Friday, 23 December 2016

Merry Christmas and best wishes for 2017

Staff will be aware that I am leaving Pennine Care in the New Year. I have been overwhelmed by the amount of people wishing me good luck and saying they are pleased for me. I have also heard the odd rumour or question as to whether my departure has anything to do with the CQC rating, or had I been positioning myself with the work I have done at a Greater Manchester level. Neither of these are true or accurate and so, having been at Pennine Care and previously Stockport mental health services for 16 years, I wanted to write a blog explaining why I am moving on.

The main feedback I have had following news of my departure is shock that after 16 years I was moving on, given I am seen to be synonymous with Pennine Care. There is also concern as to what this will mean for Pennine Care NHS Foundation Trust. This will be a brief blog in which I hope to address and answer three questions: is my move in anyway related to the Trust’s recent CQC rating? Have I been seeking other opportunities as part of my work at a GM level? What does this mean for the Trust going forward?

Taking each question in turn.

My move is not in any shape or form related to the recent CQC rating of Requires Improvement. I can understand why people might ask the question but there aren’t any links and it worries me that staff, patients or the public might think the recent rating by the CQC was significantly negative, because that just isn’t the case.

The CQC described our rating as a ‘Green’ Requires Improvement. If you read the report and look at the ratings there are many green and good ratings, we can be proud of what we have achieved. I am not trying to downplay the Requires Improvement rating, we must take the concerns raised seriously, I am just trying to provide some balance. Our CAMHS in-patient services were rated outstanding, which is a fantastic achievement, and no services were rated inadequate. Where we do Require Improvement, these are services we are actively supporting. An example of this would be the additional investment into our wards which we secured last year and have done again for 17/18.

Pennine Care’s CCGs have offered to set up a supportive Improvement Board, where we can collectively progress the action plan already in place. This support is very welcome and the CQC felt we should be able to secure an overall Good rating within a relatively short space of time. So there’s much more good news than bad, a lot to be proud of and not a reason to be moving on or be moved on!

Turning to why I am moving on. Staff work tirelessly for this Trust and for me as Chief Executive, so I thought it important to offer a personal explanation as to why I have accepted a new position. To give some context to my decision, over the nine years I was a Director of Operations and the three years I have been Chief Executive, I have been approached on a number of occasions encouraging me to apply for other positions and opportunities. I have always said no as I could never envisage a better opportunity than the one I have here at the Trust. I have loved my work at Pennine Care and am immensely proud to have led the Trust and served the six towns we provide services for. I believe in our strategy and feel we have really achieved a lot together. The Trust has a strong reputation and is viewed positively by the vast majority of stakeholders and those who use our services. We don’t get everything right but we can justifiably stand tall at the dedication of the Trust’s staff to deliver high quality and safe services.

In the last year or two, my profile as Chief Executive has been raised within Greater Manchester but I haven’t pursued this to position myself, as that just isn’t my style. All I want to do each day, and have done since I was a student nurse, is do the best job I can and try to make sure patients get the best care possible. As part of my personal objectives, I have had two in particular that I suspect have led to the opportunity I am going to. Firstly, I was tasked with influencing the Greater Manchester strategic case for health and social care to ensure out of hospital care and mental health featured in the GM strategy. I am pleased to say we definitely influenced themes 1 and 2 of the GM strategy developing (prevention and community services respectively) and we helped ensure mental health has secured its own strategic space. Secondly, during the bid for Manchester’s mental health services (which we didn’t win!) we learned the Trust’s profile and reputation wasn’t high enough. Again I was tasked with making sure the Trust was better positioned in the bid process we were pursuing. We definitely had the Trust’s qualities, values and capability showcased during the bid and received some overwhelmingly positive feedback. That said, we couldn’t compete financially, which I think ultimately left us unable to win the bid.

All of that work shone a light on Pennine Care and the great work we do. It also highlighted in the GM system the style and approach I take as a Chief Executive. Without a long winded explanation, the opportunity in Manchester and my leadership offer seemed the right fit. Once I saw the detail and the potential I have to concede I was unable to resist the challenge.

Third question: what next for Pennine Care NHS Foundation Trust? A change of leader can be unsettling and create some uncertainty. However, a leader is just one person and the Trust succeeds upon the efforts of many. Pennine Care is a valued member of a leadership community across six towns, helping lead the development of Local Care Organisations (LCOs) and as a leader for developing and implementing a mental health strategy. The Trust is valued based on all our collective efforts and this won’t be diminished by my moving on. My personal view is that the Trust has a strong future and the challenge ahead will attract a high quality leader as the next Chief Executive.

I would like to wish everyone a Merry Christmas and for those who don’t celebrate the festive season, a peaceful break and for everyone all the best for 2017.

Finally, a big thank you to all our staff who will be working during the seasonal period. I want to personally acknowledge the work you provide to keep services open 24/7, 365 days a year and the vital support this provides to people with health and social care needs.

Best wishes to everyone and I will blog in the New Year to reflect on the many achievements we have had together over many years, to celebrate the great work of the Trust as I move on to a new challenge.

Thank you,

Wednesday, 23 November 2016

Have your say on our strategy and plans

It’s safe to say that this year has been one of the most challenging yet, both for staff working tirelessly on the frontline and from a strategic point of view. We are continually required to keep delivering safe, effective care, whilst at the same time reducing costs, improving services and ‘transforming’ how we do things. It’s a balancing act and whilst we don’t always get it right, we are managing to achieve this here at Pennine Care. Thanks to the hard work of all of our staff we don’t have any major quality concerns and financially we are still in the black; only a handful of trusts are in this position across the country.

We have updated the Trust’s strategy this year because things have changed so much within health and social care over the last two years and we have to ensure we have a clear focus and direction of travel for Pennine Care.

The work on the strategy has been ongoing throughout this year, building on the numerous staff engagement events and planning held in recent times.

At its highest level, our Trust strategy includes the elements below. Much of this has stayed the same expect the values ‘CARES’ have now replaced the Principles of Care, following a Trust-wide staff engagement exercise this summer. We have also come up with a purpose to describe what we do and slightly updated our organisational goals:
Our offer to the people - give us your views

An important part of the Strategic Plan is our “offer to the people”. This outlines how we provide care to ensure it is a positive experience for patients.

As our staff, patients, their carers and family members, or people living in our communities who may access our services at some stage in their lives, we’d welcome your views on this section in particular.

Have we captured how you want your care to be delivered?
What would you like to see from our teams to demonstrate each of the bullet points?

Please let us know by completing a quick activity sheet, which can be found on our website, or by simply emailing your thoughts and feedback to with the subject ‘strategic plan’.

Over the next five years, Pennine Care will continue to work with staff, partners and our patients, carers and families, to shape and change services to ensure we deliver whole person, place-based care.

Thank you,


Friday, 20 May 2016

Our direction of travel - What does the future look like?

Everyone in Pennine Care will be aware we have our CQC inspection approaching. I have decided not to do a blog on the actual inspection as there has been a lot of communication and engagement on this. What I would say is that overall the process so far has been positive as it’s helped confirm some things we are getting right but it has also provided a lot of learning. If it helps the Trust improve then it’s a good thing.

I wanted to use this blog to talk about the Trust’s strategy for the years ahead. Our strategy is key to patient safety as we can only deliver high quality, safe patient care and provide an excellent patient experience, if we develop and deliver the right strategy for our future service delivery. Overall the direction of travel is away from hospital-based care and providing much more care ‘out of hospital’, to repeat a now well-worn phrase.

The Trust’s vision has been in place for nearly three years now and we have made some excellent strides forward. But what will the future look like? We are currently working hard to develop our new 5-year Strategic Plan, which will need to deliver on the aspirations of the Greater Manchester (GM) strategic plan and the GM mental health strategy, in addition to the six locality plans being developed for the GM towns that we currently serve.

In practice it will mean more services like Butler Green, Saffron Ward, Grange View, the Oldham Urgent Care Alliance, RAID services and enabling resources like the Health and Wellbeing college, being rolled out as a developing standard operating model for community and mental health services that enhance population health and ill-health prevention. In essence that’s what our 5-year Strategic Plan and our strategic objectives for 2016/17 will aim to address, but more on them later. The Health and Social Care Team leading devolution have set the bar for transformation very clearly, notably saying the minimum threshold for investing in new models of care being that they either a) deliver a return on investment of at least £3 for every £1 invested or b) demonstrably improve an individual’s life chances.

We have formally evaluated a number of the services above, with support from a health economics organisation and I am pleased to say they have come out really well. This is thanks to the hard work and innovation of the Trust’s staff. Not only do the above services meet transformation standards they are well valued by the people who use them. As one example, Saffron ward gets great feedback from all stakeholders and it shows a return on investment of more than £3 for every £1 invested. If we were to deliver a Saffron ward service in conjunction with enhanced intermediate care (Butler Green model) and community RAID in a town the return on investment would rise to £9 for every £1 invested. There is a need to make the case for optimal care models to deliver GMs strategic aspirations, this is but one example.

This may come across as just numbers on a page to some rather than a description of care, but the importance of the above is being able to demonstrate that care out-of-hospital, from a quality, safety and health economic perspective is a viable prospect.  This is a fundamental piece of evidence-based work, where previously many patient journeys would lead to a hospital admission, we are showing that care out-of-hospital is not only possible, it’s preferable.

So what next for Pennine Care? Despite delivering great care and our staff continuing to work hard each and every day in challenging circumstances, there remains variation in our models of care and variation in levels of investment. Simply put, we need a strategy now that drives the Trust and partners towards consistent and safe care models for out-of-hospital care. Equally we need a strategy that responds to national and regional mental health strategies to achieve the same principle - consistent models of care.

It is important because we need to make sure people who need health and social care services get the best provision for them, in the right way every time. We also need to consistently provide support that improves life chances. Most importantly, if we are to provide more services out of hospital, with greater co-delivery between community, mental health, primary care and social care services, we need to do it safely. The two Francis inquiries set out concerns that some hospital care was shown to be unsafe and made recommendations to improve patient safety. These reports remain relevant today. However, if we are to shift, as some suggest, 20% of hospital care into community settings, I worry that the next Francis inquiry won’t be around hospitals it will be related to local integrated care organisation arrangements. These are new arrangements, not tried and tested, and rely on effective working between partners - some of whom haven’t worked together before in the ways being proposed. Fortunately we have some good foundations for working well through integrated governance arrangements. In Trafford we have further integrated with council services, I have mentioned the Oldham urgent care alliance, and we are developing closer working with primary care and social care across the Trust, and for those of us with backgrounds in mental health, community mental health teams have been integrated with social care for as long as I can remember. We also have a wide range of partnership working arrangements with third sector organisations, including The Big Life Group and Mind, for example.

In summary, our strategy needs to develop consistent ways of working that provide efficient and effective new models of care and delivers those models safely. Patient safety has to remain paramount within these new ways of working.
So how do we achieve that? I think we need to go through a number of straightforward steps:

      - Restate our strategic goals;
      - Set out clear strategic objectives which aim to deliver against those goals;
      - Consult with staff, those who rely on our services and key stakeholders on those    objectives;
      - Co-produce plans to deliver against them; and
      - Deliver.

I will share our strategic goals below and then set out the objectives. In essence, the Board has agreed five goals and 10 objectives that help us to work towards our vision:

Our vision is to deliver the best care to patients, people and families in our local communities by working effectively with partners, to help people to live well.

We aim to share these goals and objectives with all our key stakeholders and work collaboratively to develop the underpinning programmes of work that will facilitate their delivery throughout the remainder of the year.

From September ’16 to March ’17 we will be engaging with staff and our other stakeholders on the new 5-year Strategic Plan, to ensure that we have identified the right programmes of work that will put Pennine Care at the forefront of community and mental health service delivery and development, within our six towns. I am confident we can manage the challenges ahead. Pennine Care is a successful Trust and we achieve great results with relatively low resources. I know this can be challenging for our staff on a day-to-day basis, but I am hopeful that within our strategy we will start to manage demand and capacity better as system leaders. The first objective below should, over time, create more capacity. You will also see a key objective relates to our staff and for me a significant element of that is our health and wellbeing strategy. This will be published soon but I wanted to stress how important it is that the Trust looks after those who work so hard to deliver the best possible care to patients/service users. In the last year or so we have introduced the emotional wellbeing service, which includes mindfulness sessions (with high numbers utilising this), Schwartz Rounds and we have listened and engaged with staff and your innovative ideas through Spark. These are just examples but underscore the importance of providing valuing staff and ensuring that you are supported to do your jobs well.

The Trust has had five strategic goals since 2006 (if memory serves me right!) and they have remained largely the same. Below is the latest version of the strategic goals. Trust staff should be aware these are included on all IPDR forms so staff can relate to these when setting their own personal objectives.

Trust Strategic Goals
1   -  Put local people and communities first
2   - Provide high quality, whole person care
        - Deliver safe and sustainable services
     - Be a valued partner
     - Be a great place to work

From this year, 2016, through to 2021 these five strategic goals will be implemented through 10 strategic objectives. I have put together a table below to summarise them and a brief note on why I think the objective is important.

Trust Strategic Objectives
The Trust’s strategic objectives for 2016/17 have taken into account key strategic drivers such as the Five Year Forward View and the GM Strategic Plan, along with on-going discussions and feedback from staff, patients, commissioners and other stakeholders. They seek to identify the ten key work streams that will require focused attention during 2016/17 to ensure that the Trust continues to make good progress towards its vision and developing strategy.

1.    Put Local People and communities first
Embed self-care and self-management practice in every service we provide.
There is increasing agreement and emerging evidence that promoting self-care and self-management empowers people to take charge of their own care. I believe informed and in charge individuals will experience better health outcomes. Self-care/self-management also frees up professional capacity .
To use the Trust’s CSR and charity programmes to add value to the prevention agenda in each town.
Greater Manchester has a transformation theme dedicated to population health and ill-health prevention. No one would argue against this yet these services are often the first to be cut and the last to get resources when finances are challenged. By making it an objective for the Trust’s social responsibility agenda, we can start to push upstream with prevention from the very start of our strategic planning.
2.    Provide high quality, whole person care
Develop local models of care, seeking commitment and investment through partnership working
This relates to the need to develop out of hospital care. To achieve this will need value propositions, innovative ideas and proposals to develop community and mental health pathways, that are viable alternatives to hospital care. Importantly, this objective aims to further our position in delivering ‘place based care’ as close to or in people’s own homes. This also requires us to demonstrate success through effective evaluation and reporting.
To devise an organisational structure that better supports LCO (Local Care Organisation) plans and works within each locality, aligned to the GM Strategic Plan.
Our priority has to be developing more care models that work for people outside of hospital. We also need to enhance mental health care across GM and specifically in the towns Pennine Care serves. This will mean working differently and through being a valued partner in any emerging integrated care arrangements, we will make the best possible contribution from our services.
3.    Deliver safe and sustainable services
To ensure that the pre and post-outcomes of the CQC inspection lead to an improvement programme that is embedded throughout the organisation, resulting in higher quality and improved safety of the services we deliver.
This is bit long winded! We need to continue to strive to improve patient care and patient safety. In particular we must ensure patient safety is assured where we make changes to services.
To achieve the financial plan for 2016/17. To develop a longer term (5-year) financial plan.
Delivering on our statutory financial duties means we remain ‘light touch’ from our regulator (NHSI), this gives the Trust the freedom to plan and deliver locally with staff and partners.
4.    Be a valued partner
Work with commissioners to agree a move to bi-lateral contract arrangements
This is a bit technical! It is a reflection that increasingly planning and delivery is through each town, not across a number of towns. Therefore we need to manage our planning and relationships within each of the towns we serve.
Develop and implement place-based models of care and decision-making structures to position Pennine Care as a valued partner in LCO arrangements
This links to the earlier objectives on local care models and in this objective we talk about delivering standard operating models for both community and mental health. As noted earlier, once we have a clearer view on what preferred models of care are we must strive to reduce variation and achieve consistent safe standards of care. It also refers to strengthening support to local leaders.
5.    Be a great place to work
Develop and implement a comprehensive Workforce Plan that meets the aims and requirements of the Integrated Business Plan 2016-2021
It will be our staff who deliver this strategy and therefore we will need a plan wrapped around the workforce, to ensure we have the right numbers of staff, with the right skills, to deliver the plan. This will also link to the strategy and the money and set out the implications of efficiency targets.
Develop and implement a comprehensive organisational development (OD) programme to improve the employee experience
As a Trust we have had an active OD strategy for more than 10 years now and I believe it pays for itself. This is the key objective for supporting our staff and includes the Health and Wellbeing strategy I mentioned earlier.

So there it is, the outline of a five year plan in one table! Reading the objectives back some read better than others but I hope they set out the broad direction of travel for you. It is difficult to summarise a big objective in a few brief words. When we (Pennine Care staff) get together in the coming months we can work through these and make sure we all have a clear and shared understanding. Delivery of our strategy will be not just be with our staff but by our staff so we need your engagement and involvement to make it work. I have said this before but the best developments in Pennine Care have been clinically led, service led, social care led, service user and carer led, that’s a fact. Examples include the Principles of Care, the Compassionate Care strategy, Saffron ward, Butler Green, RAID, our low secure unit Tatton Unit, the list goes on.

One area where I am certain we will see more development nationally is the integration of physical and mental health care. We will be making this a key feature of our standard operating models. We already seek referrals from people with long term illnesses into our IAPT services, as we know good psychological care can improve how someone copes with a lifelong condition (and improve their life chances and their self-care). To this end I think there will be increasing attention on the work Dr Sarah Burlinson leads which has drawn local and national interest. Dr Burlinson provides one of the best examples of clinically led innovation, through her work integrating physical and mental health care. I am sure we will see this work replicated not just in GM but across England as its value becomes better known.

The work of Pennine Care Trust Board is now to put the right support in place to make the strategy work. Critically, as I have said we need to break it down into year on year business plans, locally developed and understood. I look forward to taking this forward with staff and partners in the coming months.

Wednesday, 11 May 2016

The value of coaching

I first discovered coaching in 2005, in my former role as Pennine Care's Director of Operations. I had heard of coaching but never experienced it. I immediately saw the value in coaching and wished I had found it earlier in my career. 

Such was my interest, I trained as a professional coach and mentor and, with colleagues, formed the Trust's coaching service in 2008 (I think).  I am pleased to say the service is still available today and I would encourage staff to use the opportunity to support their work.

Coaching has helped me with a range of things, including developing as a leader, being more effective in my role, planning my career, managing demands, maintaining a work life balance and dealing with complex challenges.  I also used coaching to help me plan and apply for my current role as Chief Executive. Coaching helped me with many things and I have certainly developed positively as a leader and, I think, as a person.

It does require individuals to be opened minded and also to value making time for their personal development.  I think it's worth justifying the time as it has a direct relationship with the quality of care we provide as a Trust.  The better we are in our roles at work the better run the Trust is and, therefore, the better the quality of care is.

I would encourage all staff to consider using coaching and, if I could offer one reflection, you are never too young or too early in your career to seek coaching. 

Coaching empowers leaders to lead well and we need this to be in place at all levels across the Trust.

Pennine Care staff can find out more about coaching opportunities on the intranet.  

Monday, 15 February 2016

Time for actions to speak louder than words

I was briefly interviewed today by @BrekkyAliButts for BBC Radio Manchester’s breakfast show. I answered questions on the report ‘The Mental Health Five Year Forward View’ and the current state of mental health in England and specifically Greater Manchester.

I really welcome the report and will say a little more on that later. While I’m proud of all that we achieve in Pennine Care, it was uncomfortable listening to a long list of sobering facts on where mental health care fails people in our communities.

In 2011 the term ‘Parity of Esteem’ was coined with good intentions to ensure mental health care was on a par with physical care. Since then we have gone backwards in my view.

In 1999 as part of a series of ‘National Service Frameworks (NSF)’, the Government of the day launched a report specifically for mental health, from which new investment followed. Click here to read it. I know from my own personal experience at the time not all allocated funding reached the frontline, but it did lead to an overall improvement in some key areas.

However, the mental health NSF barely reached year five of its 10 year plan.  Since then there has been a series of reports and recommendations, including the arrival of Parity of Esteem in 2011 and a six point mental health strategy.

Yet today’s report talks of years of low prioritisation and chronic underinvestment in recent years. How can mental health maintain such a high profile but not receive the investment this report says is needed?

The public support it, the politicians support it, service users, carers and mental health staff all support it. The evidence is also there (in the report) to demonstrate it makes good economic sense and will improve health inequalities too. So why isn’t it happening?

Overcoming challenges

Back to the questions I faced this morning on BBC Radio Manchester (click here to listen again – forward to around 1.13).  If you listen to this you can hear Alison list example after example of where care isn’t working.

Long waits for certain types of care, people having to leave their local area for acute in-patient care, young people not getting access to the care they need. It just isn’t acceptable in my view. Before discussing the report and what I hope it will mean, I’ll share with you the position regarding Pennine Care.

Across the towns we serve we face challenges not dissimilar to the ones set out in the report. There are relatively low levels of investment in mental health, but I am hoping we are entering better times following this report and a Government commitment to invest in mental health.

I would agree with Paul Farmer (Chair of the Taskforce that has produced the report) that we now need transparency on mental health investment and clarity on where funding will go and how it will be used.

Despite some low levels of funding we do not have some of the challenges reported today; I am proud to say that we don’t send any acute patients out of area to distant hospitals - we didn’t have one episode in the last year and only a few brief instances the year before.

I know this isn’t the case elsewhere in the country. It means Pennine Care staff are working tirelessly to keep people close to their home.  However, the pressures are significant and I can’t thank our staff enough for the work they do day and night.

Maintaining quality in the face of adversity

Despite having to deliver nearly £17m of savings since 2010 I am pleased to be able to note that our overall quality has been maintained and access has improved, for example we do provide 24/7 crisis and liaison psychiatry services to hospitals.

Our 24/7 crisis services operate along an open access model and, unusually, we provide a service to children too. Overall we have increased the total number of patients seen from 32,000 in 2010 to nearly 51,000 in 2015.

We still receive good quality ratings and high scores on our Friends and Family Test, relatively low numbers of complaints and, overall, we provide safe services to the people we care for.

I am pleased that our Healthy Minds Service (psychological therapies) now takes referrals from people with long-term physical health conditions.  I think we are one of the first to actively encourage this and it is an area highlighted in today’s report.

However, this is against a backdrop of staff feeling pressures greater than I have had reported to me before. The reductions in local authority services has really been felt in community mental health teams; the work programme has, in my view, put some vulnerable people with mental illness under unnecessary and inappropriate pressure and the level of therapeutic provision (such as psychological care) can never be high enough within such limited resources.

Having listened to staff and patients over the last year, I am personally working with commissioners to call for more investment in our mental health wards.

Despite these pressures I am very optimistic that this report will make a difference. I am already seeing some very positive commissioning intentions emerging and we are revisiting our mental health strategy in Pennine Care.

The devolution work across health and social care in Greater Manchester (GM) has already made mental health a priority for the city region. Paul Farmer, as chair of the taskforce, has led an honest review, reported a plain view of the reality of the current picture and set out a very pragmatic, meaningful way forward.

Please do read the report - with a national drive and a local GM strategy I am hopeful we will see some real progress.

Overcoming the stumbling blocks

I see only two stumbling blocks to making progress.  The public and politicians recognise and call for more investment, as do those who study the evidence for good mental health care (clearly set out in the report launched today).

The first stumbling block is the overuse of hospital care. Over the last several years the wish of commissioners to invest more in mental health has been blighted by increased hospital costs every year.

Once again the Devolution Strategic Case aims to address this and, without wanting to sound blindly optimistic, in fact I am optimistic! There is a key objective to provide more care out of hospital and mental health has to be a key aspect of this movement.

The second obstacle is more difficult to articulate.  To sum it up I would say the continued presence of stigma prevents mental health achieving the parity that society deserves and needs.

I’ve heard examples of stigma shared with me through conversations high up in health departments and have witnessed it locally myself.  Mental health has been too easy to dismiss or ignore by those who influence policy or determine where investment should fall. 

Unless you’ve experienced mental health stigma yourself, or in your family or friendship circle, unless you’ve worked as a nurse, therapist or a doctor with people and their families, I think there are still large numbers of people who don’t fully understand or appreciate the devastating impact it can have.

The Mental Health Five Year Forward View sets out how you are more likely to experience mental health problems if you are from a vulnerable or marginalised group, or don’t have stable housing or employment.

If you don’t experience these issues on a daily basis, policies can be just words on a page and investment plans numbers on a page. I’m not sure I am capturing this well, but I feel certain that, as a society, or maybe even just in the NHS now, we have an inherent bias towards hospital care and physical disease.

The report today says that next steps require ‘a fresh mindset’ and I would urge everyone to reflect on their own contribution and role in ensuring mental health is a priority.
Stigma is nowhere near what it was when I started nurse training in 1984.  It was appalling 32 years ago. Now we live in much more enlightened and educated times, with members of the public leading the way in calling for better mental health care.

I think it’s time for the NHS to catch up with the public mood and deliver against the excellent report published today. 

It is now time for implementation - where actions will speak louder than words.


Tuesday, 2 February 2016

Time to grasp the nettle

I recently attended a retirement lunch for one of our mental health Clinical Directors and naturally we talked about the challenges ahead at a time where we have the Devolution Manchester Strategic Plan, a GM mental health strategy and a national mental health strategy all emerging. We shared a sense of great optimism, whilst recognising the challenges ahead will be, well, challenging.

It struck me that whilst moving forward, we still need to look back and not forget what we have done well and should celebrate and learn from our achievements but if ever there was a time to grasp the nettle, it’s in 2016.

Working together  

If 2015 was all about strategic development then 2016 should be about implementation.  This year will also be about partnerships and new ways of working together across health and social care.

But if I was to look back, what partnerships have we developed that have taken care forward and what have we implemented to do things differently?  In mental health specifically, what developments can we learn from to inform our plans for the future?

If we are to change the way we deliver health and social care to address the challenges set out in the GM Devolution Strategic Plan, what are the key two or three things we need to do differently in 2016 and beyond?  To achieve difference we have to do different.

Pennine Care launched its whole person care strategy in 2014 and I’m pleased to say that it remains relevant today and reassures me that our ambitions were the right ones.

The NHS England Five Year Forward View talked about a broad consensus on what the future should like for healthcare. Pennine Care’s strategy drew on that, as well as the voice of our staff and those who use our services. The Devolution Strategic Plan endorses much of our strategy but also sets a bigger picture vision and stretch challenge for providers to develop evermore far reaching plans, in partnership with others.

When thinking about partnerships, I look back and can see we knew then it was important that we changed the organisation and started to deliver through 'place and people', not through Pennine Care the ‘Trust’. We have still some way to go but it does mean that over the last two/three years we have been on this journey, we are comfortable working in places, with partners and developing local care organisations together. We bring to the table a strong track record on managing quality, safety, money and large groups of staff, blended locally according to the needs of each town.

Partnerships in practice

For instance in Oldham, we have worked with primary care, social care and voluntary partners to establish an independently chaired Care Consortium.  It was important to bring agencies together to promote innovation and I believe we have delivered some real change.  We are currently undertaking an evaluation of the work and will publish this over the coming weeks.

Around 25% of the Greater Manchester population have a mental health and wellbeing issue and as a GM economy, we spend more than £1bn on long term conditions linked to mental health.  So I feel very enthused about the opportunities to improve mental health care across Greater Manchester.  There are more leaders coming together than ever before and more commitment too.

The three NHS providers responsible for the majority of mental health care in GM are starting to collaborate more, such as across specialist services and supporting the acute mental health pressures facing the city. This has ranged from rapidly opening additional beds, to putting capacity in the system, through to setting up psychiatry liaison services to help with hospital pressures.

In Stockport, we have worked with commissioners and Stockport NHS Foundation Trust to set up a new ground breaking facility, called Saffron Ward.  Saffron provides intermediate care for older people with delirium, who often don’t get the care they need when in hospital. This ward, linked to our RAID services, brings people from the acute hospital setting and provides an integrated care pathway, to provide treatment and care. We have found patients and their families really value this bespoke care, the outcomes are better, older people retain more independence and it has significant financial benefits over the costs to run the service.

Through these examples I hope to show that partnership working has many faces, local partnerships, partnerships with different types of providers and between trusts with common care pathways.  In our recent experience, we have learned to listen, engage and find ways to work with partners that helps everyone feel on board and with a voice to influence how we develop services. This principle of co-production will be key to our future success.

Putting people first

So far I haven’t included the most important partnerships of all… the most significant shift in how we plan, deliver and operate care will be through the partnerships we develop with patients, carers and wider communities. Changing the way we deliver health and social care, will only work if we can change the way people use services and how they look after their own health.

I am very optimistic we can and the work Pennine Care has done through My Health My Community has seen a substantial change in our approach to care. At its heart, MHMC is a living well academy, a self-care resource and a movement towards self-management at scale.  Importantly, the self-care resources and support programmes are entirely co-produced with service users and carers, from ideas, through to development and delivery. 

The NHS has a long standing history of great care, I am proud to be a part of it and my 31 years as a nurse, a leader and now a Chief Executive. However, we have to move away from 'doing to' patients and start working with people and their communities.

As a Trust we know we haven’t got it all right, there is much to do, but for 2016 onwards our staff have partnership working, place-based delivery and whole person care as three key driving principles. Importantly, we can adapt how we work this way wherever and however the local conditions are set. Even more importantly we are changing how we relate to an individual’s care. Across all providers and with all staff, we will need to be both open minded, flexible and progressive as we move forward together.

New models of care and mental health 

The examples I have outlined show how we are developing an alternative narrative to hospital care. Hospitals do great work, but they are busy and under pressure. Local care provider arrangements have to build better and alternative care models to the offer we currently provide. But we can’t just say it needs to happen, we have to make the case for it and demonstrate propositions that we can confidently invest in, knowing it will help reduce hospital pressures and keep people out of hospital-based care.

We must be able to measure, demonstrate and show the benefit over cost of the new care systems we are building and so health economic modelling, such as that undertaken by Pennine Care, is increasingly an integral part of how we plan and implement care.

With new models of care, I still think we underestimate the importance of mental health and how good mental health care can have far reaching benefits. In 2016 we are in a much better place than when I started my psychiatric nurse training in 1984. Back then ‘psychiatric patients’ were viewed negatively, a significant amount of care was provided through large asylums, the media often portrayed people with mental illness as dangerous and talking about your mental health problem was largely still a taboo.

Today, the vast majority of care is provided in community-based settings, most often in people's own homes.  Many patients prefer to be described as service users and have far greater involvement in planning services and their own care than ever before. I would never try to say we have arrived, we still have a long way to go, but we have travelled an incredibly long distance in the right direction. 

We now have national campaigns such as Time to Change, issues on mental health are much more accepted in the media with substantially more positive reporting. Whether it’s through soap operas such as Coronation Street or EastEnders dealing sensitively with mental illness or well-known celebrities talking about their own mental health, the stigma associated with mental illness has dramatically reduced. However, it is still there, it is still a problem and we must do more.

I believe education on mental health is at the core of further reducing stigma, I think it’s at the core of delivering better health services overall. So education is key and specifically we must ensure we are acting on the evidence that demonstrates good mental health care leads to better health overall.

For example, back in 2011 the London School of Economics published a review of the evidence for good mental health care and wider health and economic benefits. The Kings Fund have also reported on the benefits of better mental health for people with long term conditions and its health economic benefits. 

The new Greater Manchester strategy also draws together the known benefits of good mental health care improving physical health and the need for good physical care for those with a severe and enduring mental illness. The body of evidence is substantial yet the investment in and integration of good mental health care in all care, remains patchy at best.

A five year forward view across Greater Manchester

This could be a blog in its own right, a book even!  I thought I would close with some key features I would like to see in place by the time we get to 2021. These are just a few examples based on where I think we need to make substantial progress: 
  • All people with health care needs having their own self-care/self-management plan and feeling in control of their care
  • Less hospital beds and more virtual beds, in people’s homes, supported by technology, care coordination and support for carers
  • Mature partnership working and collaboration, between healthcare providers, primary care, social care, third sector, housing, employment and wider
  • A collaborative system for Greater Manchester which unifies mental health care standards but delivers through local integrated models of care
  • Psychological care and mental health care at scale where it can help reduce hospital usage, improve physical healthcare outcomes and help prevent future health problems
  • A vibrant third sector and leisure sector leading on prevention and wellbeing and helping communities become more active and healthy
  • Increased prosperity across the city region and better employment prospects for those who we don’t adequately support now, specifically those with mental health needs
  • A recognised standard care offer for people in their own homes or communities, a hospital system with the time to care and reduced pressures, with far reaching programmes of health prevention and education
  • Better care and prospects for young people and support to families to give young people the best chance in life

I could go on, but I don’t need to as this is a good time for Greater Manchester. There is a shared view on what the right things are that need to be done. The trick now is selecting the two or three most important things (that will deliver the most impact) to start with in 2016 and build from there as we work towards 2021. 

I’m looking forward to being a part of it and hope you are too...