Recap of 2015 and thoughts for the New Year

As 2015 draws to a close, I thought it would be a good opportunity for some reflection over the last year and a look ahead to what’s to come in 2016.

Nationally, 2015 brought some major developments for the NHS, with NHS England starting to implement changes outlined in the Five Year Forward View.  This saw new ‘vanguard’ models of care being set up across the country to test out new ways of delivering care.  Pennine Care is a partner within the Stockport Together vanguard programme and we are keeping a close eye on developments around the country to see what models are proving to improve quality and reduce costs.  It’s likely that more test sites will be set up in 2016 as the first wave of vanguards start to produce the goods.  

This year, Greater Manchester was the first ‘city-region’ to be given greater decision making and budgetary controls over health and social care through the devolution agreement.  This has been a major programme of work since February and I personally have invested a great deal of time working with the central devolution team and Chief Executive colleagues within the NHS and Local Authorities to develop plans to radically redesign health and social care services.  This has culminated in the publication of a Strategic Plan for health and social care across Greater Manchester. 

Devolution will continue to be a key focus throughout 2016 and will inevitably result in considerable change for providers of health and care services, such as Pennine Care.  I will continue to be involved in GM devolution with the aim of ensuring community and mental health care has as much prominence as the acute sector in addressing future challenges and solutions.  This is recognised as part of the strategic plan, but it is part of my job to keep it high on the agenda.

We have had some major successes this year which we should be proud of.  At times of considerable challenge and change it can be easy to overlook all the good work that happens each and every day.  Of course I can’t mention them all, but would like to say a genuine thank you to all of our staff and supporters for their continued hard work and contributions.   

Significant highlights include:

• Our services provided care to patients nearly 2.5 million times last year
• Formation of our new Nursing and Healthcare Professionals Council and networks
• Launch of the My Health My Community self-management programme
• Five teams being shortlisted for the national HSJ Value in Healthcare Award
• Almost 500 staff accessing the new Staff Wellbeing Service in the first year
• The CQC placing the trust in the ‘lowest rate of concern’ – the only mental health trust in GM to do so
• Our fantastic Principles of Care Award winners from each division
• Making the national Best Places to Work in Healthcare listing
• On average 95% of patients would recommend our services to their friends and family
• Volunteers provided 39,360 hours of valuable support to frontline services last year 

We promote the good work of our staff and services throughout the year, so please take some time to look over the range of good new stories posted on the Trust website.

That’s not to say things aren’t difficult out in services, I know that staff are working tirelessly to deliver high quality patient care and at the same time resources are being squeezed as we have to make financial savings year on year.  I can’t promise that things are going to be easier in 2016, we still have savings to make and demands to meet, but as a Trust we will endeavour to listen to and support staff through these challenging times.

Looking forward to 2016, there are going to be some key priority areas we need to focus on as a Trust, these include:

• Preparing ourselves for a CQC inspection, likely to be late Spring or early summer.
• Making sure our services are safe and sustainable, with a major new programme being launched in the year.  It includes developing a new 5-year strategy for the Trust.
• Focusing on integration and partnership working within our towns.
• Continuing to support patients to avoid hospital wherever possible and helping them to take more responsibility for their own health and care.
• Being a key player within Greater Manchester Devolution.
• Continuing to implement the Paris clinical information system (Emis for Trafford).  
• Improving the quality of data and reporting for all services.
• Responding to tenders for existing and new services.
• Continuing to campaign for parity of esteem and improved investment in mental health services.

I will continue to provide you with updates on these priority areas at key times throughout the year, using my blog, twitter account and staff communications channels.  But if you have any feedback for me please email: ceo-penninecare@nhs.net 

I’d like to thank you again for your support throughout 2015 and wish you well for the festive season and New Year.

Michael 

In the vanguard of new ways of delivering care

I thought I would do a quick blog to tell you about the latest developments with the NHS England Five Year Forward View or 5YFV as it’s now affectionately known. 

You may have read that NHS England are now looking to develop vanguard sites as part of a 'new models of care programme'.  This is being led by Samantha Jones at NHS England, with the intention of providing a ‘proving ground’ in a number of areas, accelerating development of integrated care.   

The vanguard sites then become templates from which the rest of England learns. This spread and share approach is intended to address the challenges we face in health and social care at pace and scale. Sounds straightforward enough but England faces a challenging five years ahead.

There is a detailed document online about how the 5YFV will be put into action, but look at page 9, 3.3 if you don’t have time to read the whole document, but it is worth a full read

I read through the criteria for applying to be a vanguard site, you had to apply against one of four categories - multispecialty community providers (MCPs); integrated primary and acute care systems (PACS); additional approaches to creating viable smaller hospitals and models of enhanced health in care homes.

I couldn’t see how we fit into any category. I knew we would be part of submissions in at least three of the towns we serve, as part of the partnerships in those towns. However, because I feel we are to an extent uniquely placed as an organisation and because we are pushing so much to transform and advance care, I put one in anyway on behalf of the Trust. To our surprise we were short listed to attend workshops for a final selection process.

I think the staff in Pennine Care should see this as an achievement in itself, 269 areas applied and this was short listed down to just 63. So yesterday Katy Calvin-Thomas, Henry Ticehurst, Richard Spearing and I went down to London to present to the third and final day of the workshops. 

Here is our original submission - please do read this in particular as I think it captures where we are up to as an organisation. It also shows our latest thinking and just how exciting the challenge is we face. Yes exciting. I think we are truly in the vanguard of new ways of providing care. That’s why I put the application in and it was great to be shortlisted.

I’d be surprised if we were selected to go right through to be a vanguard site, as our submission didn’t easily fit. Also, I didn’t think our ‘pitch’ (a seven minute presentation) went very well. I became a bit tongue-tied and nervous trying to squeeze a broad ambitious agenda into a few sound bites. Katy, Henry and Richard rescued it well and I recovered for the question and answer bit. 

I am sharing my experience, which was personally a bit embarrassing, because I think it goes with working outside of our comfort zone. In Pennine Care, many of our staff and leaders are working outside of their comfort zone, working hard under pressure and really pushing the delivery of new and different services. I am grateful for all the work and success to date, its making a real difference to improving care and helping people live as independently and empowered as possible.

Nothing ventured, nothing gained I suppose. And whilst we might not become a first wave vanguard site, we still have an important role to play informing the agenda for new models of care and also the new Devolution Manchester work developing care out of hospital for the city region.

As we always say though, the single most important agenda is getting it right in Pennine Care, that's with partners and working well with staff and patients to deliver new integrated models of care. After yesterday, listening to some really excellent presentations, I know we are definitely on the right tracks and in some areas ahead of the game. Our staff can rightly feel proud of what they are achieving in the pursuit of improving the health outcomes of the communities we serve.

I do think that NHS England and the new models of care programme should be congratulated for the approach taken to securing vanguard sites. There was some criticism of the process, around how the voting worked, whether it was a fair approach but it was a lot fairer than years gone by, when decisions were made behind closed doors and within networks that weren’t accessible. 

I spoke with Samantha Jones afterwards and she was open and interested in the work we are doing in Pennine Care. NHS England Chief Executive, Simon Stevens, sat and chatted through our challenge with Richard Spearing. Jackie Lynton Head of Transformation at NHS Improving Quality wants to support our work on diversity and Rob Webster, Chief Executive of the NHS Confederation, has shown great support to the Trust. We are in a more open, transparent and involving era, the playing field is ever more level and I think we should applaud the positives in that.

Coming up next time, a video blog (or vlog), where I expand more on the challenges we face going forward. 

I miss my comfort zone!

Michael 

We're right on track - review of the 5YFV

A couple of weeks ago, Simon Stevens, Chief Executive of NHS England, launched the NHS Five Year Forward View (5YFV), setting out a future vision for the NHS, why change is needed, what change might look like and how it can be achieved.

As it happened, the 5YFV was launched on the same day I was working with the Trust's senior leaders on our own strategy, which was both timely and endorsing of the plans we have been working on in recent years.  So I want to highlight areas where the 5YFV chimes with the Pennine Care vision and strategy we launched earlier this year...


“when people do need health services, patients will gain far greater control of their own care – including the option of shared budgets combining health and social care. The 1.4 million full time unpaid carers in England will get new support, and the NHS will become a better partner with voluntary organisations and local communities.”

Across the Trust we are training staff and promoting self-care as a first line intervention.  With My Health, My Community (was formerly the Living Well Academy) we are promoting carers support, developed with them that works for them. In many areas we are growing integration of health and social care delivery.

“the NHS will take decisive steps to break down the barriers in how care is provided between family doctors and hospitals, between physical and mental health, between health and social care. The future will see far more care delivered locally but with some services in specialist centres, organised to support people with multiple health conditions, not just single diseases.”

We continue to roll out Mental Health Matters and Physical Health Matters training to all of our staff. In October, the Trust's Psychological Medicine Team won a national Positive Practice in Mental Health award for its ground breaking psychological services for physical health conditions. We are joining up with hospitals, primary care, social care and the third sector to deliver new ways of operating care services.

“One new option will permit groups of GPs to combine with nurses, other community health services, hospital specialists and perhaps mental health and social care to create integrated out-of-hospital care - the Multi-speciality Community Provider. Early versions of these models are emerging in different parts of the country, but they generally do not yet employ hospital consultants, have admitting rights to hospital beds, run community hospitals or take delegated control of the NHS budget.”

This captures both the partnership board approach we have established in Oldham and the one we are developing in Heywood Middleton and Rochdale. These partnership boards ensure all organisations can make a valued contribution.  At present in these partnerships include community, mental health, GPs and wider primary care, as well as third sector providers and social care. We are also hoping to extend this to include housing associations too.

“A further new option will be the integrated hospital and primary care provider - Primary and Acute Care Systems - combining for the first time general practice and hospital services, similar to the Accountable Care Organisations now developing in other countries too.”

Going forward, Pennine Care will be able to make a positive contribution as a specialist provider of community and mental health solutions as part of developing models of integration.  As a Trust, we are now placed to provide ‘bespoke’ developments and contributions which will differ from town to town.

“Across the NHS, urgent and emergency care services will be redesigned to integrate between A&E departments, GP out-of-hours services, urgent care centres, NHS 111, and ambulance services. Smaller hospitals will have new options to help them remain viable, including forming partnerships with other hospitals further afield, and partnering with specialist hospitals to provide more local services. Midwives will have new options to take charge of the maternity services they offer. The NHS will provide more support for frail older people living in care homes.”

In Trafford the Community Enhanced Care Service is now showing a demonstrated return on investment, generating deflection away from hospital and preventing people from ever reaching the hospital door. The Trust's RAID service (mental health liaison into hospitals) has recently been evaluated and demonstrated significant returns.

“The foundation of NHS care will remain list-based primary care. Given the pressures they are under, we need a ‘new deal’ for GPs. Over the next five years the NHS will invest more in primary care, while stabilising core funding for general practice nationally over the next two years. GP-led Clinical Commissioning Groups will have the option of more control over the wider NHS budget, enabling a shift in investment from acute to primary and community services. The number of GPs in training needs to be increased as fast as possible, with new options to encourage retention.”

In Oldham, the Trust leads the Integrated Provider Hub for mental health investment. As a consequence of GP-led commissioning the Trust has been empowered to shift mental health investment away from hospital-based care.

“In order to support these changes, the national leadership of the NHS will need to act coherently together, and provide meaningful local flexibility in the way payment rules, regulatory requirements and other mechanisms are applied. We will back diverse solutions and local leadership, in place of the distraction of further national structural reorganisation.” 

This is a welcome position for Pennine Care, where we have found top down structural reorganisation could never overcome the need for local solutions delivered from partnership working. The competing demands and different cultures of each stakeholder can only come together through locally determined and committed leadership.

In going forward the Trust intends to continue with its vision and strategy.  As the 5YFV notes there is a ‘broad consensus’ on the direction required; across Pennine Care, between commissioners and providers this is largely in place.  The challenge now is to construct new integrated arrangements within this broadly agreed direction of travel.

What's really good about the 5YFV is that it connects with the 'broad consensus,' leaving you feeling like its speaking to your local work, affirming we are in the right direction. I think we are but we can't be complacent and have to work hard now on translating vision into delivery.