Wednesday, 31 December 2014

New Year, New Challenges, New Opportunities

As we approach the end of 2014 and look forward to 2015, I thought I’d write a blog ahead of the New Year.

I hope everyone who celebrates Christmas enjoyed their seasonal festivities.  Whilst Christmas can be a great time for friends and families to get together, it can also be a struggle for those going through a tough time, bringing back difficult memories or adding to a sense of isolation for some.

Pennine Care is a 24/7, 365 days-a-year provider and many of our staff will have worked over Christmas to ensure those who rely on our services received the care they needed.
I want to acknowledge those staff who keep services operating, whilst Christmas and New Year is taken off by many.  The care we provide is critical for so many people and amongst all the festivities it’s easy for some to forget that NHS staff work day and night throughout the season. So a big thank you and much appreciation to Pennine Care staff and the partner staff we work with.

The NHS England Five Year Forward View
Well it’s been a year (just about) since I took up post as Chief Executive. I have thoroughly enjoyed it and I am grateful for the great support I have had from Trust staff, partner organisations and wider leaders in the NHS. It has been incredibly rewarding, at times really tough, but I am still as pleased and as proud to be doing the job one year on.

If anything, I am more proud than ever. Recently NHS England published its Five Year Forward View and guidance on implementation. If you read this you will see a strong endorsement for the strategy we have been pursuing, with partners, for approaching two years now. 

Here is a snapshot from the Health Service Journal (HSJ) describing the guidance:
The guidance, The Forward View into Action, says those sites chosen to be in the “vanguard” must already have a record of “tangible progress” to new ways of working over the past year and positive relationships between commissioners and providers.
The selected areas will receive investment from the transformation fund, announced earlier this month as part of the chancellor’s autumn statement.
A support programme will be co-developed rapidly with the initial sites which aims to “blend the provision of technical expertise with peer learning, and removal of barriers to change”, the document said.

In particular it says areas must have “realistic ambitions for activity diversion initiatives”.
It added: “Unless and until it is clear that demand has reduced, we strongly advise system resilience groups not to switch off additional winter capacity for urgent and emergency care.”
The guidance was published jointly by NHS England, Monitor, the NHS Trust Development Authority, Public Health England, Health Education England and the Care Quality Commission.

The key new requirements and initiatives set out in the document are:
  • clinical commissioning groups must increase their spend on mental health by at least as much as the increase in their allocation;
  • new commissioning for quality and innovation payments for treatment of sepsis and acute kidney injury, which replaces the requirement to report patient safety thermometer and friends and family trust data, will become part of the national contract;
  • a new CQUIN on improving urgent and emergency care;
  • a “revitalised” national quality board to review the current state of quality of care and barriers to delivery of high quality care;
  • a new workforce advisory board, chaired by Health Education England with senior membership from across the system, to develop a health and care workforce with the skills to support the implementation of new models of care;
  • providers and commissioners to agree plans to make further progress towards seven day working; and
  • CCGs and providers to agree plans to improve antibiotics prescribing in secondary and primary care.
Simon Stevens, chief executive of NHS England, said: “Today we are allocating extra cash for towns, cities and villages across England to help the local NHS meet the rising demands and changing needs of the patients we’re all here to serve.
“Frontline nurses, doctors and other staff are working incredibly hard, including over this holiday period, but with a growing population and an aging population it’s clear the health service can’t just keep running to catch up. Instead we need to begin to radically reshape the way we care for patients, which is why there is such widespread support and enthusiasm for the NHS Five Year Forward View.”

What it means for Pennine Care?

I don’t know whether we will go forward to be part of the ‘vanguard’ schemes. It’s not my decision anymore, and that’s a sign of the progress we have made. We have shifted from the old fashioned ‘sovereignty’ of Foundation Trusts and moved to place-based delivery. So we now work alongside partners and build local service delivery through local partnership boards.

The six towns we work in are each at different stages of development, but in my view there is a common sense of direction.  Therefore, if we were to go forward and submit an expression of interest, it would be a decision made by the partnerships with commissioners.

Who is in these partnerships?  Pennine Care, the local authority or social care provider, the Acute Trust, the third sector and importantly a strong relationship with primary care. We also see partnerships growing to include housing and links to employment.

If the partnerships thought we should submit an expression of interest to be a ‘vanguard’ site, I think we would be in a good position to be selected. The criteria say applications should be from those with a track record of already developing these models of care. NHS England describes these models (in our case) as Multiple Specialty Community Providers, which very much reflects the type of partnerships we have been forming over the last one to two years.

Critically, the models for implementation must demonstrate genuine diversion activity – that is, the diversion of patient care into the community and away from acute trusts. I am pleased, impressed and keen to share the diversion work we have been building for two years. Across the Trust we now provide RAID services (Rapid Assessment Interface and Discharge) or mental health liaison services for the acute hospitals. 

In Trafford, we have developed a community enhanced care service for physical health presentations. Both have been developed where commissioners have really backed schemes to deliver diversion.

Both of these schemes have been evaluated; RAID independently by the University of Chester and the evaluation of the Trafford service has been jointly signed-off by Trafford Clinical Commissioning Group and Pennine Care. 

Both demonstrate significant diversion activity and we intend to share these service models across Greater Manchester and wider. I believe they should form a key foundation for models of care outside of hospital.

I will talk more on service models in future blogs. One key theme amongst all of the above is change; significant change and change at scale. I am pleased to say Pennine Care staff have embraced this challenge and we are making great strides forward to deliver community based redesign of services.

Financial pressures

During the Party Political Conference season, and through lobbying of the political parties and the Department of Health by the NHS Confederation, NHS Providers and many of the Colleges, the financial pressures on the NHS were finally debated. Plus there is additional money being made available.

I personally don’t think additional money will substantially change the £45 million efficiency target Pennine Care has. We still face significant redesign challenges and any money should only pump prime change. We will never be able to shore up the current system; it’s unaffordable and pretty much everyone now agrees that.

However, we have yet to see the money challenge and the NHS Five Year Forward View put together as one clear plan. I think this is work we need to lead locally, as there will never be a top down magic bullet for this challenge. We have to manage redesign plus savings. It’s not ‘do more with less’, as some have said. It is ‘create different with less’ and optimise resources through better partnership working.

In summary the NHS still faces a significant financial challenge and we mustn’t let the forthcoming election cloud our thinking or slow our decision making. Plans and savings still need taking forward.

In the early part of 2015, Pennine Care  will commence large scale engagement with our staff, to discuss, consult and plan together on future challenges. Please do connect with this discussion; it will be our largest ever planned engagement.

I understand that It can be difficult to engage positively with plans for change when these changes lead to worries about job security.
So I thought I would end this blog, where I started my first one a year ago, talking about money, challenges of change and job security, and the risks of redundancies.

When I have been out on service visits over the last few years, questions on job security have been high on the agenda of staff. This is entirely understandable. More than a few years ago, I was always very upbeat as we very rarely made anyone redundant. In the years since then, the levels of savings required has risen and the impact of year on year savings has moved us towards far more redesign and significant changes to services and the jobs our staff do.

Pennine Care’s staff , Staff Side representatives and organisations have worked closely together to deliver these savings year on year. Last year was no exception; we delivered over £7 million of savings (Cost Improvement Plans or CIPs, as they are known in the NHS). Going forward we face more than £8 million of CIPs every year for five years. Who knows, additional investment may soften this - I hope so -  but either way we face a substantial challenge.

£8 million, on average, is the equivalent to around 220 job posts. That means, in theory if we only made the savings through pay, we have to lose 1,000 jobs over 5 years. With redesign you may also need to reduce further to introduce new roles.

In terms of job security, it may make stark reading, but I think we need to take a measured look at this and I hope that by doing so, I can give staff some reassurance.

Firstly, whilst we do have to make these savings, we are committed and determined, along with our Staff Side partners, to keep staff in jobs and avoid redundancies wherever possible.
Each year, we actually lose around 8% of staff a year through turnover (such as
retirement and moving to different jobs), which equates to just under 500 staff. It’s an over simplification but if we didn’t recruit to the posts where people leave we could still recruit 280 staff and achieve the CIP.

So yes, there is a risk we will have to make redundancies due to savings, but as you can see, that risk is very much lessened by natural turnover each year.

The CIPs and the need to change the way we deliver services does mean far reaching change - to achieve £8 million of CIPs will mean formally going through cases for change, consulting on changes to people’s posts, redeployment and yes, at times, redundancy. But against a backdrop of 500 staff going every year, it does make the challenge somewhat more achievable without large scale redundancy.

As I was writing this I thought I would revisit the redundancy figures for 2014/15. We had to make over £7 million of CIPs this year. How many compulsory redundancies did we make?

I agree that’s seven too many, but it’s not 200. We also made 17 redundancies through voluntary agreements. That’s 24 in total, still a much lower figure than you might imagine when first considering the several million pounds worth of CIPs we have to make.

If staff ask me a question on job security on my next service visit, I will say it isn’t like it was. The need for change is ever pressing and the impact on roles from redesign will be there for some time to come. However, there is still a good deal of job security and far more in Pennine Care (where we have stable, well-managed finances) than in some other public sectors and other parts of the NHS.

I hope this gives some assurance to the Trust’s staff and I can give my personal reassurance that we remain determined to keep as many people in work as we possibly can during 2015.

I would hope with relative job security you will engage in the conversations we are planning in the New Year to discuss the challenges ahead. The more engagement we have with staff and the more people contribute their ideas, the more we can lower the risk of redundancies together. That’s because, in my view, we will make the best plans based on the views and thoughts of staff who work in services every day.

I really do hope that gives some reassurance as we move into 2015.

Finally, I would like to thank each and every one of our staff in Pennine Care for all their hard work, commitment and dedication to delivering the best possible patient care in the communities we serve, and wish them all the very best for 2015 - Happy New Year.

Wednesday, 19 November 2014

The importance of the flu jab

Please read this important 'guest' blog from our Medical Director Dr Henry Ticehurst.

As Medical Director for the Trust, I want to reinforce why it is vital for every member of staff to have the flu vaccine.

I had my flu vaccination on October 13. If you haven’t had it yet, this is a message from me to ask you to do so.

The rationale for the vaccination is clear and it has a strong evidence base.

Influenza is a nasty illness and, for normally healthy people, it can confine you to bed for some time. This in itself has massive potential effects on the services we run – we all know it doesn’t take too many colleagues to go off sick before we get in to some real difficulties.  But for those we treat - especially those with long-term conditions, the frail elderly and the young - it can be fatal.

We have a target of 75 per cent staff take-up. This is a national target and, again, it is not an arbitrary target.  It is set to afford our community maximum protection to ensure any spread is contained. So I am asking you to please be one of those 75 per cent.

You have all received details of vaccination sessions in your borough, along with instructions on how to let us know if you receive your vaccinations elsewhere.  

I know you are very busy but I’d urge you to have your flu jab to keep yourself, the people you work with and our service users in the best of health this flu season.

Staff can find more information about the flu campaign, including a list of sessions and a consent form on the intranet here.

So, to summarise, did I have severe side effects? Well, no, because you can’t get flu from the vaccine. A few snuffles, but to be honest I’ve had worse man-flu!
I hope Henry's note will prompt you to get your flu jab if you haven't yet. If you have, thank you, it really does make a difference. And don't forget if you're like me, with a son with asthma and elderly parents, it protects your family too. 

Monday, 3 November 2014

We're right on track - review of the 5YFV

A couple of weeks ago, Simon Stevens, Chief Executive of NHS England, launched the NHS Five Year Forward View (5YFV), setting out a future vision for the NHS, why change is needed, what change might look like and how it can be achieved.

As it happened, the 5YFV was launched on the same day I was working with the Trust's senior leaders on our own strategy, which was both timely and endorsing of the plans we have been working on in recent years.  So I want to highlight areas where the 5YFV chimes with the Pennine Care vision and strategy we launched earlier this year...

“when people do need health services, patients will gain far greater control of their own care – including the option of shared budgets combining health and social care. The 1.4 million full time unpaid carers in England will get new support, and the NHS will become a better partner with voluntary organisations and local communities.”

Across the Trust we are training staff and promoting self-care as a first line intervention.  With My Health, My Community (was formerly the Living Well Academy) we are promoting carers support, developed with them that works for them. In many areas we are growing integration of health and social care delivery.

“the NHS will take decisive steps to break down the barriers in how care is provided between family doctors and hospitals, between physical and mental health, between health and social care. The future will see far more care delivered locally but with some services in specialist centres, organised to support people with multiple health conditions, not just single diseases.”

We continue to roll out Mental Health Matters and Physical Health Matters training to all of our staff. In October, the Trust's Psychological Medicine Team won a national Positive Practice in Mental Health award for its ground breaking psychological services for physical health conditions. We are joining up with hospitals, primary care, social care and the third sector to deliver new ways of operating care services.

“One new option will permit groups of GPs to combine with nurses, other community health services, hospital specialists and perhaps mental health and social care to create integrated out-of-hospital care - the Multi-speciality Community Provider. Early versions of these models are emerging in different parts of the country, but they generally do not yet employ hospital consultants, have admitting rights to hospital beds, run community hospitals or take delegated control of the NHS budget.”

This captures both the partnership board approach we have established in Oldham and the one we are developing in Heywood Middleton and Rochdale. These partnership boards ensure all organisations can make a valued contribution.  At present in these partnerships include community, mental health, GPs and wider primary care, as well as third sector providers and social care. We are also hoping to extend this to include housing associations too.

“A further new option will be the integrated hospital and primary care provider - Primary and Acute Care Systems - combining for the first time general practice and hospital services, similar to the Accountable Care Organisations now developing in other countries too.”

Going forward, Pennine Care will be able to make a positive contribution as a specialist provider of community and mental health solutions as part of developing models of integration.  As a Trust, we are now placed to provide ‘bespoke’ developments and contributions which will differ from town to town.

“Across the NHS, urgent and emergency care services will be redesigned to integrate between A&E departments, GP out-of-hours services, urgent care centres, NHS 111, and ambulance services. Smaller hospitals will have new options to help them remain viable, including forming partnerships with other hospitals further afield, and partnering with specialist hospitals to provide more local services. Midwives will have new options to take charge of the maternity services they offer. The NHS will provide more support for frail older people living in care homes.”

In Trafford the Community Enhanced Care Service is now showing a demonstrated return on investment, generating deflection away from hospital and preventing people from ever reaching the hospital door. The Trust's RAID service (mental health liaison into hospitals) has recently been evaluated and demonstrated significant returns.

“The foundation of NHS care will remain list-based primary care. Given the pressures they are under, we need a ‘new deal’ for GPs. Over the next five years the NHS will invest more in primary care, while stabilising core funding for general practice nationally over the next two years. GP-led Clinical Commissioning Groups will have the option of more control over the wider NHS budget, enabling a shift in investment from acute to primary and community services. The number of GPs in training needs to be increased as fast as possible, with new options to encourage retention.”

In Oldham, the Trust leads the Integrated Provider Hub for mental health investment. As a consequence of GP-led commissioning the Trust has been empowered to shift mental health investment away from hospital-based care.

“In order to support these changes, the national leadership of the NHS will need to act coherently together, and provide meaningful local flexibility in the way payment rules, regulatory requirements and other mechanisms are applied. We will back diverse solutions and local leadership, in place of the distraction of further national structural reorganisation.” 

This is a welcome position for Pennine Care, where we have found top down structural reorganisation could never overcome the need for local solutions delivered from partnership working. The competing demands and different cultures of each stakeholder can only come together through locally determined and committed leadership.

In going forward the Trust intends to continue with its vision and strategy.  As the 5YFV notes there is a ‘broad consensus’ on the direction required; across Pennine Care, between commissioners and providers this is largely in place.  The challenge now is to construct new integrated arrangements within this broadly agreed direction of travel.

What's really good about the 5YFV is that it connects with the 'broad consensus,' leaving you feeling like its speaking to your local work, affirming we are in the right direction. I think we are but we can't be complacent and have to work hard now on translating vision into delivery.

Tuesday, 28 October 2014

A look back at the last year

It was great to take some time to reflect on our achievements from the past year at the Trust’s Annual General Meeting (AGM) earlier this month.  It was my first AGM as Chief Executive and I was really proud of what we have achieved as a Trust.  When you see it all together it really hits home.  

I want to say thank you to all our staff who work tirelessly providing care despite the challenging times we are in, looking after people's mental and physical health and supporting patients, people and families to meet their health and social care needs. 

Nearly six thousand dedicated staff work tirelessly to look after people with health and social care needs. And behind each and every of those contacts is a story of helping somebody young or old, patient or carer, who is vulnerable, in pain, suffering, and in need of our help. The work we do is important and makes a difference - it touches the lives of thousands of people every day. 

Community services highlights 

2013/14 was a highly successful year for our community services.  We secured the contract for Trafford community services and we retained the contract for something like 96% of the community services in Oldham.  These are just two big examples that show time and again that Pennine Care is the partner of choice for Greater Manchester when it comes to running community and mental health services.  It shows a big tick against the work of our staff in the community for their care, compassion and expertise.

Overall it shows a direction of travel to care outside of hospital.  For patients it means your care is more often in your home or closer to your home. We are also building in self-care programmes, educating people on the condition they have.  In my view, care at home is more personal, more dignified and it puts the patient at the centre of their care aiming to empower them to take control in the way care is planned with them.

Mental health highlights 

Because of our long standing background of providing mental health services it means we have a strong connection with communities.  It also means we are psychologically-minded, which is often underestimated in providing good modern healthcare.  I think by and large we provide excellent mental health services and since 2002 when the Trust was formed I believe the care has increased in quality year on year. 

Patients now get more timely care, better access to psychological therapies, reduced waits if you attend A&E, better mental health support on medical wards if you are in hospital with dementia or confusion and if you come into hospital with a mental illness the wards where patients stay are of a much higher quality than 10 years ago.

Keeping care in the community 

Care outside of hospital won’t just happen, we have to make a case for it to happen.  If we are to transform care from long standing pathways that end in hospital, to care pathways that keep people out of hospital we have to be able to demonstrate that what we do works.

Increasingly now we are seeing the metrics, the data that shows we can deflect care away from hospitals and provide care in community settings.

Look at these figures - if you are assessed by our RAID team you are six times less likely to be admitted to an acute hospital.  The University of Chester study on this has shown a potential £3.3 million savings could be realised from the deflected activity.

Similarly, in Trafford where the CCG have invested in an urgent enhanced care team, we are seeing that people are less likely to be admitted, more likely to be cared for outside of hospital, accessing more timely community treatments, and potentially deflecting £1 million of activity away from hospital. 

Better care more cost effective, in or near to people’s homes.

Staff engagement 
We want Pennine Care to be a great place to work. Often we are, sometimes we are not. We have become a better employer but we must do more. Over the last year we have had good close engagement with many of our staff. I’ve tried to live up to my commitment to being open and transparent with a regular blog and tweets.

We have established a new occupational health service with a staff wellbeing service, a more psychologically minded offer for support to our staff. Stress is one of the key reasons for absence from the workplace and we must make sure as a mindful employer we provide the right care and support for our staff doing busy and at times stressful work.

Over the next year we intend to get closer to our staff than ever before.  If we are to meet the challenges ahead we have to work well together, the Board, managers, clinicians, support staff everyone making a contribution to build and deliver plans for our long term future. 

There’s so much to be proud of and many exciting and at times difficult challenges ahead. As your Chief Executive I am proud and grateful for the opportunity to be leading this Trust as we go forward.

This short animation captures some of the key stats and facts about the Trust from last year: 

Thank you. 

Monday, 15 September 2014

Time for an open debate on the future of health and care

In a recent HSJ article, Sir John Oldham was reported as calling on politicians to immediately begin a public debate on the future of funding for health and care services.  To turn up the volume to very loud, there has this week been an unprecedented coming together of health leaders booming for this debate to take place now, in support of the 2015 Challenge Manifesto.

Sir John led an independent commission on whole person care for the Labour Party, which was published in February this year. One of its recommendations was the commissioning of an “independent national conversation”, backed by all political parties that would “recognise the need for a longer term agreement with the people of the country on what health and social care should be, how and where it is delivered, and how it should be paid for”.

The debate has been sparked further by Kate Barker who recently published a report as part of the King’s Fund commission on the future of health and social care, calling for a major expansion of free social care and for councils’ care budgets to be pooled with a “significant” proportion of the NHS budget.

HSJ quoted Sir John as saying: “[the debate] should start now. There’s been enough consensus [about the funding problem].

“We need to make decisions that inevitably this side of an election politicians will be reluctant to [make]. But we need to start that conversation.”

While I wholeheartedly agree with Sir John Oldham's comments, and with the whole person care commission which is informing our strategy, I wonder if he heard the echo of his words after he made his comments? 

I don't think politicians are going to start this debate, however I think the public would welcome it.  They know we have financial challenges and are intelligent and responsible enough to help political leaders make informed judgements on how to address this growing problem. 

Large scale reorganisation to create health and social care organisations would become the project for the next two to five years. The project for the next decade needs to be care outside of hospital, psychologically minded care (vastly underestimated) and promoting self-care and behaviour change in how health is provided. 

This will need driving by policies that act as incentives for care in the community and boldly state hospitals are not health, health is in the communities, some of whom on occasion need hospital care. 

The approach in Tameside is the closest I have seen that is trying to create an integrated care organisation. The initiative is very positive, bold and aims to focus on care outside of hospital and achieve an affordable, coherent health and social care offer. In reality, I still think this will be a number of partners working together under the umbrella of an Integrated Care Organisation (ICO).  

Achieving one clean organisation will be challenging and I believe will always require partners who can make a particular contribution in the mix somewhere. However, initiatives like this should be applauded for taking an open and transparent approach to tackling national issues at a local level. 

However, as I said at the beginning, this debate should be happening at a national and political level.  My concern without the national debate is that we will drift into making reorganisation the goal, and if we do that becomes the project.  

You can shuffle the deck chairs of management but you won't get real change until we steer a very different course for health and social care for the coming decade.

Friday, 12 September 2014

Thank you et Merci Beaucoup

Since I launched my blog back in April, I'm pleased to say that it has now received more than 5,700 views.  Whether that’s a glance through, a thorough read, received well or otherwise - a big thank you for taking the time to read it.

I hope my posts are helpful, especially for staff to keep in touch with my thoughts and where we are up to with current challenges and developments within the Trust.   

I have had mostly very positive feedback on the blog, from emails, comments posted on the blog, twitter and even a chat by the water cooler.  All feedback is welcome and I hope it encourages discussion within teams.

There has only been one or two negative comments, these are still welcome, we can only lead effectively if we hear the good and the not so good.  

These are challenging times and we are having to make changes, save money and at times make redundancies.  I know this can make it difficult and add pressure at work, I am aware of it and one of our strategic goals is for Pennine Care to be a great place to work.  

But as well as talking about these issues on my blog, I also want to use it as a way of highlighting the good work that I see happening around the Trust every day.  Despite the challenges, we mustn't forget to celebrate success.    

I am still really keen to hear your thoughts about the blog - either post a comment, send me a Tweet or email. 


The use of French within this post is my seamless link to talk about the roll out of PARIS, our new digital care record system.  Given we are going through organisational change, pretty much constantly somewhere in the Trust, I am so impressed with how staff have received the new system. 

Despite busy jobs, service changes and increasing demands, when I have met teams everyone has been committed to making the new system work. I think that’s because everyone knows it will improve patient care and ultimately how we work to deliver care. There have been some challenges, glitches and things we haven’t got right and staff have told me when I have visited. We need to hear when things aren't working so we can fix it and learn from it.

I just wanted to say thank you, or merci beaucoup, to all our staff on implementing the new system and for being so welcoming when I have come out to meet teams as they get to grips with the new system.  It's great to see large paper files being closed and consigned to the archives. The system will improve care, provide a platform for mobile working, but it will also surely save thousands upon thousands as we become a paper-light organisation.

Finally, I was really tickled to hear how the Community Mental Health Team at Sudden Resource Centre had launched PARIS in their service. I understand the office was aromatic with the smell of coffee, staff wore stripy Parisian tops, strings of onions around their necks and no doubt one or two "Allo Allo" style accents here and there (younger staff may want to Google Allo Allo or tune into Gold on your TV!). Well done to the team - I’m on the lookout for photographs of your first day with PARIS! 

Monday, 28 July 2014

Rugby League is leading health and wellbeing

We recently held an event at SalfordRed Devils ground in support of the charity, Rugby League Cares (RLC) and the great work of the charitable foundations across rugby league. The event was supported by Pennine Care, the Red Devils Foundation and the One Medical Group.

In Pennine Care, we believe health and wellbeing work is most successful when it is delivered in communities, in ways that make sense to local people. All too often we promote healthy messages, or health professionals tell people to stop smoking, drink less or lose weight, without truly thinking through how hard it can be to stop or change something to improve your health.

Rugby League Cares and the charitable foundations of rugby league’s professional clubs and State of Mind promote health and wellbeing – with a difference. Firstly, they know their communities and their communities know them. It opens doors and rugby league fans will listen to ambassadors from their clubs, maybe more than they would their GP. Secondly, to quote one of the speakers at the event, Professor Alan White, “there’s more to sport than sport”. Sport reaches people and communities in a unique way the NHS could never replicate.

Mike Farrar and Professor White spoke at the event about this. There’s more on sport and health here and here

There is an emerging evidence base for sport and how it promotes physical activity and improves health. We don’t do enough to promote this. It is this link that led me to be interested in working with rugby league partners to bring together the event, which aimed to launch the idea of ‘A Year of Health and Wellbeing in Rugby League’.

I was fortunate enough to open the event with my own personal experience and it went something like this…

“In welcoming everyone today, rather than talking about health policy or the work of the NHS, I just wanted to share a personal reflection on how the great game of rugby league positively influences people’s lives.

This is Mick, known to some as Michael, in the Army he was called Mac. I call him Dad. There he is barbecuing aged 88. Dad’s a lifelong Leeds Rugby League, now Leeds Rhinos, fan. He was at a very famous final in 1968 to see Leeds win a very close game in difficult wet conditions.

As I grew up, from a an early age he would take me to many Leeds games at Headingly and as a tradition we would go on Boxing Day to watch Leeds play at home. Dad’s love of rugby league and many sports rubbed off on me. He would talk about how fit players were and how important it was to look after your health. He encouraged me to be active, to play sport and to play team games. I played rugby through school and beyond. 

I'm convinced that Dad’s love of Leeds rugby league and the sport in general was a key reason I had such a positive experience of sport as young boy and as a young man.

Terry Flannagan, Chair of Rugby League Cares, talks about how people benefit immensely from their experience of rugby league. I definitely did.

The work of Rugby League Cares and the professional clubs’ charities and foundations understand communities, rugby league communities, like the one I grew up in, and they know how to bring the game and its positive image into people's lives to influence and improve health and wellbeing. Their work and their contribution is often unheralded. Hopefully we can shine a light more on their great work.

As Terry says the foundations are champions helping hundreds of thousands of people to lead healthier and wealthier lives. Rugby League Cares, the foundations and the ground breaking mental health work of State of Mind are ambassadors for the game and ambassadors for better health in rugby leagues game and its communities.

Whenever health is mentioned we usually think of the NHS. Health isn't the NHS. Health is something we own, our health and something the NHS plays a part in. But in talking too much about the NHS we talk too little about the difference the foundations, State of Mind and others can make and do make to people's health and wellbeing. Today is about bringing their work to the front more. I believe we the NHS can do more to promote and support their great work and the benefits of that will pay for themselves.

I think we should think of today in two ways, as a celebration of what's already been achieved and as a challenge for 2015 to achieve even more.”

The event went very well and there was a real energy about the possibilities of promoting health through rugby league’s connection with its grassroots communities.

I found something really interesting during the day and the notion has stayed with me since. It links to these lines from my opening welcome; ‘Whenever health is mentioned we usually think of the NHS. Health isn't the NHS.’

A number of people came up to me and said that comment had really struck a chord with them. As one person said to me, “If there’s one message I will take from today it’s that health is my health, not something the NHS will sort out when I get ill, but something for me to look after. I’m responsible for my health and to sort it out before I get a heart attack, not wait for the NHS to fix something after I have one.”

I think we do, all too often, think of health as the NHS. This is symptomatic of the dependency model we have created over many decades. The NHS is a provider of healthcare, to people who need support when their health deteriorates or when we can protect against illness, for example immunisation.

Health isn’t the NHS, it is something we experience, we literally live and breathe it every day. We can’t control our health entirely, some accidents and illnesses can’t be foreseen or prevented, but we can improve our health significantly by taking as much responsibility for it as we can.

In trying to shine a light on Rugby League Cares, the Clubs’ Foundations and State of Mind at this recent event, we made a small attempt to nudge our collective thinking away from health is the NHS. The work of these charities (look them up) is phenomenal and they reach hundreds of thousands of people every year, helping people make better health decisions and get more active. They do a lot for small amounts of investment, so they are good value too.

If we are to provide care outside of hospital, if we are to provide health and wellbeing support that communities engage with, then the solution won’t be the NHS. It has a part to play, a very important role. However, the NHS has to work with and embrace partners and together we have to build a very different health offer. One that gives health back to people and moves it away from the dependency model of the NHS.

Tuesday, 22 July 2014

Leading by example

My latest blog is helped by the Chief Operating Officer at Oldham Clinical Commissioning Group, Denis Gizzi.

Denis doesn’t blog, many say he should, but he does offer great leadership insights.  I was lucky enough to be copied into a note he sent to his staff one Friday afternoon recently.  It neatly described how the CCG had worked with our community services to respond to a family’s concerns about the care provided to their relative. 

It was really well received and I asked him if he’d have any objections to me sharing it. I will let his words speak for themselves, please read below:

“Dear colleagues,

It's been a strange week, but I thought I'd do something I've not done before (and probably won't make a habit of), which is to share a couple of thoughts at the end of a busy week.

You've all heard my mantra on 'time to value' over the last 12 months and I know there is a healthy slice of polite acknowledgement.  Here is a local patient example I’d like to share: 

The family contacts me directly as they are worried and concerned about the lack of care co-ordination following the hospital discharge of a 94 year old gentleman with many co-morbidities.

The CCG team reacts. Clinical advice is sought. Community clinicians are engaged. Mistakes are corrected. Care co-ordination is put in place. The family are understandably anxious. Full assessment and care package in place within a few days.

The family contacts me again.  State 'we had no idea what a CCG was, we now know, the CCG has saved my father’s life.   This may be a little exaggerated, who knows.  What really matters is that 'time to value' has been demonstrated, it is real, it touches people’s lives, and it works because people care about bringing a resolution to an individual's problems as quickly as possible. Time to value? Yes it is very important.

I'm not going to pick out individuals for praise, it's a team effort. Some of these problems were resolved out of standard hours. It is noted and greatly appreciated.

So you see, it's not management mumbo-jumbo, it's what our public expect from us. They want us to make good decisions, act on them, and make change happen quickly. We are getting better at it, but clearly we need to do more.”

I just thought it was a great example of how leaders can show a commitment to staying true to what the public want to see in how we lead their NHS.

Wednesday, 9 July 2014

An eye opening visit to Bury

There are many good reasons to go to Bury - the World Famous Bury Market  or the East Lancashire Steam Railway or the very beautiful Burrs Country Park... but last week I went to Bury for a very good reason, to visit the Bury Community Stroke Team. 

I mention Bury’s well-known tourist attractions such as the World Famous Market because people travel far and wide to visit. Yet when we mention examples of healthcare worth travelling to see, Sweden or USA are often mentioned, but not Bury.

Well, I spent an inspirational afternoon with the Bury Community Stroke Team, managed by Lisa and led by Jo, and it was well worth the short journey up the M66.  As much as I’d welcome a visit to Jönköping or Boston, the Bury Community Stroke Team show we can reach for world class care here in the UK!

The service is a great example of where commissioners and providers have come together to do the right thing for patients - improve care pathways and empower people to manage their own healthcare needs.

Whenever I read about healthcare, plan strategy or visit services, I look for a number of things - a well-led service, clear operational plans and specifications, the promotion of self-care, whole person care and the holy grail of good physical and mental health care combined. 

If I had been playing community stroke service Bingo (that well known pastime!) I would have been shouting ‘house’ after thirty minutes of Jo and her team describing their service: 
  • Did they measure outcomes that could be part of an overall indicator of performance to demonstrate value? Tick - they use EQ5D5L, something I hadn’t known about but understand other community services uses also.  Excellent.
  • Do they promote self-care? Tick - they are running a self-care course and are also developing modules to be run through the Trust's Living Well Academy
  • Technology? Tick – they use Healthtalkonline and Speech and Language Therapists use apps to help people following a stroke.
  • What about the psychological aspects of the community care pathway for stroke? Tick - The team has worked with the Bury psychological therapies team to develop the psychological offer in the overall care pathway. They are now trained in Brief Solution Focused Therapy and Motivational Interviewing and speak positively about whole person care. 

As I said I was inspired and it was a perfect example of how Trusts like Pennine Care are well placed to provide whole person care to our patients. 

I can’t do justice to how impressive this team really is. It’s early days and they are still building the data to measure overall performance, but all the core ingredients are there to deliver a world class service. The team should be rightly proud of themselves and commissioners congratulated for attending to the out of hospital care needs on the stroke pathway.

District nursing visit 

A few days later and I was back in Bury.  I know there are great quality bargains to be grabbed on the market but I didn’t have time to stop unfortunately, as I was visiting one of the district nursing teams for work. Although I’m not sure having the privilege to spend time with dedicated, skilled, professional nurses can really be described as work. 

I spent the morning with Sian, Vicky, Karen and Jo talking about the challenges faced in district nursing services.  I was fortunate to shadow Karen carrying out her clinical duties and talking to her reminded me how complex and demanding the district nursing role is.

In my last blog, I talked about polarities and managing change and within Pennine Care we have recently carried out a district nursing review, involving nurses from all of our boroughs. 

We and system leaders up and down England mustn’t forget that district nurses are busy, skilled professionals who carry out complex, difficult and demanding work. 

As hospitals try to move care outside of hospital and GPs look for support to high levels of demands, where does the care go?  Into community services and often to the district nurse. They can rarely say no to demands, go about their hard work effectively (but often quietly) and make a huge difference to the lives of people who need their care.

The community models of care, especially district nursing, need dedicated thought leadership, investment of time and resources to develop models and an understanding that a district nursing team has the same floors and ceilings of capacity as a ward does. 

We talk about hard truths for ward staffing levelswhich I fully agree with, but it isn’t just wards that have to be safely and effectively staffed, so does the community.

It was a real pleasure to spend time with such a hard working team, not short on ideas on what they feel needs to be done. But I think the NHS system needs to listen more to their voice and not overlook the community filling in the sandwich between primary care and hospitals. 

Friday, 27 June 2014

Opposites attract - listening to everyone's point of view

I have been learning more recently about polarity management.  I probably couldn’t do it justice to try and describe the theory here but it’s a simple concept once you understand it - read here or watch this video

I wanted to write about it as I think it’s key to managing change in a trust like Pennine Care. So I will talk about it as plain as I can, avoiding the theory bit.

If you think about relationships; can opposites attract?  Can a Marmite lover live and dine harmoniously with a Marmite hater (or other reputable yeast based spreads!)? Can a Manchester United fan live happily ever after with a partner who supports the noisy neighbours from over the way?

When I was thinking about this, whether at work or at home, there is always a need to understand someone else’s point of view, likes and dislikes, beliefs and values.  Essentially that’s the theory behind polarity management; you can’t work or live with someone unless people try to understand each other. Relationships don’t work unless there is some give and take.

Equally where someone states their point of view to the exclusion of hearing another’s, this will tend to push people apart. We have all heard the phrase, ‘poles apart’ where two people just can’t agree on some matter or other.

Putting it into practice 
So what does this mean for Pennine Care and how we manage our strategy and work with our staff in future years? This might sound barn door obvious, but we have to listen to and work with the views of our staff.

If as Chief Executive, I continually communicate the need for change, transformation, redesign and improvement but it’s not unreasonable that some staff may ask "what’s wrong with the work I do now?" Often the argument for change can be received as a criticism by those who value what works now.

In a recent workshop with Executive Director colleagues, we looked at the following polarities, or opposites of a type:
  • Change and Continuity
  • Competition and Collaboration
  • Team and Individual
  • Cost and Quality
  • Integration and Specialisation

In these areas, we discussed that there are positives and potential negatives or upside and downside cases.  So in the case for changing something, there are potential benefits, but equally some might argue that maintaining what has worked up to date has benefits. And you could put arguments for and against either change or continuity.

People value different things and if you don’t acknowledge that or understand that, you can frustrate, ignore even lose people in what you are trying to do. The polarities of how people view things are important, it is a tension I believe we should view positively and embrace.

The tension works something like this - if you argue for change with someone who values keeping continuity, you are likely to increase their focus on the negative aspects of change.  If you don’t value what works well now, you are likely to focus on the negatives of things staying the same.

“If it ain’t broke don’t fix it” or ‘Don’t throw the baby out with the bath water” are both phrases which reflect the views people sometimes express when discussing change.

Recognising the good 
So why am I blogging about this? The language of the NHS at present is packed full of change at scale, transformation, significant financial efficiencies, redesign, more generic care work is needed and so on. The financial challenges I discussed in my first blog have introduced a driver for change that is being continually pushed and one that’s often underpinned with claims of inefficiency in the NHS and the need to improve care.

But the more the NHS, leaders and commentators talk predominantly about the need for change, and focus on inefficiency to the exclusion of celebrating the great work that the majority of staff do every day, the more likely staff will be turned off by the prospect of change. Staff will start feel more and more the subject of change, rather than a participant in a dialogue about the future of their service.

And in Pennine Care we need to manage change well and be mindful we don’t throw the baby out with the bath water, or devalue someone’s hard work by talking about how we need to make things better through redesign and efficiency programmes.

I think we do need to change the way we run some services and some change, I anticipate, will be far reaching. However, rather than start with "These services need transforming and we need to save money" I want to start with "What are the really good things we do and how can we use the really good things as a starting point to talk about how we can take services forward?"

It will be challenging as the financial savings are steep. However, we can’t let the financial challenges drive us into making quick decisions on what our plans should be, without talking to staff, our patients and partners first. So we have to include staff and all of our stakeholders in our discussions and engage them in developing the plans to deliver our vision.

I hope this all makes sense. This week I signed off a programme which aims to engage each and every single member of staff in Pennine Care, around 6,000 people, to talk about the future and how together we will move forward. This will begin late summer through to early autumn and will continue throughout the next few years.

Using a range of methods, events, workshops, meetings, social media, intranet forums, we intend to work with our staff to build a shared narrative on future plans. It won’t be easy, there will be lots of different views! We will have to make some difficult decisions. I’m determined though, we will make our plans carefully, in close partnership with our staff and partners. Pennine Care is built by experienced staff who provide great care. We need their views and expertise to inform our future plans.

Comment below or tweet your thoughts to @MichaelMcCourt1

Wednesday, 28 May 2014

30 minutes on transformation and ideas for change

Ok, I have really been struggling to find the time to blog but I keep hearing how valuable people are finding it so thank you for your comments.  

I have just found thirty minutes and I have set myself a task to tell you as much as I can about our transformation programme in that time *closes door and slides down in  chair so no one can see me!*

Last week I spent nearly four hours with the executive team talking about the next phase of our challenge. We have since launched our vision and strategy but now need to work with our staff, service users, carers and partners to talk about the plans we need to develop and put in place… and let’s not forget we also have to find around £45 million of savings over the next five years.

The vision and the strategy are crucial to a successful future but all the plans in the world are meaningless if we don’t lead a well-run organisation now. I like the concept of high reliability organisations, which I think is derived from the aviation industry.  It also has been adopted and applied by many healthcare organisations.

Simply put, it promotes a culture of safety and learning from adverse events. I already think we do this well, but we can do even better and drive out variation and improve standards even more. Given the challenges we face, and the change we will have to go through, keeping this as a priority is key.

Every leader and all staff in Pennine Care have a responsibility to provide safe patient care and we all have a shared responsibility to not only spot problems but to develop solutions together.

A culture of safety means ensuring we are clinically-led. This can be challenging as clinicians, understandably, are often concerned about the impact on quality due to financial savings. Whilst it is challenging I believe the only solution is to work even more closely together and to share the responsibility to find the best plans to take services forward and reduce costs.

I also am of a view that we have to hold an ambition to improve services, even when facing £45 million savings plans. I don’t think we should just assume, give up or accept the notion that this level of savings will make things worse or reduce services. It will change services, yes, but £231 million (the pot left behind) is still a lot of income and we should work together to design a future that makes the best use of this investment.

I’m not wearing rose-coloured spectacles or being blinkered to the challenge, but if we put patients first then we have to drive to deliver the best possible change for them. We can’t change the financial climate we are in but we are in control of our attitude and approach to the challenges we face.

*Half way through the thirty minutes… tick, tick, tick!*  

We also talked about the vision and strategy. I am really pleased we have put together a vision and a strategy, including a plan on a page of our Service Development Strategy. This sets out our overall ambition rather than our detailed plans.  

Therefore, in the last 12 minutes of my 30 minute blog I’ll share some quick thoughts on what each of the transformation programmes could mean.  The transformation programme has seven steps:

Living well
This means promoting self-care and self-management, health literate and empowered patients. If patients can be less reliant on current care systems we may be able to change the way hospitals work and our community-based services are designed.

Living well may mean more care coordination, risk stratification, expert patient programmes and different team make up and skill mix and different provider models to deliver care.

Easy access
Better co-ordinated access is something many patients ask for. In Oldham we are working with Age UK to appoint four ‘Promoting Independence in People (PIP)’ workers, who will help patients to navigate through the system to become empowered in managing their own health and care needs.

This has meant changing our multi-disciplinary teams and having different non-professional workers join from the voluntary sector. It is just one example of how we are doing things differently and better.

Whole person care
I have a view that parity of esteem in mental health means better physical care for people with mental illness, as well as better psychological care for people with physical health conditions. This aspect of a person’s care is still barely featured in models of care.

Cognitive Behavioural Therapy (CBT) or psychoeducation should be a standard aspect of our care pathway for long term conditions and means making sure our staff are more broadly trained.

It also means we need to bring our mental health and community teams closer together, providing integrated care to each patient.

Places that work
Our care should be provided in the homes of people we care for or as close to their homes and families as possible. This means we need to organise services around our local communities and neighbourhoods, not around professional groups or disciplines.

It doesn’t mean losing professional identity, we need strong clinical voices, but delivering locally with primary care, social care and community resources.

Better use of technology
I could write on this alone but I’d rather ask a question - how much does technology play a part in the care you deliver in your team? And do you use the latest technology in your team?

I know the Trust has a responsibility to put this in place and we are doing this with the PARIS clinical system, but do you drive it forward in your teams? How modern are you in your thinking on different ways to deliver care?

I would put forward that rather than digital by design, nurses and health care professionals should be working digitally by prescription. The application of technology should be a common feature of assessing someone’s needs, as you would for wound care or medicine.

Fewer buildings
Buildings are expensive and I’d rather work differently and invest in staff than bricks and mortar. The problem is buildings are also a hard habit to give up, but we have to reduce the cost of office space.

Where we have buildings we should open them up to communities and interested groups when we aren’t using them. We often leave an expensive building empty in the evenings and at weekends, when community groups would love to have some space to meet in.

Different ways to deliver care
We have to think broadly what this could mean? Different ways of delivering different aspects of what we do, set up a social enterprise maybe? We have discussed this as one example. Some commissioners have a view that some of our services are uneconomic, I also think we could do some things better at a reduced cost. We have to find ways to deliver better value in some areas.

Bed-based care is a significant cost and some trusts are reducing their bed base. I think we have avoided going any further than our historical changes, for good reasons, but we should still have the conversation and look again.

I could go on and on considering what transformation planning might mean but I have run out of time!  What I will say in closing is that it is critical that we involve patients, carers, staff and stakeholders in developing plans to respond to our challenges, and that we must not lose sight of being a great place to work.  Pennine Care must still engage, recognise and reward our staff for the hard work, dedication and commitment they give every day.

We owe our staff both of those points to support them through the challenges we will face together.

Tweet your thoughts to @MichaelMcCourt1 or comment below. 

Wednesday, 14 May 2014

International Nurses Day - my story

I just thought I’d share my nursing story through the blog, which I drafted for International Nurses Day. 

I joined the NHS as a student nurse in October 1984, aged 18. My reasons for wanting to be a mental health nurse were many, but I have two memories as a child and younger teenager that stand out. I had an aunty with depression and alcohol problems, who we all loved very much. At times she couldn’t always look after her children so well and so my mum did her bit. We also looked after their dog for a while. I can remember just thinking how kind my mum was and how much of a difference her support was making. It made me value the importance of kindness and being caring for others.

A few years later my mum had her own difficulties. She developed depression and agoraphobia. Like my mum a few years before I wanted to do my bit, aged 13 or 14, to help and care for her when she needed support most. My sister and I helped her reduce her medication, spending time with her to reduce her dosage and we gave her lots of positive feedback. Mum really struggled to get out with her experiencing agoraphobia, so I would walk her to work before school (it helped she was a dinner lady at my school!).

I also came up with a plan to help mum build her confidence to go out on her own and so I set her targets to leave the house on her own, first to the nearest lamppost, then to the second, and eventually around the block on her own. A teenage CBT therapist looking back!! And my mum has just got stronger and stronger since then, she still has her challenges but overall she has done brilliant. Importantly, she has developed ways to manage her life and health her way, with a bit of support from others only now and then.

I found being caring in support of mum rewarding and it felt like I was giving her something back for bringing me up in a loving home. As I got older it just felt a natural choice to do something to help others, to join a caring profession.

Now in my current role, I try to never forget the importance of what we do to help and care for others, how important and life making the work can be. We face some tough challenges ahead, I know we must stay close to our values as we work through those challenges. Importantly, as with my mum, we must work with people to empower them to manage their care and be in control of their health.