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 

Progress, opportunities and challenges ahead

We recently held the Trust's Annual General Meeting and Principles of Care Awards.  It was great to see more than 200 people there, staff in the main but Governors, members, commissioners and supporters too. 

The AGM is an opportunity to look back at the progress we have made over the last 12 months, whilst also looking forward to the year ahead and the opportunities and challenges that presents.   These things can be a bit dry at times, but we try to keep the presentations informative and concise, whilst delivering some important messages that I want to ensure all staff hear.  

On reflection

As I approach two years being in post, and with last year 2014/15 my first full year in post, I thought I would share a brief reflection on my time as Pennine Care's Chief Executive. At a time when many reports in the media say how difficult and unattractive Chief Executive roles are, for me it remains a privilege and I continue to carry out the role with great pride. I am always mindful that the number one aim of my job is to support staff and help them provide the best care possible. It is probably the most challenging time the NHS has ever faced, it is definitely the most challenging time in my 31 years in the NHS.

And despite the challenges we face, I am humbled on a regular basis by the continued hard work, commitment and care provided by all of the staff I meet as I go about my work. It reminds me each time of the importance of doing the best I can to support dedicated staff, who just want to provide the best patient care possible. I thanked everyone at the AGM and I just want to repeat that thanks here, to all the staff of Pennine Care and those who work closely with the Trust. 

Community care

Our community and mental health services provided care to patients across our six boroughs nearly 2.5 million times last year.  This is a phenomenal figure and shows just how hard our staff are working day in and day out to meet patient needs, during times of increasing demands and pressures.  So thank you to each and every one of you. 

One of the main aims of most of our services is to keep patients from having to go in to hospital, by providing high quality care at home or within the community.  We also have services that allow people to return home more quickly when they have been in hospital.  Not only is this better for the patient, it also delivers cost savings, which is so important in these times of financial challenge we find ourselves in.   

We have recently undertaken an economic evaluation of some of our key services in this area - Butler Green in Oldham, Saffron Ward in Stockport and the Psychiatry Liaison (RAID) service – and together they have achieved 23,164 deflections from hospital and saved the economy £4 million in acute costs in one year alone.   Imagine what could be achieved if we could expand this across all of our towns and even Greater Manchester, which is what we aim to do as part of the Greater Manchester Devolution programme. 

We have also been working closely with commissioners in our towns to implement more integrated approaches to community-based care, involving partnerships with a range of providers and moving towards services working together in neighbourhoods.  This will continue to be a key theme moving forward in order to meet commissioner expectations and deliver our cost and quality improvement strategies.

Staff engagement

Staff engagement has continued to be a major focus over the last year, and of course we made the HSJ and Nursing Times Best Places to Work list.  This is based on the results of the NHS Staff Survey, taking staff feedback to directly measure performance in relation to a number of different areas.  This year’s survey is now out, so please take the time to respond.

Quality

Dr Henry Ticehurst, our Trust Medical Director, gave us an overview of the progress that has been made with regards to quality and clinical leadership.  Ensuring the clinical voice is well represented within Pennine Care is essential and the Nursing and Healthcare Professionals Council and associated groups is a key enabler of this and continues to be a growing force within the Trust.  The Care Quality Commission (CQC) placed Pennine Care in the ‘lowest rate of concern’ as part of its new Intelligent Monitoring programme.  Pennine Care was the only mental health provider in Greater Manchester to achieve this rating, which is a testament to our high standards of care and patient safety.

Finances

Martin Roe, Exec Director of Finance, also gave a sobering overview of the annual accounts which basically showed that although we have been able to deliver our required financial savings year on year, we realistically only have one more year where financial balance can be achieved.  Martin described 2016/17 as being ‘a watershed year’ both for the Trust and the NHS as a whole, as providers continue to struggle to meet the required efficiency targets set by the Government.  Pennine Care’s overall target is £47.5 million over five years.  Our target for this current year is £7.6 million, which we are forecasting to achieve but this then jumps up to £10 million for the years thereafter, which is much more challenging. 

Principles of Care Awards

To end on a lighter note, I would just like to acknowledge the fantastic achievements of the winners from the Principles of Care Awards.  A video of the winners from each division was shown on the night, which were truly inspirational and remind you what it’s all about – caring people delivering the best care possible to people who need it.  All of the videos are now on the Trust’s YouTube channel, so please take some time to watch them and I hope you find them as moving as I did.  Particularly congratulations to the highly commended Bury learning disabilities dementia team, and the Bury children’s diabetes nurses who were named overall winners. 

The presentation slides from the evening are on the Trust website if you want to review them, or watch this short video clip from the event: 

Thank you

Michael

Twitter: @MichaelMcCourt1

National direction set

The NHS Confederation last week published a letter to the Prime Minister, David Cameron, to urge the Government to provide political will and financial backing to secure the future of hard pressed NHS services.  This was co-signed by 50 leaders in healthcare, including me.

The publication of the letter coincided with a major speech from Mr Cameron (link) and Chief Executive of NHS England, Simon Stevens (link).   

The overarching themes from these speeches was further commitment to implement the Five Year Forward View, making a 7-day NHS a reality, greater focus on healthy lifestyles and prevention and treating mental health with equal importance as physical health.  The Government has pledged to provide the NHS with an additional £8 billion in funding by 2020, but this is in the context of the NHS still needing to find £22 billion in efficiency savings. 

The level of change and challenge facing the NHS will continue to be significant, but we now have a clear sense of direction and purpose at a national level, guided by the Five Year Forward View.  On a more regional level, Greater Manchester is progressing plans for the devolution of health and social care from central government to the city region.  

At a Trust level, Pennine Care continues to be a high performer in terms of both quality and finance.  However, we still need to achieve £47.5 million in efficiency savings over the next five years to contribute to the overall NHS target of £22 billion.  This will be tough at times but we must ensure that the care and safety of our patients and the wellbeing of our staff are at the forefront of any changes we make.  We are now engaging with our staff widely on developing plans for the future and I would encourage all of you to get involved. 

I would encourage you to read these when you can as it will help to give you a sense of direction for the NHS over the next five years.  We will of course provide regular updates about how these changes will impact our frontline staff as it becomes clear. 

Thank you

Michael 

Video blog Q&A - April 2015

My first video blog (or vlog as they are also known I am told) is now ready for viewing!  

Thank you to the members of staff who sent in questions, I have tried to summarise and answer them in this video, but there were quite a few so there will be another video blog coming soon too.  

It's the first time I have done a video blog and was a bit hesitant about being on camera, but hopefully it helps to answer some of your queries. 

In this Q&A I talk about what the Five Year Forward View means for us at Pennine Care, how we are supporting hospital pressures, why partnership working is so important, what whole person care means to me, integration of community and mental health services and what's the one thing I would like us to focus on as a Trust. 

It's only seven minutes, so not too long.  I would really like to hear your feedback and further questions. This is all part of building our communication and engagement with staff and partners so we can plan together for the future.

Thank you,

Michael 

The importance of the flu jab

Please read this important 'guest' blog from our Medical Director Dr Henry Ticehurst.

As Medical Director for the Trust, I want to reinforce why it is vital for every member of staff to have the flu vaccine.

I had my flu vaccination on October 13. If you haven’t had it yet, this is a message from me to ask you to do so.

The rationale for the vaccination is clear and it has a strong evidence base.

Influenza is a nasty illness and, for normally healthy people, it can confine you to bed for some time. This in itself has massive potential effects on the services we run – we all know it doesn’t take too many colleagues to go off sick before we get in to some real difficulties.  But for those we treat - especially those with long-term conditions, the frail elderly and the young - it can be fatal.

We have a target of 75 per cent staff take-up. This is a national target and, again, it is not an arbitrary target.  It is set to afford our community maximum protection to ensure any spread is contained. So I am asking you to please be one of those 75 per cent.

You have all received details of vaccination sessions in your borough, along with instructions on how to let us know if you receive your vaccinations elsewhere.  

I know you are very busy but I’d urge you to have your flu jab to keep yourself, the people you work with and our service users in the best of health this flu season.

Staff can find more information about the flu campaign, including a list of sessions and a consent form on the intranet here.

So, to summarise, did I have severe side effects? Well, no, because you can’t get flu from the vaccine. A few snuffles, but to be honest I’ve had worse man-flu!

--

I hope Henry's note will prompt you to get your flu jab if you haven't yet. If you have, thank you, it really does make a difference. And don't forget if you're like me, with a son with asthma and elderly parents, it protects your family too. 

Thank you et Merci Beaucoup

Since I launched my blog back in April, I'm pleased to say that it has now received more than 5,700 views.  Whether that’s a glance through, a thorough read, received well or otherwise - a big thank you for taking the time to read it.

I hope my posts are helpful, especially for staff to keep in touch with my thoughts and where we are up to with current challenges and developments within the Trust.   

I have had mostly very positive feedback on the blog, from emails, comments posted on the blog, twitter and even a chat by the water cooler.  All feedback is welcome and I hope it encourages discussion within teams.

There has only been one or two negative comments, these are still welcome, we can only lead effectively if we hear the good and the not so good.  

These are challenging times and we are having to make changes, save money and at times make redundancies.  I know this can make it difficult and add pressure at work, I am aware of it and one of our strategic goals is for Pennine Care to be a great place to work.  

But as well as talking about these issues on my blog, I also want to use it as a way of highlighting the good work that I see happening around the Trust every day.  Despite the challenges, we mustn't forget to celebrate success.    

I am still really keen to hear your thoughts about the blog - either post a comment, send me a Tweet or email. 

PARIS  

The use of French within this post is my seamless link to talk about the roll out of PARIS, our new digital care record system.  Given we are going through organisational change, pretty much constantly somewhere in the Trust, I am so impressed with how staff have received the new system. 

Despite busy jobs, service changes and increasing demands, when I have met teams everyone has been committed to making the new system work. I think that’s because everyone knows it will improve patient care and ultimately how we work to deliver care. There have been some challenges, glitches and things we haven’t got right and staff have told me when I have visited. We need to hear when things aren't working so we can fix it and learn from it.

I just wanted to say thank you, or merci beaucoup, to all our staff on implementing the new system and for being so welcoming when I have come out to meet teams as they get to grips with the new system.  It's great to see large paper files being closed and consigned to the archives. The system will improve care, provide a platform for mobile working, but it will also surely save thousands upon thousands as we become a paper-light organisation.

Finally, I was really tickled to hear how the Community Mental Health Team at Sudden Resource Centre had launched PARIS in their service. I understand the office was aromatic with the smell of coffee, staff wore stripy Parisian tops, strings of onions around their necks and no doubt one or two "Allo Allo" style accents here and there (younger staff may want to Google Allo Allo or tune into Gold on your TV!). Well done to the team - I’m on the lookout for photographs of your first day with PARIS! 

Opposites attract - listening to everyone's point of view

I have been learning more recently about polarity management.  I probably couldn’t do it justice to try and describe the theory here but it’s a simple concept once you understand it - read here or watch this video. 

I wanted to write about it as I think it’s key to managing change in a trust like Pennine Care. So I will talk about it as plain as I can, avoiding the theory bit.

If you think about relationships; can opposites attract?  Can a Marmite lover live and dine harmoniously with a Marmite hater (or other reputable yeast based spreads!)? Can a Manchester United fan live happily ever after with a partner who supports the noisy neighbours from over the way?

When I was thinking about this, whether at work or at home, there is always a need to understand someone else’s point of view, likes and dislikes, beliefs and values.  Essentially that’s the theory behind polarity management; you can’t work or live with someone unless people try to understand each other. Relationships don’t work unless there is some give and take.

Equally where someone states their point of view to the exclusion of hearing another’s, this will tend to push people apart. We have all heard the phrase, ‘poles apart’ where two people just can’t agree on some matter or other.

Putting it into practice 

So what does this mean for Pennine Care and how we manage our strategy and work with our staff in future years? This might sound barn door obvious, but we have to listen to and work with the views of our staff.

If as Chief Executive, I continually communicate the need for change, transformation, redesign and improvement but it’s not unreasonable that some staff may ask "what’s wrong with the work I do now?" Often the argument for change can be received as a criticism by those who value what works now.

In a recent workshop with Executive Director colleagues, we looked at the following polarities, or opposites of a type:

• Change and Continuity
• Competition and Collaboration
• Team and Individual
• Cost and Quality
• Integration and Specialisation

In these areas, we discussed that there are positives and potential negatives or upside and downside cases.  So in the case for changing something, there are potential benefits, but equally some might argue that maintaining what has worked up to date has benefits. And you could put arguments for and against either change or continuity.

People value different things and if you don’t acknowledge that or understand that, you can frustrate, ignore even lose people in what you are trying to do. The polarities of how people view things are important, it is a tension I believe we should view positively and embrace.

The tension works something like this - if you argue for change with someone who values keeping continuity, you are likely to increase their focus on the negative aspects of change.  If you don’t value what works well now, you are likely to focus on the negatives of things staying the same.

“If it ain’t broke don’t fix it” or ‘Don’t throw the baby out with the bath water” are both phrases which reflect the views people sometimes express when discussing change.

Recognising the good 

So why am I blogging about this? The language of the NHS at present is packed full of change at scale, transformation, significant financial efficiencies, redesign, more generic care work is needed and so on. The financial challenges I discussed in my first blog have introduced a driver for change that is being continually pushed and one that’s often underpinned with claims of inefficiency in the NHS and the need to improve care.

But the more the NHS, leaders and commentators talk predominantly about the need for change, and focus on inefficiency to the exclusion of celebrating the great work that the majority of staff do every day, the more likely staff will be turned off by the prospect of change. Staff will start feel more and more the subject of change, rather than a participant in a dialogue about the future of their service.

And in Pennine Care we need to manage change well and be mindful we don’t throw the baby out with the bath water, or devalue someone’s hard work by talking about how we need to make things better through redesign and efficiency programmes.

I think we do need to change the way we run some services and some change, I anticipate, will be far reaching. However, rather than start with "These services need transforming and we need to save money" I want to start with "What are the really good things we do and how can we use the really good things as a starting point to talk about how we can take services forward?"

It will be challenging as the financial savings are steep. However, we can’t let the financial challenges drive us into making quick decisions on what our plans should be, without talking to staff, our patients and partners first. So we have to include staff and all of our stakeholders in our discussions and engage them in developing the plans to deliver our vision.

I hope this all makes sense. This week I signed off a programme which aims to engage each and every single member of staff in Pennine Care, around 6,000 people, to talk about the future and how together we will move forward. This will begin late summer through to early autumn and will continue throughout the next few years.

Using a range of methods, events, workshops, meetings, social media, intranet forums, we intend to work with our staff to build a shared narrative on future plans. It won’t be easy, there will be lots of different views! We will have to make some difficult decisions. I’m determined though, we will make our plans carefully, in close partnership with our staff and partners. Pennine Care is built by experienced staff who provide great care. We need their views and expertise to inform our future plans.

Comment below or tweet your thoughts to @MichaelMcCourt1

The bottom line

Welcome to my first blog post!

I have had positive feedback on my efforts to be as open and transparent as possible, so thank you. Both Twitter and Trust communications have been well received so far and the idea of this blog is to provide further thoughts on Trust strategy, challenges and the wider health and social care system.

It’s intended to contribute to the reader’s thoughts and views, I hope, and promote discussion and debate.  It is primarily for Trust staff, but stakeholders and interested others are also very welcome.

So, where to start?
In April we will launch the Trust’s vision and strategy. I will soon blog about that specifically. However, I’d like to take a few steps back for this first blog and talk about money.

Surely I should be talking about patient care, quality and values? Well yes, it is the reason I joined the NHS as a student nurse in 1984 and why I get up each day for work, to deliver the best care possible.  But I don’t think we can get on to that without discussing the financial context in which we work.

As a student nurse, even as a staff nurse and a ward manager, I didn’t understand where the money came from to run services. It didn’t cross my mind to think who paid my wages. We are now in different times.

Nowadays I think we all have to have an awareness of the costs of care and the restraints on funding. It has to be an integral part of our plans alongside developing the best care possible. It isn’t easy to do but we must.

There are misconceptions that the NHS budget has been spared from financial efficiencies but in reality it hasn’t.  In percentage terms we might not have had the scale of financial challenges Councils are facing, but we still have to make considerable financial efficiencies year on year.

In 2010, Sir David Nicholson set the Nicholson Challenge against a backdrop of the UK economy in upheaval. He tasked NHS leaders with finding £20 billion of savings, whilst improving quality.

Yesterday the new Chief Executive for NHS England, Simon Stevens, took his new start as a moment to speak frankly.  He said the NHS is facing its biggest sustained budget crunch in years and that success in the coming years will require "a team effort – involving the biggest team in the biggest effort the NHS has ever seen..."  which we are all a part of.

What does it mean for Pennine Care?

I’ll try to explain Pennine Care’s funding challenge as simply as possible (it’s the only way I can understand it!).

Each year we negotiate our contracts with commissioners which include quality and performance requirements, and the price they will pay for services. The price paid is the amount of money we have to run the Trust in that year, to pay wages, pay employers pension contributions and national insurance contributions, rent costs, heat buildings, transport, medicines etc...

The amount we receive this year is less than last year. This is due to a reduction of 1.5% on the prices paid by commissioners across the NHS. The commissioners are required to do this by the government (as part of the overall drive for savings in the NHS). So immediately we have less money than we had last year. We have less money to spend, but the costs are actually going up.  The cost of the 1% wage rise (admittedly only for some following the pay award) isn’t a part of our contract settlement, the Trust has to find money to cover these costs, and each year other costs increase as well. Utilities always go up, cost of medicines always go up and there are many other cost increases -  all have to be met from within that contract value, which is already 1.5% less than the year before.

Then the financial rules we are governed by (from Monitor our regulator) mean that we must generate a surplus, which means putting funds aside to pay for keeping our buildings and equipment in good order, and also to pay for large projects such as capital investment in improving wards or in our new IT systems. A small surplus also gives our commissioners, patients and staff confidence that we are strong enough financially to continue operating even if something unexpected came along. (Remember Woolworths?)

So we have to do better than just break even and the surplus we have to generate is around £2 million.

So in summary, we know the cost of providing our services is around £273 million based on the current financial year but we sign a series of contracts for 1.5% less than this because of a reduction imposed nationally, then from that reduced amount we have to pay increased costs and still generate a surplus. This leaves us short of money and the figure that amounts to is about £8 million, which has to be found through making savings across the Trust.

Is anybody still reading this? Stay with me!

So what does £8m savings mean?

Pennine Care has been successful at meeting savings targets year on year, with minimal job losses.  But it is getting more difficult to find the money.  The £8 million we need to find this year represents the equivalent cost of 218 jobs at band 6.  And that’s why I wanted to start the blog with a post on money, to explain where proposals for redesign and cases for change come from.

When members of Pennine Care's Trust Board spend time with services, there is one consistent theme staff raise, job security. I understand that and I want staff to feel as certain and secure as possible. There is inevitably change required when finding large sums of money to save, but I want to assure our staff we are working really hard to retain staff and keep redundancies to an absolute minimum. 

And that is the reason why we need to be open and transparent.  Nobody wants to be faced with the financial challenge, but it’s a reality we all must face together.  We try incredibly hard to not disrupt patient care and support staff through the changes.  We also ensure we involve staff and patients in the decisions we make.

But making financial savings is now an integral part of the world in which we work, and so unlike when I was a student nurse, we all have to be aware of it.

I’d like to acknowledge and thank staff for continuing to work so hard, so positively and delivering excellent care, despite the financial challenges we face. I continue to be impressed and proud of the enthusiasm, commitment and professional behaviour of staff.

As Chief Executive I don’t underestimate how challenging it is working in the NHS in the current economic climate. Despite these challenges I want the Trust to be a great place to work, a rewarding employer and a supportive organisation. I know that where we achieve that we get the best care.

Next blog I’ll discuss how the financial challenges are creating positive opportunities to improve patient care.

Michael

Twitter: @MichaelMcCourt1