I have spent the last couple of days at the national NHS Confederation
conference, which was held in Manchester.
This is an annual event, bringing together clinical and
managerial leads from health and social care organisations across the country
to hear latest policy updates and local developments and to network with
colleagues.
I generally try to go to these every couple of years and
in recent years, the mood has generally been a bit low. However, I thought there was a notable
difference this year, as the mood was more upbeat and positive.
There has been much in the media about the financial
challenges of the NHS and it looks as if this is now being taken seriously at a
national level.
Key
speakers:
We heard from Jeremy Hunt, Secretary of State for Health
and Social Care and Simon Stevens, Chief Executive of NHS England about how
this is being taken forward.
They spoke about how negotiations are well developed on
the long-term funding of the NHS and that there is likely to be an announcement
in the next week or so, to coincide with the NHS 70th birthday.
They also spoke about how a long-term plan for the NHS
will be developed over the summer through a co-production approach with health
and care organisations and the public.
Although it wasn’t clear exactly how this was going to be
undertaken, there was a clear intent for there to be another ‘Five/Ten Year
Forward View’ or ‘NHS Plan’ by the autumn with clear priorities.
There were also a number of other key messages that are particularly
relevant to us and give some clues about what is likely to be in this long term
plan.
The
importance of mental health services
The importance of mental health and community services
was a massive feature of the conference. The importance of mental health as
everyone’s business was spoken about in most forums and there was a key note
speech and panel debate on the main stage of the conference, for the first time
I can remember.
Simon Stevens spoke about mental health forming a key
focus of any long term plan, and in particular, highlighted the need to
continue improving services and support for children and young people.
Helpfully, he talked about the need to work with wider
sectors, including digital platform companies.
This recognised that health and care organisations aren’t able, on their
own, to address the needs of children in such an age of complex social media.
Community
services supporting out of hospital care:
Simon also stressed the important part that community
services play, together with social care and primary care, in supporting out of
hospital care.
Interestingly, he spoke about how the term ‘out of
hospital’ care is not a great description of the breadth and value of the
support and services provided.
He feels that we need to develop a different language and
move beyond referring to services simply as ‘in hospital’ and ‘out of
hospital’. I wholly agree with this as
it still tends to view care seen through an acute lens, when we know that the
vast majority of people cared for in community settings rarely require hospital
care.
Improving
efficiency:
You may have picked up in the national media about the
work that Lord Carter has been undertaking on behalf of NHS Improvement to
review efficiency, firstly in hospitals, but more recently in mental health and
community services.
Over the last 18 months he has been working with a range
of mental health and community NHS organisations and his report was published
last month. Click
here to access a copy.
This review looked at how mental health and community trusts operate, what
‘good’ looks like, what approaches to improving productivity and efficiency are
already in place and what opportunities there are to further build on this. In
other words, are we all doing things in the best possible way and what
opportunities are there to deliver the best care, at the best cost?
This was a particularly important piece of work and I
heard at the conference the key findings and how the learning was being shared.
One particularly impactful finding from this review was
that on average (from the organisations they worked with) a community nurse is
only able to spend about 88 days in a year on direct patient care. Excluding
leave, it seems people have to spend huge amounts of time either travelling, dealing
with poor systems for accessing and recording information, or overly
bureaucratic admin processes.
Undoubtedly some of this admin and travelling is
essential, but it’s also clear that significant work needs to be done to
improve systems and to work in new and innovative ways.
Positively, improvement work is underway on our IT
systems; examples include the Paris electronic patient record, the wide scale
roll out of mobile working and the use of innovative technology, such as
Omnijoin. You
can read a great example of how a service benefited from Omnijoin here.
And I know that we are also doing work to look at the
caseloads of our community nurses and our community mental health teams, so
this will help identify our own stats. But we will need to find ways of
creating more manageable caseloads and more time for direct care if we are to
realise the vision for more care in ‘out of hospital’ services.
Staff
health and wellbeing:
Given the above, unsurprisingly, discussions about staff
health and wellbeing featured largely.
Niall Dickson, Chair of the NHS Confederation, talked about ‘the plug in
the workforce being as important as the tap’ – in other words we need to focus
as heavily on keeping the people we have, as we do on bringing more people into
services.
This was backed up by Health Education England which
highlighted that, despite increasing training for staff across specialities and
professions, this increase was being outrun by people leaving the service – and
not simply because they were due to
retire. We are losing staff from the NHS because they are making a choice to
go.
People who work in health and care are hugely committed
and every number in these statistics is a person who has not felt able to
continue working for the NHS.
This makes me feel sad at the loss to the NHS of those
individuals and for whatever reason has made them feel they need to leave; but
also motivated to try and make a difference. And this really emphasises for me the importance of staff
health and wellbeing and the challenge to all of us to create a positive
working environment.
I have said previously about how important this is to
me. I firmly believe that if we get it
right for our staff, we will get it right for the people who use our services.
I am passionate about this as a priority.
As an organisation that has expertise in mental health,
we should be better able than most to make a real difference to our staff
mental health and wellbeing.
I am really keen to understand why people leave our organisation
and would welcome some really open and honest conversations about this. If we know what the real issues are, we can
do our utmost to resolve them.
We already undertake exit interviews with staff who are
leaving - however this comes right at the end.
I want us to be having these conversations early on, before staff even
consider leaving.
As a starting point I would really like to know what the
top three reasons are for people leaving our organisation, so we can start by
tackling the big problems. I am more than aware that a significant issue
affecting most staff is pressure and demand; and tackling this is a major
priority for us.
However, there may be other things we are less aware of.
I have written previously about the work we are doing to
better understand our culture and to create a more just and learning culture. I know some of you will have had the
opportunity to attend the workshops we have held or complete the cultural audit
survey. I am also just about to write to staff who have expressed an interest
in supporting this improvement journey, regarding next steps.
I will be holding the first meeting of our Cultural
Improvement Group in July and staff health and wellbeing will be one of the
many conversations we have. I am really
interested in learning how we can create a more positive workplace environment
and retain the great staff we have.
Even if you are not involved in the group, I’d still
really like to hear your feedback and suggestions for improvement. You can contact me on 0161 716 3006 or at
Claire
Molloy
Chief Executive
Chief Executive
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