An example of integrated care – my visit to ORCAT

We hear a lot about health services changing to become more ‘integrated’. Put simply, this means working closely together so the care patients receive is more joined up.

At Pennine Care, we are working with partner organisations across our footprint to integrate more services and improve patient experience. I recently visited the ORCAT service – a perfect example of this.

ORCAT (or Oldham Rapid Community Assessment Team) was set up by the Oldham Urgent Care Alliance. Pennine Care is a key member of the alliance, which is a partnership of 10 health, care and voluntary sector organisations developed to improve outcomes for local people by enhancing current services.

ORCAT works closely with colleagues at The Royal Oldham Hospital, including those in the A&E department, to react quickly and prevent people from being admitted to hospital if they can be supported at home with the right professional help. Once at home, the team takes a partnership approach to assessment and care planning to understand what level of support the individual may need to live as safely and independently as possible.

It consists of therapists, nurses, health care assistants and mental health practitioners from Pennine Care NHS Foundation Trust, social workers from Oldham Council, and a Promoting Independence in People (PIP) support worker from Age UK Oldham, who have been brought together to work as one multi-agency team.

As well as preventing people from being admitted to hospital by identifying them early, the team works closely with hospital-based nurses, doctors, discharge coordinators and the RAID mental health liaison team to also support patients who have been admitted to the wards who could be discharged early with the support of the service. 

I met with three members of the team - Cathy, Rachel and Claire – as many others were out and about supporting people at the hospital or in their homes.

It was a really good afternoon; we talked through the service model which was brought to life by patient stories that illustrated the support not only for the patient but for families and carers as well.

Everyone talked about how great the ‘team’ feel was and the fact that each member’s contribution was of equal value to the end outcome. The team really valued the input of the Age UK PIP worker, which makes a huge difference to the team’s success.

The team has worked very hard to build relationships with colleagues in the local hospital and over the past few months things have really moved on in terms of embedding the service.  However, they acknowledged there is still some way to go with raising profile for GPs, so that they understand the potential for people to be supported at home by the team. The GPs who they do work with are really impressed with the support the team is able to mobilise at pace and the range of issues that they are equipped to deal with. 

There were, of course, a few frustrations felt by the team – these were mostly around the type of things that can add delay to discharges. Overall, it was lovely to hear that all three staff were enthusiastic, energetic and said they really enjoyed their job and went home knowing that they’d made a real difference to someone’s life.

While I was there, I noticed a compliment that had been sent in by a relative. With the team’s permission, I wanted to include a snippet of it in this blog as I think it really demonstrates how the team can support people:

“Immediate support following discharge from hospital of my 94 year old father… ORCAT is a fantastic service and were a lifeline to our family. All the ORCAT workers who supported my father combined efficiency and knowledge of care for the elderly with kindness, patience and encouragement. They were excellent. The service is well coordinated, ensuring effective care was in place from day 1 after discharge. This is the health service at its best. *Gold Star*”

I went away feeling really upbeat and very impressed with the dedication and values that shone through the staff I spoke with. Thanks to Claire, Cathy and Rachel for meeting with me.

Judith Crosby

Executive Director of Service Development and Sustainability

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 

Time for an open debate on the future of health and care

In a recent HSJ article, Sir John Oldham was reported as calling on politicians to immediately begin a public debate on the future of funding for health and care services.  To turn up the volume to very loud, there has this week been an unprecedented coming together of health leaders booming for this debate to take place now, in support of the 2015 Challenge Manifesto.

Sir John led an independent commission on whole person care for the Labour Party, which was published in February this year. One of its recommendations was the commissioning of an “independent national conversation”, backed by all political parties that would “recognise the need for a longer term agreement with the people of the country on what health and social care should be, how and where it is delivered, and how it should be paid for”.

The debate has been sparked further by Kate Barker who recently published a report as part of the King’s Fund commission on the future of health and social care, calling for a major expansion of free social care and for councils’ care budgets to be pooled with a “significant” proportion of the NHS budget.

HSJ quoted Sir John as saying: “[the debate] should start now. There’s been enough consensus [about the funding problem].

“We need to make decisions that inevitably this side of an election politicians will be reluctant to [make]. But we need to start that conversation.”

While I wholeheartedly agree with Sir John Oldham's comments, and with the whole person care commission which is informing our strategy, I wonder if he heard the echo of his words after he made his comments? 

I don't think politicians are going to start this debate, however I think the public would welcome it.  They know we have financial challenges and are intelligent and responsible enough to help political leaders make informed judgements on how to address this growing problem. 

Large scale reorganisation to create health and social care organisations would become the project for the next two to five years. The project for the next decade needs to be care outside of hospital, psychologically minded care (vastly underestimated) and promoting self-care and behaviour change in how health is provided. 

This will need driving by policies that act as incentives for care in the community and boldly state hospitals are not health, health is in the communities, some of whom on occasion need hospital care. 

The approach in Tameside is the closest I have seen that is trying to create an integrated care organisation. The initiative is very positive, bold and aims to focus on care outside of hospital and achieve an affordable, coherent health and social care offer. In reality, I still think this will be a number of partners working together under the umbrella of an Integrated Care Organisation (ICO).  

Achieving one clean organisation will be challenging and I believe will always require partners who can make a particular contribution in the mix somewhere. However, initiatives like this should be applauded for taking an open and transparent approach to tackling national issues at a local level. 

However, as I said at the beginning, this debate should be happening at a national and political level.  My concern without the national debate is that we will drift into making reorganisation the goal, and if we do that becomes the project.  

You can shuffle the deck chairs of management but you won't get real change until we steer a very different course for health and social care for the coming decade.

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! 

Leading by example

My latest blog is helped by the Chief Operating Officer at Oldham Clinical Commissioning Group, Denis Gizzi.

Denis doesn’t blog, many say he should, but he does offer great leadership insights.  I was lucky enough to be copied into a note he sent to his staff one Friday afternoon recently.  It neatly described how the CCG had worked with our community services to respond to a family’s concerns about the care provided to their relative. 

It was really well received and I asked him if he’d have any objections to me sharing it. I will let his words speak for themselves, please read below:

“Dear colleagues,

It's been a strange week, but I thought I'd do something I've not done before (and probably won't make a habit of), which is to share a couple of thoughts at the end of a busy week.

You've all heard my mantra on 'time to value' over the last 12 months and I know there is a healthy slice of polite acknowledgement.  Here is a local patient example I’d like to share: 

The family contacts me directly as they are worried and concerned about the lack of care co-ordination following the hospital discharge of a 94 year old gentleman with many co-morbidities.

The CCG team reacts. Clinical advice is sought. Community clinicians are engaged. Mistakes are corrected. Care co-ordination is put in place. The family are understandably anxious. Full assessment and care package in place within a few days.

The family contacts me again.  State 'we had no idea what a CCG was, we now know, the CCG has saved my father’s life.   This may be a little exaggerated, who knows.  What really matters is that 'time to value' has been demonstrated, it is real, it touches people’s lives, and it works because people care about bringing a resolution to an individual's problems as quickly as possible. Time to value? Yes it is very important.

I'm not going to pick out individuals for praise, it's a team effort. Some of these problems were resolved out of standard hours. It is noted and greatly appreciated.

So you see, it's not management mumbo-jumbo, it's what our public expect from us. They want us to make good decisions, act on them, and make change happen quickly. We are getting better at it, but clearly we need to do more.”

I just thought it was a great example of how leaders can show a commitment to staying true to what the public want to see in how we lead their NHS.

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

30 minutes on transformation and ideas for change

Ok, I have really been struggling to find the time to blog but I keep hearing how valuable people are finding it so thank you for your comments.  

I have just found thirty minutes and I have set myself a task to tell you as much as I can about our transformation programme in that time *closes door and slides down in  chair so no one can see me!*

Last week I spent nearly four hours with the executive team talking about the next phase of our challenge. We have since launched our vision and strategy but now need to work with our staff, service users, carers and partners to talk about the plans we need to develop and put in place… and let’s not forget we also have to find around £45 million of savings over the next five years.

The vision and the strategy are crucial to a successful future but all the plans in the world are meaningless if we don’t lead a well-run organisation now. I like the concept of high reliability organisations, which I think is derived from the aviation industry.  It also has been adopted and applied by many healthcare organisations.

Simply put, it promotes a culture of safety and learning from adverse events. I already think we do this well, but we can do even better and drive out variation and improve standards even more. Given the challenges we face, and the change we will have to go through, keeping this as a priority is key.

Every leader and all staff in Pennine Care have a responsibility to provide safe patient care and we all have a shared responsibility to not only spot problems but to develop solutions together.

A culture of safety means ensuring we are clinically-led. This can be challenging as clinicians, understandably, are often concerned about the impact on quality due to financial savings. Whilst it is challenging I believe the only solution is to work even more closely together and to share the responsibility to find the best plans to take services forward and reduce costs.

I also am of a view that we have to hold an ambition to improve services, even when facing £45 million savings plans. I don’t think we should just assume, give up or accept the notion that this level of savings will make things worse or reduce services. It will change services, yes, but £231 million (the pot left behind) is still a lot of income and we should work together to design a future that makes the best use of this investment.

I’m not wearing rose-coloured spectacles or being blinkered to the challenge, but if we put patients first then we have to drive to deliver the best possible change for them. We can’t change the financial climate we are in but we are in control of our attitude and approach to the challenges we face.

*Half way through the thirty minutes… tick, tick, tick!*  

We also talked about the vision and strategy. I am really pleased we have put together a vision and a strategy, including a plan on a page of our Service Development Strategy. This sets out our overall ambition rather than our detailed plans.  

Therefore, in the last 12 minutes of my 30 minute blog I’ll share some quick thoughts on what each of the transformation programmes could mean.  The transformation programme has seven steps:

Living well

This means promoting self-care and self-management, health literate and empowered patients. If patients can be less reliant on current care systems we may be able to change the way hospitals work and our community-based services are designed.

Living well may mean more care coordination, risk stratification, expert patient programmes and different team make up and skill mix and different provider models to deliver care.

Easy access

Better co-ordinated access is something many patients ask for. In Oldham we are working with Age UK to appoint four ‘Promoting Independence in People (PIP)’ workers, who will help patients to navigate through the system to become empowered in managing their own health and care needs.

This has meant changing our multi-disciplinary teams and having different non-professional workers join from the voluntary sector. It is just one example of how we are doing things differently and better.

Whole person care

I have a view that parity of esteem in mental health means better physical care for people with mental illness, as well as better psychological care for people with physical health conditions. This aspect of a person’s care is still barely featured in models of care.

Cognitive Behavioural Therapy (CBT) or psychoeducation should be a standard aspect of our care pathway for long term conditions and means making sure our staff are more broadly trained.

It also means we need to bring our mental health and community teams closer together, providing integrated care to each patient.

Places that work

Our care should be provided in the homes of people we care for or as close to their homes and families as possible. This means we need to organise services around our local communities and neighbourhoods, not around professional groups or disciplines.

It doesn’t mean losing professional identity, we need strong clinical voices, but delivering locally with primary care, social care and community resources.

Better use of technology

I could write on this alone but I’d rather ask a question - how much does technology play a part in the care you deliver in your team? And do you use the latest technology in your team?

I know the Trust has a responsibility to put this in place and we are doing this with the PARIS clinical system, but do you drive it forward in your teams? How modern are you in your thinking on different ways to deliver care?

I would put forward that rather than digital by design, nurses and health care professionals should be working digitally by prescription. The application of technology should be a common feature of assessing someone’s needs, as you would for wound care or medicine.

Fewer buildings

Buildings are expensive and I’d rather work differently and invest in staff than bricks and mortar. The problem is buildings are also a hard habit to give up, but we have to reduce the cost of office space.

Where we have buildings we should open them up to communities and interested groups when we aren’t using them. We often leave an expensive building empty in the evenings and at weekends, when community groups would love to have some space to meet in.

Different ways to deliver care

We have to think broadly what this could mean? Different ways of delivering different aspects of what we do, set up a social enterprise maybe? We have discussed this as one example. Some commissioners have a view that some of our services are uneconomic, I also think we could do some things better at a reduced cost. We have to find ways to deliver better value in some areas.

Bed-based care is a significant cost and some trusts are reducing their bed base. I think we have avoided going any further than our historical changes, for good reasons, but we should still have the conversation and look again.

I could go on and on considering what transformation planning might mean but I have run out of time!  What I will say in closing is that it is critical that we involve patients, carers, staff and stakeholders in developing plans to respond to our challenges, and that we must not lose sight of being a great place to work.  Pennine Care must still engage, recognise and reward our staff for the hard work, dedication and commitment they give every day.

We owe our staff both of those points to support them through the challenges we will face together.

Tweet your thoughts to @MichaelMcCourt1 or comment below. 

Improving quality in challenging times

I am often asked ‘why can’t you just use your surplus to make savings and protect services?’  which is a valid question I will try to answer.

The Trust's financial surplus in simple terms is there to both keep the Trust afloat (in the black not the red) and to pay for high cost projects to improve patient care (capital investment).  Our surplus each year is around £2 million and could never cover the level of efficiencies we have to make.  It is a one off sum of money (like money in a savings account), whereas the efficiencies are against spend each and every year (like reducing your outgoings at home). 

Rather than a technical explanation, I will give examples of how the surplus has benefitted staff and patients alike over many years:

• The excellent ward improvements in Tameside and Stockport, completed in 2013, cost around £7 million, paid for from the Trust’s surplus.
• PARIS and the roll-out of a modern information system, improving patient information and staff working practices has been funded from the Trusts surplus.
• We enjoy high levels of maintenance and in-year improvements to our environment funded from the Trust’s surplus.
• In the next few years we will refit/redesign/refurbish wards in Oldham, this will be funded from the surplus

Compared to 10 years ago, the majority of staff and patients now benefit from being in high quality environments. This couldn’t have been achieved without sound financial management, which is a reason why managing money well is an integral part of delivering excellent care.

Savings

Pennine Care isn’t the only Trust making savings, all NHS Trusts have to.  All Councils are having to make savings and very significant reductions in costs.  Commissioners (who buy our services on behalf of the public) are making difficult decisions on priorities in a climate of reducing investment and increasing demand. Everyone across health and social care is working with the challenge of reduced levels of funding and increasing demands for services.

This means commissioners are increasingly concerned with the value they get for each pound they spend, more so now than ever. Providers like Pennine Care, have to make our own efficiencies, under increasing scrutiny.  We have to ask, is the care we deliver the best possible within the most efficient cost envelope?

If commissioners can’t be convinced of the value and productivity of what we provide, there is every chance they will stop buying it, or buy it from someone else. There has never been a more important time than now to be able to demonstrate that what we provide is effective and good value. Commissioners are now guided to use competition to test for value and that’s why we have so much activity around tenders for services we already operate.

Focus on patients and quality

Whilst I didn’t welcome the financial crisis, I very much welcome the patient focused debate that has been generated as a consequence of economic upheaval. Every pound spent has to buy something effective and efficient, and we have to drive out any variation or inefficiency.

I heard a patient story recently, from a daughter about her mum. Mum had had more than one stroke and lived alone, she needed a lot of care to support her. It wasn’t great to hear that the disjointed care was in part delivered by Pennine Care. What was great was how we fixed it once they raised their concerns. Their concerns? Multiple practitioners and agencies going in to provide care to mum, with no one speaking to each other. Disjointed, unproductive and at times unhelpful care. That isn’t efficient or effective.

I use that as an example of where we need to make changes and improvement. I do know that we deliver excellent care more often than not and that staff are hard working. But, in the current climate can we always demonstrate that? Do we communicate it well where we do provide excellent care? I don’t think we do sufficiently.

And that’s where the new vision and strategy will come in, when it is launched this month. It will set out what we believe everyone wants in terms of excellent care, it will describe what we think success will look like, based on what staff and stakeholders have told us.

Whole system change

It’s not just our challenge either. Rob Webster, the new Chief Executive of the NHS Confederation has recently said NHS Chief Executives need to lead outside of their organisations and lead across systems. What he meant by that is that we all now have to look beyond Pennine Care, beyond our usual NHS borders, and form new partnerships to deliver better and more efficient care.

And Pennine Care’s collective challenge in all of this? As every pound spent has to be spent well, we all need to demonstrate that what we provide works and how we deliver it is good value. I’ll write more on that in the future, but that’s why I started blogging about money to acknowledge that the current climate can make things tough. But also to set out that the reality that we must ensure we deliver evidence-based care, consistently and at the most efficient cost possible.

I think the journey we are on is one of improvement and there is the real prospect of exciting change and redesign. It will be challenging but I truly believe care will improve as we work through each step together.

With two posts on money done, next time more on our vision and strategy.

Michael

Twitter: @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