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.