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.
