No more compromises on quality

Over the last few weeks I’ve been hearing some pretty strong messages coming from staff about the pressures they are under, facing increasing demands and a never ending flow of referrals.  From talking with clinical leaders and managers at the planning day last week, I heard lots of examples of where services are stretched too thinly and as a result you aren’t able to provide the safe and high quality levels of care you want to.     

We have very caring and committed staff who want to do their very best for people who use our services and I know you have been very accommodating in trying to stretch services to meet increasing demand. But it is not acceptable for our services to be stretching caseloads beyond their means without this being recognised with additional resources. This isn’t good for our staff, it certainly isn’t good for patients and it hides a fundamental problem of a mismatch between the expectations of our services and available resources. 

So what are we going to do about it? 

As a start, we need to be having a different conversation with our commissioners about what we can provide within the resources we are given, as is starting to happen at a national level about the total funding the NHS has.  We should not be trying to meet greater and greater demand, with an expectation we can continue to provide everything we currently do, if this means we are providing a lesser standard of care.  There should be no more compromises on quality. 

In order to change things, we are beginning to have this conversation with our commissioners about the quality, financing and demands of our services.  We have signaled an intent to agree some clear and fixed standards of quality for all of our services and to co-produce with staff and our commissioners a service offer that ensures we can deliver to these standards. 

This may mean not being able to provide everything we currently do. I know how difficult it is for staff to say ‘no’ when all you want to do is provide care and support to everybody who needs it.  But if it isn’t safe or affects quality, then we are going to have some difficult discussions about a different service offer and what we potentially won’t be able to do. So, agreeing these standards, thresholds and pinch points needs to be a clinically-led discussion, in collaboration with our commissioners, service users and local communities.

As a starting point, we are currently working on putting some quality principles into our contracts for next year for those services that are struggling the most, which includes our mental health wards, district nursing and community mental health teams.  This will provide us with a lever through which to start negotiations about what resources these services need in order to meet demand and provide safe, high quality care.  It also means that staff can be clearer about what is and isn’t acceptable and are empowered to escalate when safety or quality is being impacted.  

These improvements won’t happen overnight, but I want to reassure staff that you have the full support of the Board to address the challenges facing you on the frontline.  We need to support you to get back to providing the very best care you can, without compromise. 

I’d be really interested in hearing your thoughts about this, so do email ceo-penninecare@nhs.net with any feedback.

Many Thanks
Claire 

Claire Molloy
Chief Executive 

"I wasn't prepared for just how profound it would be" - my experience of a Schwartz round

I attended a Schwartz round last week as part of Mental Health Awareness Week.  I had some idea of what to expect but I wasn't prepared for just how profound an experience it would be. 

I was asked to join the panel, along with three other colleagues, to share our stories about when we have experienced a difficulty or pressure and how we came out the other side, linked to the theme of 'survive or thrive'.  

I can’t disclose the names of the people on the panel or their stories because Schwartz rounds are completely confidential sessions.  What I can say is that each person’s story was completely different but there was still something to relate to from each experience.  

This included feelings of parental guilt when balancing work and life, being overwhelmed by workload or expectations, dealing with a major incident and experiencing a crisis at home.  All of the stories were incredibly moving; I was taken aback by how every single one of us could relate to the notion of surviving or thriving, no matter what role or position, and this was felt by everyone in the room (around 40 staff members).  

It really was a powerful session and made me think more about my own mental wellbeing, as well as how we support staff across the Trust who are experiencing a difficult time at home or in work.  After all, we are all human and could do with reminding ourselves that work is just one part of who we are.

If you haven’t ever been to a Schwartz round before I really would recommend it.  You don’t have to be on the panel or participate in the discussion if you didn’t want to, you can still go and listen and hopefully learn something.  Teams and departments can also request a Schwartz round to address a particular theme or issue, just get in touch via: pcn-tr.schwartzround@nhs.net 

Staff wellbeing service 

The need for staff wellbeing services has been clearly identified across the Trust, with stress and mental health related staff sickness accounting for at least half of all occupational health referrals.  Last year, 115,882 working days were lost due to staff sickness! 

The staff wellbeing service was launched in September 2014 after the Trust decided to use our in-house expertise to deliver psychological therapies to staff, rather than outsourcing to an external provider. The aim was to deliver a completely confidential free service to all employees, offering a wide range of interventions to help support staff through mild to moderate psychological difficulties that were impacting on their functioning at work.

The service has proven to be a great success - 507 staff were seen during the first year, with 19% supported back in to work and 72% helped to remain in work.  The service now receives around 40 referrals on average each month. 

The Executive Directors have recently reviewed a business case to support the staff wellbeing service and based on the results, we were delighted to approve permanent funding to ensure it continues to provide vital mental health support to the workforce. 

If you want to know more about the staff wellbeing service, there is lots of information on the Trust intranet - you have to be on the network to access this link. 

Keith Walker

Executive Director of Operations

New Chief Executive appointed

As staff will be aware, Pennine Care has been undertaking a recruitment process to select a new Chief Executive over the last few months.  I am now pleased to announce that Claire Molloy has been appointed to the position.  

Claire has been the Chief Executive of Cumbria Partnership NHS Foundation Trust for the last four years.  The trust provides mental health and community services across the county of Cumbria, employing 3,500 staff.  Prior to that she held the position of managing director at Heart of England NHS Foundation Trust and has worked within primary, community and acute settings. 

It is anticipated that Claire will start in post from September.  In the meantime the trust’s existing interim leadership arrangements will continue.  

Claire was selected due to her proven track record as a Chief Executive, particularly at a trust providing mental health and community care across a broad footprint.  During the process, she demonstrated extensive experience of building strong relationships with partners in order to improve patient care and is passionate about staff engagement to build a strong and motivated workforce.  

All of these attributes are very much in line with Pennine Care’s strategy and values and I am confident that she, along with the executive team, will provide the trust with strong leadership into the future.

The selection process was thorough, involving staff, stakeholder and patient panels, as well as a final interview.  The appointment was ratified by the trust’s Appointment and Remuneration Committee, before being approved finally by the Council of Governors.

Commenting on her appointment, Claire said: “I am very much looking forward to working with everyone at Pennine Care and building on the fantastic work that is already taking place across the trust.  I believe this will be best achieved by working collaboratively with staff, patients and partners within each town.  I understand there are many challenges facing the trust and wider health and social care system across Greater Manchester, so look forward to overcoming them together.”

Staff and stakeholders will continue to be provided with updates regarding Claire’s appointment, as well as progress towards recruiting a new Chair in preparation for my term coming to an end in October.  

Thank you for your continued hard work and commitment. 

John Schofield

Chairman

My visit to the Bury Community Mental Health Team

I went to visit the Community Mental Health Team in Bury based at Humphrey House this week, it was a chance to learn more about what they do and understand the challenges they are facing.  

For those who don’t know, Community Mental Health Teams (often called CMHTs) support people living in the community who have complex or serious mental health problems.  This includes people with severe depression, anxiety, psychological difficulties and psychotic symptoms.  CMHTs are multi-disciplinary teams made up of mental health nurses, social workers, occupational therapists, support workers and consultant psychiatrists who work with the team.  

It was clear that the Bury team are incredibly committed to providing the best care they can to patients, but they are feeling the pressure of increasing caseloads and finding that patients have got more complex needs.  The team talked a little about how more service users are now using the illegal drug Spice, which seems to be a growing problem across Greater Manchester and has been widely reported in the Manchester Evening News recently.

Given that the clinical challenges are demanding enough, I formed the view that there is more that we can do to improve the working environment particularly in relation to medical records, IT and car parking.  I will be raising the issues at the next Executive Director team meeting with a view to prioritising better infrastructure support.

I just want to thank the team manager Dawn Parker and her team for giving up their time to meet with me and for their honesty in the challenges they are facing.   Their commitment to patients was clear to see and they have to make some really difficult decisions on a daily basis in order to keep people safe and manage the service effectively. 

The exec team will be conducting more visits around the trust on a regular basis and will share updates with staff via the blog. 

Thank you

Martin 

Martin Roe, Chief Executive (Acting)

Mental Health Awareness Week (MHAW) 2017 runs from Monday 8 to Sunday 14 May.

It is a national campaign by the Mental Health Foundation. This year's theme is ‘surviving or thriving’, which aims to shift the focus away from mental ill-health to explore how you can thrive in life with good mental health.

Visit the Pennine Care website for lots more information on mental health. 

Time to grasp the nettle

I recently attended a retirement lunch for one of our mental health Clinical Directors and naturally we talked about the challenges ahead at a time where we have the Devolution Manchester Strategic Plan, a GM mental health strategy and a national mental health strategy all emerging. We shared a sense of great optimism, whilst recognising the challenges ahead will be, well, challenging.

It struck me that whilst moving forward, we still need to look back and not forget what we have done well and should celebrate and learn from our achievements but if ever there was a time to grasp the nettle, it’s in 2016.

Working together  

If 2015 was all about strategic development then 2016 should be about implementation.  This year will also be about partnerships and new ways of working together across health and social care.

But if I was to look back, what partnerships have we developed that have taken care forward and what have we implemented to do things differently?  In mental health specifically, what developments can we learn from to inform our plans for the future?

If we are to change the way we deliver health and social care to address the challenges set out in the GM Devolution Strategic Plan, what are the key two or three things we need to do differently in 2016 and beyond?  To achieve difference we have to do different.

Pennine Care launched its whole person care strategy in 2014 and I’m pleased to say that it remains relevant today and reassures me that our ambitions were the right ones.

The NHS England Five Year Forward View talked about a broad consensus on what the future should like for healthcare. Pennine Care’s strategy drew on that, as well as the voice of our staff and those who use our services. The Devolution Strategic Plan endorses much of our strategy but also sets a bigger picture vision and stretch challenge for providers to develop evermore far reaching plans, in partnership with others.

When thinking about partnerships, I look back and can see we knew then it was important that we changed the organisation and started to deliver through 'place and people', not through Pennine Care the ‘Trust’. We have still some way to go but it does mean that over the last two/three years we have been on this journey, we are comfortable working in places, with partners and developing local care organisations together. We bring to the table a strong track record on managing quality, safety, money and large groups of staff, blended locally according to the needs of each town.

Partnerships in practice

For instance in Oldham, we have worked with primary care, social care and voluntary partners to establish an independently chaired Care Consortium.  It was important to bring agencies together to promote innovation and I believe we have delivered some real change.  We are currently undertaking an evaluation of the work and will publish this over the coming weeks.

Around 25% of the Greater Manchester population have a mental health and wellbeing issue and as a GM economy, we spend more than £1bn on long term conditions linked to mental health.  So I feel very enthused about the opportunities to improve mental health care across Greater Manchester.  There are more leaders coming together than ever before and more commitment too.

The three NHS providers responsible for the majority of mental health care in GM are starting to collaborate more, such as across specialist services and supporting the acute mental health pressures facing the city. This has ranged from rapidly opening additional beds, to putting capacity in the system, through to setting up psychiatry liaison services to help with hospital pressures.

In Stockport, we have worked with commissioners and Stockport NHS Foundation Trust to set up a new ground breaking facility, called Saffron Ward.  Saffron provides intermediate care for older people with delirium, who often don’t get the care they need when in hospital. This ward, linked to our RAID services, brings people from the acute hospital setting and provides an integrated care pathway, to provide treatment and care. We have found patients and their families really value this bespoke care, the outcomes are better, older people retain more independence and it has significant financial benefits over the costs to run the service.

Through these examples I hope to show that partnership working has many faces, local partnerships, partnerships with different types of providers and between trusts with common care pathways.  In our recent experience, we have learned to listen, engage and find ways to work with partners that helps everyone feel on board and with a voice to influence how we develop services. This principle of co-production will be key to our future success.

Putting people first

So far I haven’t included the most important partnerships of all… the most significant shift in how we plan, deliver and operate care will be through the partnerships we develop with patients, carers and wider communities. Changing the way we deliver health and social care, will only work if we can change the way people use services and how they look after their own health.

I am very optimistic we can and the work Pennine Care has done through My Health My Community has seen a substantial change in our approach to care. At its heart, MHMC is a living well academy, a self-care resource and a movement towards self-management at scale.  Importantly, the self-care resources and support programmes are entirely co-produced with service users and carers, from ideas, through to development and delivery. 

The NHS has a long standing history of great care, I am proud to be a part of it and my 31 years as a nurse, a leader and now a Chief Executive. However, we have to move away from 'doing to' patients and start working with people and their communities.

As a Trust we know we haven’t got it all right, there is much to do, but for 2016 onwards our staff have partnership working, place-based delivery and whole person care as three key driving principles. Importantly, we can adapt how we work this way wherever and however the local conditions are set. Even more importantly we are changing how we relate to an individual’s care. Across all providers and with all staff, we will need to be both open minded, flexible and progressive as we move forward together.

New models of care and mental health 

The examples I have outlined show how we are developing an alternative narrative to hospital care. Hospitals do great work, but they are busy and under pressure. Local care provider arrangements have to build better and alternative care models to the offer we currently provide. But we can’t just say it needs to happen, we have to make the case for it and demonstrate propositions that we can confidently invest in, knowing it will help reduce hospital pressures and keep people out of hospital-based care.

We must be able to measure, demonstrate and show the benefit over cost of the new care systems we are building and so health economic modelling, such as that undertaken by Pennine Care, is increasingly an integral part of how we plan and implement care.

With new models of care, I still think we underestimate the importance of mental health and how good mental health care can have far reaching benefits. In 2016 we are in a much better place than when I started my psychiatric nurse training in 1984. Back then ‘psychiatric patients’ were viewed negatively, a significant amount of care was provided through large asylums, the media often portrayed people with mental illness as dangerous and talking about your mental health problem was largely still a taboo.

Today, the vast majority of care is provided in community-based settings, most often in people's own homes.  Many patients prefer to be described as service users and have far greater involvement in planning services and their own care than ever before. I would never try to say we have arrived, we still have a long way to go, but we have travelled an incredibly long distance in the right direction. 

We now have national campaigns such as Time to Change, issues on mental health are much more accepted in the media with substantially more positive reporting. Whether it’s through soap operas such as Coronation Street or EastEnders dealing sensitively with mental illness or well-known celebrities talking about their own mental health, the stigma associated with mental illness has dramatically reduced. However, it is still there, it is still a problem and we must do more.

I believe education on mental health is at the core of further reducing stigma, I think it’s at the core of delivering better health services overall. So education is key and specifically we must ensure we are acting on the evidence that demonstrates good mental health care leads to better health overall.

For example, back in 2011 the London School of Economics published a review of the evidence for good mental health care and wider health and economic benefits. The Kings Fund have also reported on the benefits of better mental health for people with long term conditions and its health economic benefits. 

The new Greater Manchester strategy also draws together the known benefits of good mental health care improving physical health and the need for good physical care for those with a severe and enduring mental illness. The body of evidence is substantial yet the investment in and integration of good mental health care in all care, remains patchy at best.

A five year forward view across Greater Manchester

This could be a blog in its own right, a book even!  I thought I would close with some key features I would like to see in place by the time we get to 2021. These are just a few examples based on where I think we need to make substantial progress: 

• All people with health care needs having their own self-care/self-management plan and feeling in control of their care
• Less hospital beds and more virtual beds, in people’s homes, supported by technology, care coordination and support for carers
• Mature partnership working and collaboration, between healthcare providers, primary care, social care, third sector, housing, employment and wider
• A collaborative system for Greater Manchester which unifies mental health care standards but delivers through local integrated models of care
• Psychological care and mental health care at scale where it can help reduce hospital usage, improve physical healthcare outcomes and help prevent future health problems
• A vibrant third sector and leisure sector leading on prevention and wellbeing and helping communities become more active and healthy
• Increased prosperity across the city region and better employment prospects for those who we don’t adequately support now, specifically those with mental health needs
• A recognised standard care offer for people in their own homes or communities, a hospital system with the time to care and reduced pressures, with far reaching programmes of health prevention and education
• Better care and prospects for young people and support to families to give young people the best chance in life

I could go on, but I don’t need to as this is a good time for Greater Manchester. There is a shared view on what the right things are that need to be done. The trick now is selecting the two or three most important things (that will deliver the most impact) to start with in 2016 and build from there as we work towards 2021. 

I’m looking forward to being a part of it and hope you are too... 

Michael 

. 

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

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.

An eye opening visit to Bury

There are many good reasons to go to Bury - the World Famous Bury Market  or the East Lancashire Steam Railway or the very beautiful Burrs Country Park... but last week I went to Bury for a very good reason, to visit the Bury Community Stroke Team. 

I mention Bury’s well-known tourist attractions such as the World Famous Market because people travel far and wide to visit. Yet when we mention examples of healthcare worth travelling to see, Sweden or USA are often mentioned, but not Bury.

Well, I spent an inspirational afternoon with the Bury Community Stroke Team, managed by Lisa and led by Jo, and it was well worth the short journey up the M66.  As much as I’d welcome a visit to Jönköping or Boston, the Bury Community Stroke Team show we can reach for world class care here in the UK!

The service is a great example of where commissioners and providers have come together to do the right thing for patients - improve care pathways and empower people to manage their own healthcare needs.

Whenever I read about healthcare, plan strategy or visit services, I look for a number of things - a well-led service, clear operational plans and specifications, the promotion of self-care, whole person care and the holy grail of good physical and mental health care combined. 

If I had been playing community stroke service Bingo (that well known pastime!) I would have been shouting ‘house’ after thirty minutes of Jo and her team describing their service: 

• Did they measure outcomes that could be part of an overall indicator of performance to demonstrate value? Tick - they use EQ5D5L, something I hadn’t known about but understand other community services uses also.  Excellent.

• Do they promote self-care? Tick - they are running a self-care course and are also developing modules to be run through the Trust's Living Well Academy. 

• Technology? Tick – they use Healthtalkonline and Speech and Language Therapists use apps to help people following a stroke.

• What about the psychological aspects of the community care pathway for stroke? Tick - The team has worked with the Bury psychological therapies team to develop the psychological offer in the overall care pathway. They are now trained in Brief Solution Focused Therapy and Motivational Interviewing and speak positively about whole person care. 

As I said I was inspired and it was a perfect example of how Trusts like Pennine Care are well placed to provide whole person care to our patients. 

I can’t do justice to how impressive this team really is. It’s early days and they are still building the data to measure overall performance, but all the core ingredients are there to deliver a world class service. The team should be rightly proud of themselves and commissioners congratulated for attending to the out of hospital care needs on the stroke pathway.

District nursing visit 

A few days later and I was back in Bury.  I know there are great quality bargains to be grabbed on the market but I didn’t have time to stop unfortunately, as I was visiting one of the district nursing teams for work. Although I’m not sure having the privilege to spend time with dedicated, skilled, professional nurses can really be described as work. 

I spent the morning with Sian, Vicky, Karen and Jo talking about the challenges faced in district nursing services.  I was fortunate to shadow Karen carrying out her clinical duties and talking to her reminded me how complex and demanding the district nursing role is.

In my last blog, I talked about polarities and managing change and within Pennine Care we have recently carried out a district nursing review, involving nurses from all of our boroughs. 

We and system leaders up and down England mustn’t forget that district nurses are busy, skilled professionals who carry out complex, difficult and demanding work. 

As hospitals try to move care outside of hospital and GPs look for support to high levels of demands, where does the care go?  Into community services and often to the district nurse. They can rarely say no to demands, go about their hard work effectively (but often quietly) and make a huge difference to the lives of people who need their care.

The community models of care, especially district nursing, need dedicated thought leadership, investment of time and resources to develop models and an understanding that a district nursing team has the same floors and ceilings of capacity as a ward does. 

We talk about hard truths for ward staffing levels, which I fully agree with, but it isn’t just wards that have to be safely and effectively staffed, so does the community.

It was a real pleasure to spend time with such a hard working team, not short on ideas on what they feel needs to be done. But I think the NHS system needs to listen more to their voice and not overlook the community filling in the sandwich between primary care and hospitals.