Listening, sharing and appreciating

I’ve been in listening mode over the last fortnight.

I’ve attended recent sessions about our future strategy position paper with both corporate staff in Trust HQ and community staff from Heywood, Middleton and Rochdale (HMR), where I’ve heard views and concerns. 

I’ve also heard brilliant stories about the results of listening at our Go Engage celebration event. And I’ve been incredibly moved by a powerful and inspirational story at our Board meeting from a teenager on our mental health Horizon Unit in Bury.

While technology has changed the way we work and communicate, nothing beats face-to-face communications in order to really hear someone, understand their issues and respond sensitively and positively.

I heard loud and clear the emotional impact that our future plans have had on community staff in HMR when I met with them this week. They talked about feeling “gutted” and “let down”, because they are so proud of what they have achieved and are anxious not to lose this. 

I acknowledged this and committed to doing everything possible to build in safeguards to not unravel their superb work and positive relationships.  

No-one in the whole system would want that. Their success and the success in all our localities is down to the people working there who have made it happen. And so I am hoping that, regardless of whatever structural changes happen, these staff will still be doing great things in the future whoever they work for.   

At the corporate staff sessions, I saw that people are still digesting the news and wondering what it means for them. I recognise that for these staff they are both impacted by the changes as well as needing to help the organisation enact the changes. 

So the strong commitment and hard work these teams have always shown will be needed now more than ever. I also appreciate, because of the nature of corporate support, that there is less clarity around some things right now. 

They understandably are looking for answers, many of which we don’t have at this early stage. However, we are working through some of the areas you have flagged up where we know we need to give a clear steer such as recruitment to vacant posts and roll out of the electronic patient record. So for now, it’s business as usual but we are expecting to provide clarity in a number of these areas very shortly.  

Like a lot of you, I have personally been impacted by big changes of this sort many times in my NHS career, and have also been responsible for leading and managing such change on numerous occasions. I know how anxiety inducing it can be and although I don’t have all the details and answers yet, it’s important to put myself in your shoes and deliver the sort of open and compassionate leadership you would expect.  

The last couple of weeks have made me think about four things. The power of listening. The power of people. The power of recognition. And the power of hope.

Despite worries about what the changes might mean for people personally, I’ve been really struck by your strong desire to do a good job; and to build on, not lose, the good work you’ve achieved.   Recognising what has been achieved is important. A compliment shows respect, admiration, gratitude, trust, appreciation, and hope. It can lift moods and impact our outlook and it shows that we are valued.

And so it is important over the coming months that we take every opportunity to pay our compliments and to show our thanks and appreciation for what people are doing. There are always plenty of opportunities to do this. 

I was at the launch of our young people’s mental health research unit yesterday where I heard about the great research being undertaken to inform better practice and outcomes for people.I also attended the celebration event for our second cohort of Go Engage staff earlier last week, where I heard about the really innovative engagement work they are doing. Both events were positive ways of recognising and valuing great work and they made me feel inspired and hopeful about the future.

Plus, many congratulations to Rickaia Brown our e-rostering project manager who has just been crowned rising star in the Women in IT Excellence Awards. And also to Dr Sarah Burlinson and Nathan Randles who both won awards last night from the North West division of the Royal College of Psychiatrists. Sarah won 'consultant of the year' and Nathan ‘service user of the year’, which is brilliant.

And talking of hope, my week was really made by a story of hope from a teenager talking about her personal journey and the support she has been receiving from our services. She is just about to leave our Horizon Unit and spoke so eloquently about moving from a dark place where she felt “no-one could fix me’ to her plans to now become a mental health nurse. It was incredibly moving and inspirational. Pain is real, but so too is hope.

Good engagement is needed now more than ever and so too is the sharing of positive stories and praising each other. 

I promise to keep on listening and doing my best to recognise and appreciate your hard work.

Claire

Claire Molloy
Chief Executive

My visit to #Thrive in Rochdale

My week started with a great visit to the #Thrive team in Rochdale. I always hear such positive things about this mental health and wellbeing service for children and young people, but nothing beats visiting a service to really appreciate the benefits it brings to a community.

As well as providing a range of support and activities, such as counselling and online courses, #Thrive helps young people access other types of support, such as sport, drama, music or art, as well as signposting to other mental health services. 

It's a superb example of multi-agency working, with our staff working in partnership with other organisations.

Over the last year, I’ve visited lots of community health services and most of our inpatient mental health wards, but haven’t managed to spend as much time with children’s services. 

This visit was great opportunity to hear more about services for young people and I am intending to try and get out to more of these services over the coming months. In particular, I have heard a lot of great things about the Hope and Horizon units at Fairfield Hospital, Bury, so really want to visit as soon as possible.

I had a long chat with the #Thrive team manager about the potential future strategy, which has given me plenty of food for thought. They are part of community services but, because of the successful integrated model they have for children and young people in Rochdale, they have a strong connectivity with mental health services. 

I knew that staff in this locality had particular concerns about the possible provider split for community and mental health services; many of their staff came to our public board meeting in October when our future strategy position paper was discussed. So, it was good to talk about this on my visit and I am planning on attending a session in Heywood, Middleton and Rochdale to talk to people about their concerns.  

It is clear that the commissioners in Rochdale are very happy with the services we provide and the integrated children’s model is really making a difference. This was reflected in another meeting I had this week with the senior leaders from the clinical commissioning group and local authority in this locality. 

So, we will need to use the next few weeks to explore different scenarios that protect some of the great integration work taking place, not just in Rochdale, but also other localities.

And that’s the genuine purpose behind this engagement period; to hear your views and ideas. As I’ve said before, there does appear to be support from our partners on the overall proposal, so the general main direction of travel is unlikely to change unless we hear a stronger rationale for something different. 

This is the purpose of listening, not just to be sensitive and responsive to your concerns, but to hear specific views about different aspects of the proposal and how it affects different localities, so that these can inform final proposals if possible.

I hope you are all having the chance to feedback, either through the staff engagement sessions which we asked your senior managers to set up, or through other channels such as your line manager or partnership officer.

I know that the proposals are impacting on people in different ways and any big changes of this sort create anxiety and uncertainty, but business as usual must always run strongly alongside any proposed changes. Both are about delivering the best possible care to patients, whether that’s in the here and now or the future. It’s the reason we are all here.

So, once again, thank you for your ongoing engagement and commitment. I do encourage you to take every opportunity to share your views and concerns over the next few weeks and we will ensure we share regular updates through the weekly bulletin that has been established.

Thank you,

Claire

Claire Molloy
Chief executive

Guest blog and announcement on our future (position paper included)

Today our Board had a challenging discussion about our future strategy; one in which we reflected on our previous aspirations and the changing world in which we find ourselves.   

When we took on community services, we had a vision we could make a real difference to people’s lives. By aligning community and mental health services within the same organisation, we felt local people could truly benefit from a 'whole person' service approach; bringing physical and mental health together.

We wanted to showcase the combined impact that these two complementary 'Cinderella' services could make - to support the hospitals buckling under the strain and, mostly importantly, help change lives. We felt that we could provide a local voice and also a safe haven and nurturing environment for our community services.

We have achieved some great things, particularly around children's and older people services, the two ends of life's full spectrum.  Our physical health services benefited from a psychological perspective and vice versa.

But, for a whole host of reasons, we have not been able to fully realise the vision we had for integrated, whole person care.

Now, with the rise of local care organisations (LCOs), we are seeing strong locality ownership for improvement, with a desire for local providers to be very visible and active within borough-based partnerships. 

While people have worked very hard to do this for both mental health and community services, we have struggled to represent all elements of our portfolio with the same strong voice in each LCO.

And that has brought us to today. With a heavy heart, but a huge dose of realism, the recommendations in the position paper on our future strategy were approved by our board this afternoon.  Click here to read our position paper.

As you know, it proposes that we look at community services developing as part of local care organisations and concentrate our efforts on mental health and learning disability services in their widest sense. Allowing both to extend, enhance and fulfil their potential for the benefit of local people in this changing new world.

It was good to see around 30 people in attendance at the board meeting, nearly all of those staff. We opened up the meeting for public questions on our strategy position paper, which included queries about specific services, next steps and possible future providers.

We understand and respect the different emotions that people are feeling, which include disappointment and worries about the future. And we want to always work and behave with complete integrity and compassion. The questions provided an opportunity for us to talk about close partnerships, strong relationships with commissioners and being a strong local alliance member, as the future is about collaboration.  

This is all about people and we talked about our responsibilities as a board to never do anything detrimental to patient care.

While the Board has approved the direction of travel in principle, we need to gather lots of views before our final strategy goes to our board in December.

It's been a journey to get us to this first stage. I hope that the time many services have been with us has been well spent, but accept that this time may be coming to an end.

We should always do the right things for the right reasons, even if it's hard. And that includes acknowledging we might not be the best organisation to continue providing a service.

So, let's keep talking. We want to hear your views and will be putting plans in place to do this. Let's all help shape the future.

Thank you.

Henry

Dr Henry Ticehurst
Medical Director

Guest Blog

It’s 12 months since I joined Pennine Care as Chair, so I thought it was a good time to write a blog.

So much has happened over the last year, with a lot of work on developing our new strategy, culture and the refreshed vision and values to support this. I’ve also had the opportunity to get out and about and visit many different teams, which is without question the best part of my job. I never cease to be impressed, humbled and full of admiration for what you do, day in and day out.

There’s so much more I want to learn about the services you deliver, how your teams work, and the fantastic people that work here.  But I also think it might be helpful to learn some more about me.

So, I’m taking this opportunity to reveal something about myself.

Something personal which has had a huge impact on my life. Something which will hopefully help those who already know me or will meet me soon – and also those who welcome an open and honest message about understanding and respecting everyone as individuals, whatever our challenges.

It’s also important we all feel safe, comfortable and supported if we open up about personal information. Especially when we work for an organisation such as ours.

You see, I’ve been managing a long term health condition whilst holding down a high profile role

Two years ago I had heart failure.

I hate the word 'failure' to describe my living, beating heart, but when I asked another doctor how he'd describe what happened he called it 'heart inadequacy’ which is worse!

Its sometimes easy to forget the psychological impact of a ‘label’, until its ours to wear.

I was visiting Ghana when it happened. I’ve got diabetes and high blood pressure runs in my family, but I started to take a lot of extra medication on this holiday as I was feeling really rotten.

A few days after I returned home, I woke  one morning and was struggling to breathe. It was scary enough for me to visit my GP, and before I knew it I was in an ambulance rushing to the MRI. I was in hospital for 10 days, and the care was amazing. We all know how wonderful the NHS is and how lucky we are to have it.

I now have to take 14 tablets every day, which I find both stressful and tedious. I line them up in pairs, according to their shape – anything to make it feel less of a daily trial.

Only four out of the 14 have side effects, but they are gruelling side-effects and take their toll. That means, especially with sometimes very long days of meetings, that I can struggle.

My mind is fine, it’s just my body that lets me down, but the drugs do mean that I struggle. And it does get me down.

I tell you this in the spirit of openness and caring about the impact it can have on our family, friends and colleagues and so you have more of an understanding about why sometimes I may appear fazed.

I have four children who worry, my son just wants the doctors to ‘fix me’ my eldest daughter practically moved in when I came out of hospital, my middle and youngest daughters worried for some time whenever I went to the GP in case I ended up in A&E again and my adorable grandchildren (6 & 7) worry about me dying.

We also laugh about it though, as there are plenty of funny moments. My relationship with lifts and stairs, and my reaction to being advised to get a ‘blue badge’ are just a couple they tease me about.

Laughing is a good medicine, but one of the best things is that when needed I can indulge in my ‘guilty pleasure’ TV court shows - Judge Judy, People’s Court, Paternity Court and judge Rinder – without feeling I should be ‘up and about’ busying myself all the time.

So, I’ve opened up my ‘weak’ heart to you all. It’s still bursting with pride to be part of our fantastic organisation.   I just want you to know that my passion for and commitment to the Trust is strong and I will work to ensure that I carry out my role effectively.

Thank you for reading.

Evelyn Asante-Mensah MBE
Chair

The best of times, the worst of times

I can’t believe it’s my one year anniversary!

I remember giving a presentation at last year’s annual general meeting (AGM), when I was just two weeks in post as your new chief executive. When I stood up on Wednesday to talk at this year’s AGM I thought; the days can sometimes be long,  but the years are certainly short!

It was good to update a packed house at the AGM on our key developments over the last 12 months and the work we have been doing on developing greater clarity about the future direction of our organisation; strengthening clinical and professional leadership; our partnership working; and some highlights of the many service developments you have been working on over the last year.  It was also an opportunity for openness and honesty about the challenges ahead, within the current climate of increased demand for services and major financial constraints.

The future of Trafford services

I think it is the novel ‘A Tale of Two Cities’ that starts with the line ‘It was the best of times, it was the worst of times’ and this certainly summed up Wednesday, if not life in general at the moment. 

It started in a very tough way, as that morning our board made the very difficult decision to serve notice on our Trafford community services contract. We genuinely believe that this is doing what is best for the people of Trafford, although we completely recognise how hard this will feel for our staff working in that locality.  

While this decision evoked some strong emotions for us, our board is trying to make strategic decisions about where best we can focus as a trust to have the biggest impact and make the greatest difference to patients. We do care, and sometimes the hard decisions have to be made because we care and because we are not prepared to compromise on quality.  

So, while I know there will be a lot of sadness that our journey in Trafford is coming to an end, I think that this decision opens up the opportunity for a more robust debate about the resourcing of community services. 

We want  our community services to have a strong local champion who is positioned to secure the vital resources needed for innovation and improvement. They deserve that, and we believe that letting go might better help them achieve their potential. We are hopeful that this decision will prove a catalyst for a stronger focus on the financial issues within the health economy. 

As I have noted previously, in all the discussions I have been in, the hugely significant and valuable role that community services provide is seen by everyone, and people appreciate that these services depend on the skilled and committed people who deliver them. 

It’s important to remember that, alongside a lot of work that now needs to take place to ensure a smooth and successful transfer, it’s very much business as usual. We have been so grateful for the strong leadership in our Trafford teams and the mature way staff have engaged in this difficult process. I know that they will be continuing to do everything they can to provide good services during the transition and in the future.

In terms of our overall Trust strategy, just a reminder that we are aiming to finalise it by December, and will engage with you in October and November about what this might mean. As I’ve said many times before, I am totally committed to being as upfront with you, as early as possible, about things.

Lifting spirits with our AGM and Cares Awards

While the decision on Trafford was the worst part of Wednesday, the best part was undoubtedly the AGM and the Cares Awards. The theme over this last year has been excellence in challenging times. 

We’re still striving for that of course, but it’s clear that maintaining spirit and resilience is also emerging as an important theme. Your health and wellbeing is vitally important and we need to support you to cope with the day-to-day pressures of working in a fast moving and demanding environment.

I opened up the Cares Awards talking about spirit and resilience. Our motivational speaker Dr Ed Coats, an adventurer and hospital doctor, then made us laugh, gasp and listen in awe as he spoke about resilience during his Antarctica expedition to the South pole – billed as the toughest endurance race on the planet - with James Cracknell and Ben Fogle.

He was inspirational, but then it was a truly inspirational evening all round. The Manchester Survivors' Choir, made up of children and adults directly affected by the Manchester Arena attack, brought a tear to the eye with their rendition of ‘Rise Up’. And the award videos, showcasing the work of our truly fantastic finalists, made our hearts burst with pride. 

Congratulations to all the divisional winners – it was so uplifting to hear your stories and the impact you are having for people you work with. This year I was part of the judging panel choosing the overall winner; we had such a tough time as the quality of the shortlisted services was outstanding. 

But huge congratulations to the Stockport palliative care dementia liaison service team, our overall winners – a tremendous achievement as there were so many gold star finalists.  

It was such a wonderful way to end the day, and as I drove home that night I felt a mixture of pride, optimism and hope. Pride about our staff, optimism that the difficult decisions being made are the right ones for patients and the teams that care for them, and hope about the future. 

I know these are anxious times, but if the spirit and resilience shown over the last year and at our awards is anything to go by, we have incredible people that can help us get through anything.  

Claire Molloy
Chief executive

Our strength lies in our differences not our similarities

I always enjoy getting out and about meeting teams and chatting about what you do and your experiences. It’s not just a great opportunity to see first-hand the superb work taking place, but I always find it a grounding reminder of what it’s all about and why we are here. Its uplifting to see the level of commitment to making a difference. 

I only wish I had the time to fit more visits into my diary as I do enjoy these so much. It's a big patch we cover, as you know, and I sometimes envy how my hospital colleagues can literally pop into wards to say hello on their way to the canteen. It's been especially difficult to be out and about over the last few weeks as I've needed to attend a lot of meetings and events focused on strategic issues such as partnership working, cultural change and the development of our vision and values.

82 year old star in Oldham

All important stuff and very interesting and enjoyable as its core to the changes we are trying to make. But it was really refreshing to visit staff and service users from the Healthy Young Minds and Rehab and High Support teams in Oldham on Monday where I buried an NHS 70^th time capsule in the garden with them, before having a look around. 

One of the stars I met there was Jill Dodge, an 82 year old receptionist who has been working with the team for 14 years. Yes, it’s not a typo – 82 – and full of positive energy! There are some days, like a lot of you I’m sure, when I feel tired and anticipate the relaxation of retirement with hopefulness (some way off yet!). But meeting Jill, such a wonderful bundle of energy, has made me feel inspired and re-energised - I definitely need a spoonful of whatever she has been having!

It’s was so heartening to see how much we value the experience that Jill brings, and I love that we are not seeing age as a barrier to still being able to make a huge contribution to our local communities. Long may that continue.

Equality and diversity concerns

However, we are not getting our approach to diversity right in all areas. 

I was very concerned to see recent figures highlighting that BME staff in this organisation are less likely to be appointed to senior posts and more likely to be subject to formal conduct and disciplinary processes.  This is incredibly worrying information and we really need to understand what sits behind this and to support changes in a positive way.

The Board will shortly be undertaking a development session dedicated to equality and diversity, as we recognise the importance of this area. We are committed to understanding the experience of staff and people who use our services and, most importantly, to taking action to address areas where we know we aren’t yet getting it right.

This will form an important part of our culture work going forward - looking at what kind of organisation we want to ‘be’ and what we see as important and of value to us. And from mine and the Board’s perspective, a diverse and inclusive workforce greatly enriches us and is definitely something to be valued. 

Wiser, positive, better

So, our challenge is to show, through the narrative we tell about what sort of organisation we want to be, and then through behaviours that reflect this, that we value everyone in the organisation. We want every individual to feel able to participate and achieve their potential. I truly believe that a diverse mix of experience, backgrounds and beliefs leads to better discussions, decisions and outcomes for everyone.

Our strength lies in our differences not our similarities. And that strength will help create a wiser, positive, better organisation.

Best wishes,

Claire Molloy
Chief Executive

Shaping our future

Since I joined our organisation last September, I have been forming a picture regarding our longer term direction of travel. One of the key issues coming from staff in the cultural audit and from our partners is that people aren’t clear on Pennine Care’s strategy and the role we want to play in the local care organisations (LCOs) evolving in each of the boroughs we serve. 

In other words, what sort of organisation do we want to be? What contribution should we be making? And what does this mean for where we are going?

So over the last six months or so, we have been doing work to be clearer about our longer term strategy and to ‘refresh’ our organisational narrative. We have been clear that high quality care and support is at the heart of our approach but, as I have indicated previously, we need to consider what this means in the context of the resources we have and the way care models are changing through the LCO work.

This important stream of work on strategy sits alongside work to change the way the organisation is run to create a more positive, enabling culture; as well as getting on and delivering some of the improvement priorities we know we have now, such as safe staffing, strengthening our informatics, and preparing for CQC inspection in the autumn.

Over the last year I have talked about all of these three areas (Strategy; Culture change; Delivery Priorities) but today I wanted to say a little bit more about how we are developing our strategy.

Over the next few months work in this area is really going to ramp up as we are hoping to have a much clearer strategy by the end of December. We are hoping to have a draft by the end of October so that we can use November and December to engage with people on what this might mean and to help shape any final approach.

In order to get to this place, there are three key pieces of work taking place over the next few months:

1. Commissioning intentions - we are working with CCGs and local authorities to confirm their commissioning intentions going forward with regards to community services. The current contracts we hold for our community services technically end in March 2019 (with the exception of Trafford, for which we agreed a contract extension to March 2020). So, we need to have clarity with our commissioners about what role they see us playing in the provision of community services in the future; and consider the best alignment with developing LCOs 
2. Clinical and financial sustainability - we need to complete the work we have been doing with our commissioners over the last six months on service reviews and how best we can match service offers to the resources we collectively have so that we don’t compromise quality and safety. This work is due to come to a conclusion soon and the outcomes will clearly be helping shape decisions about our strategy going forwards
3. Vision and Values - we are also working on reviewing our vision and values. Regardless of what services we deliver, it’s important that we define what kind of organisation we want to be? I put you, our staff at the heart of this, and more work will follow in the coming months to flesh this out

Building on the last point above, I am keen that we move quickly on this work given its importance. During August we will be holding a number of small workshops with people who’ve already been involved in the cultural audit work to help shape our vision and values.

Once we have a first ‘clay pot’ of these, they will be tested out at bigger events with key leaders across the Trust in September, October and November, and in particular, we want our staff in these events to help shape a supporting behaviours framework. This will be followed by a big event in early December to share more widely – so watch this space for details about the events which should be out shortly.

As I mentioned earlier, the overall intent is to use all this work to set a clear strategy for the Trust to be signed off at the December Board meeting.

I acknowledge that for some time there has been rumour and speculation regarding the Trust’s future and this has created anxiety and uncertainty for staff. I am hoping that the process outlined above will help to crystallise our future direction, although I also acknowledge that in doing so, the potential for change itself creates concerns about what it might mean. This is especially the case in Trafford as we have advised staff and partners that we are doing some specific work with partners to explore the options for the future provision of community services in that locality.

I know that what is happening in Trafford, and wider in some of the discussions people are having through LCO development, could create uncertainty about the future for some people. I am committed to being as upfront with you as early as possible about any proposed changes; and open and transparent in engaging with you on our plans for the future as they evolve and develop.

I would like to reassure you that all partners see the valuable role that our services provide. In every discussion I am part of, there is recognition of the hugely significant value our services play; of the immensely committed staff we have; and of our expertise in delivering a broad range of services. All of this means that I am confident we will continue to have an important role and make a positive contribution in the future.

Best wishes,

Claire Molloy
Chief Executive