Time to grasp the nettle

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

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

Working together  

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

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

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

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

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

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

Partnerships in practice

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

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

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

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

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

Putting people first

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

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

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

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

New models of care and mental health 

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

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

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

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

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

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

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

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

A five year forward view across Greater Manchester

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

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

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

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

Michael 

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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.

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