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,
Michael

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... 

Michael 

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