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.