Friday, 15 June 2018

A national focus on the future

I have spent the last couple of days at the national NHS Confederation conference, which was held in Manchester.

This is an annual event, bringing together clinical and managerial leads from health and social care organisations across the country to hear latest policy updates and local developments and to network with colleagues.

I generally try to go to these every couple of years and in recent years, the mood has generally been a bit low.  However, I thought there was a notable difference this year, as the mood was more upbeat and positive.

There has been much in the media about the financial challenges of the NHS and it looks as if this is now being taken seriously at a national level.

Key speakers:
We heard from Jeremy Hunt, Secretary of State for Health and Social Care and Simon Stevens, Chief Executive of NHS England about how this is being taken forward. 

They spoke about how negotiations are well developed on the long-term funding of the NHS and that there is likely to be an announcement in the next week or so, to coincide with the NHS 70th birthday. 

They also spoke about how a long-term plan for the NHS will be developed over the summer through a co-production approach with health and care organisations and the public.

Although it wasn’t clear exactly how this was going to be undertaken, there was a clear intent for there to be another ‘Five/Ten Year Forward View’ or ‘NHS Plan’ by the autumn with clear priorities.

There were also a number of other key messages that are particularly relevant to us and give some clues about what is likely to be in this long term plan.

The importance of mental health services
The importance of mental health and community services was a massive feature of the conference. The importance of mental health as everyone’s business was spoken about in most forums and there was a key note speech and panel debate on the main stage of the conference, for the first time I can remember.

Simon Stevens spoke about mental health forming a key focus of any long term plan, and in particular, highlighted the need to continue improving services and support for children and young people.

Helpfully, he talked about the need to work with wider sectors, including digital platform companies.  This recognised that health and care organisations aren’t able, on their own, to address the needs of children in such an age of complex social media.

Community services supporting out of hospital care:
Simon also stressed the important part that community services play, together with social care and primary care, in supporting out of hospital care.

Interestingly, he spoke about how the term ‘out of hospital’ care is not a great description of the breadth and value of the support and services provided. 

He feels that we need to develop a different language and move beyond referring to services simply as ‘in hospital’ and ‘out of hospital’.  I wholly agree with this as it still tends to view care seen through an acute lens, when we know that the vast majority of people cared for in community settings rarely require hospital care. 

Improving efficiency:
You may have picked up in the national media about the work that Lord Carter has been undertaking on behalf of NHS Improvement to review efficiency, firstly in hospitals, but more recently in mental health and community services.

Over the last 18 months he has been working with a range of mental health and community NHS organisations and his report was published last month.  Click here to access a copy.

This review looked at how mental health and community trusts operate, what ‘good’ looks like, what approaches to improving productivity and efficiency are already in place and what opportunities there are to further build on this. In other words, are we all doing things in the best possible way and what opportunities are there to deliver the best care, at the best cost?

This was a particularly important piece of work and I heard at the conference the key findings and how the learning was being shared.

One particularly impactful finding from this review was that on average (from the organisations they worked with) a community nurse is only able to spend about 88 days in a year on direct patient care. Excluding leave, it seems people have to spend huge amounts of time either travelling, dealing with poor systems for accessing and recording information, or overly bureaucratic admin processes.

Undoubtedly some of this admin and travelling is essential, but it’s also clear that significant work needs to be done to improve systems and to work in new and innovative ways. 

Positively, improvement work is underway on our IT systems; examples include the Paris electronic patient record, the wide scale roll out of mobile working and the use of innovative technology, such as Omnijoin.  You can read a great example of how a service benefited from Omnijoin here.

And I know that we are also doing work to look at the caseloads of our community nurses and our community mental health teams, so this will help identify our own stats. But we will need to find ways of creating more manageable caseloads and more time for direct care if we are to realise the vision for more care in ‘out of hospital’ services.

Staff health and wellbeing:
Given the above, unsurprisingly, discussions about staff health and wellbeing featured largely.  Niall Dickson, Chair of the NHS Confederation, talked about ‘the plug in the workforce being as important as the tap’ – in other words we need to focus as heavily on keeping the people we have, as we do on bringing more people into services.  

This was backed up by Health Education England which highlighted that, despite increasing training for staff across specialities and professions, this increase was being outrun by people leaving the service – and not simply because they were due  to retire. We are losing staff from the NHS because they are making a choice to go.

People who work in health and care are hugely committed and every number in these statistics is a person who has not felt able to continue working for the NHS.

This makes me feel sad at the loss to the NHS of those individuals and for whatever reason has made them feel they need to leave; but also motivated to try and make a difference. And this really emphasises for me the importance of staff health and wellbeing and the challenge to all of us to create a positive working environment.

I have said previously about how important this is to me.  I firmly believe that if we get it right for our staff, we will get it right for the people who use our services. I am passionate about this as a priority. 

As an organisation that has expertise in mental health, we should be better able than most to make a real difference to our staff mental health and wellbeing.

I am really keen to understand why people leave our organisation and would welcome some really open and honest conversations about this.  If we know what the real issues are, we can do our utmost to resolve them.

We already undertake exit interviews with staff who are leaving - however this comes right at the end.  I want us to be having these conversations early on, before staff even consider leaving.

As a starting point I would really like to know what the top three reasons are for people leaving our organisation, so we can start by tackling the big problems. I am more than aware that a significant issue affecting most staff is pressure and demand; and tackling this is a major priority for us.

However, there may be other things we are less aware of.
I have written previously about the work we are doing to better understand our culture and to create a more just and learning culture.  I know some of you will have had the opportunity to attend the workshops we have held or complete the cultural audit survey. I am also just about to write to staff who have expressed an interest in supporting this improvement journey, regarding next steps. 

I will be holding the first meeting of our Cultural Improvement Group in July and staff health and wellbeing will be one of the many conversations we have.  I am really interested in learning how we can create a more positive workplace environment and retain the great staff we have.

Even if you are not involved in the group, I’d still really like to hear your feedback and suggestions for improvement.  You can contact me on 0161 716 3006 or at 

Claire Molloy
Chief Executive

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