeing these standards, thresholds and pinch points needs to be a clinically-led discussion, in collaboration with our commissioners, service users and local communities.

As a starting point, we are currently working on putting some quality principles into our contracts for next year for those services that are struggling the most, which includes our mental health wards, district nursing and community mental health teams.  This will provide us with a lever through which to start negotiations about what resources these services need in order to meet demand and provide safe, high quality care.  It also means that staff can be clearer about what is and isn’t acceptable and are empowered to escalate when safety or quality is being impacted.  

These improvements won’t happen overnight, but I want to reassure staff that you have the full support of the Board to address the challenges facing you on the frontline.  We need to support you to get back to providing the very best care you can, without compromise. 

I’d be really interested in hearing your thoughts about this, so do email with any feedback.

Many Thanks

Claire Molloy
Chief Executive 


  1. I think this provides a really clear and strong message of support for staff. Thank you. The block contract type in place for community doesn't seem to have upper/lower tolerances above and below which the income changes as was the case with a contract with Mastercall many years ago to address significant variation in demand.
    regards Julia Garlick

  2. Very positive message and hopefully it will be acted upon by the Commissioners. I have worked in Mental Health for 27 years and I have never experienced a period like we have been going through over the past few years.

  3. It would be interesting to get some feedback about what the commissioners initial response is. It can't all be about targets and numbers.

  4. I believe that in order to support front line services we need to have more cohesive corporate function that is able to demonstrate and evidence clearly the impact of this decision so that our commissioners and board are faced with the information they require to tackle these challenges both in terms of the consequences of this decision and the consequences of not adhering to this decision. I don't believe elements of our corporate services are structured in a way to provide the very best support to our clinical services. Perhaps an overall Exec Director of Corporate Services or maybe for Finance and Performance would help to connect these 2 interlinked areas of work.

  5. This is a really positive message Claire. Even the best staff member can only keep so many plates spinning...

  6. This is like a breath of fresh air, thank you for listening to the frontline staff and acknowledging our concerns around staff and patient safety.
    I await changes to ensure that the service is safe and effective.

  7. Mike Livingstone1 December 2017 at 11:59

    A positive and challenging message that is patient and staff centred. This approach has my full backing as a Board Member and I will strive to make it a reality over time in service of our patients and our fantastic staff.
    Mike Livingstone Non-Executive Director

  8. This is exactly the type of message that's been needed for a long time!

  9. I was very pleased to hear initial communications from Clair about supporting staff so they can do a good job. This has now filled me with more hope for change.

  10. Thanks for your support, it feels as if you have listened to our concerns and worries... hope my manager is as understanding when I cant facilitate all my visits or accept any more referals :-/

  11. Sense prevails at last ! No more forcing a large square peg into a small round hole. Realistic visions will make great changes that will naturally add impetus to the changes that are needed. All layers of the health service needs to take stock , review , pause, keep the great and rebuild the routines and habits that are adding even greater pressures.
    I knew I was right to be hopeful of a new CEO , Claire Malloy I had renewed faith that things could be different when I heard you were coming to Pennine Care , up to now I am not disappointed.
    With all the good will , care and desire to improve quality of patient experience and great leadership based on consultation anything is possible .
    I have loads of ideas that may or may not help and will e mail these to you next week .
    Thank you for your passion and confident direction

  12. Like colleagues above I agree this is a really important and refreshing step forward. I would also like to see us engage more proactively with local politicians as these changes need to link into the wider Devolution agenda and the most cost-effective solutions to many of the issues we face involve improved partnership working. I also agree that there is a need to renegotiate our relationships between operational managers and corporate services to strengthen the Trust's negotiating position.

  13. Thank you for an honest, assertive and compassionate post, Claire. Your realistic, pragmatic approach really comes through, as does your care for staff and patients. It feels like you are facing the challenge alongside us, rather than asking us to continue to step into the unknown!

  14. Maybe it would be productive for our Commissioners to come to down to the "shop floor" to gain a real understanding of the day to day barriers we overcome to support our patients and carers. This was a suggestion early on in the transformation process under taken last year for Heywood, Middleton and Rochdale.

  15. As a non-clinical staff member working on a continually busy, challenging mental health inpatient ward I also welcome your comments in this post. Greater demands for services over the months have significantly increased what was once a manageable work load. I value myself on providing impeccable care in all areas of my work and at the moment I feel this is being compromised. There is a real concern around safety and inevitably mistakes being made.
    These discussions need to happen sooner rather than later, recognised and acted upon otherwise the consequences will be devastating for patients, staff and the Trust.

  16. What a refreshing read. So many services are running on good will of staff to keep afloat and its often felt like community services are cinderella services who need to prop up gaps and do more for less. Its no wonder we struggle to recruit and retain and this in turn means more spend on agency/pressure of £££. We do need to be more like private sector in our approach to contracts and expectations. I look forward to some change to address. Thank you Claire. Frustrated but dedicated of Bury