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
|
|
Objective
|
Purpose
|
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
|
|
Objective
|
Purpose
|
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
|
|
Objective
|
Purpose
|
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
|
|
Objective
|
Purpose
|
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
|
|
Objective
|
Purpose
|
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.
