Well-led review and CIPs

I talked last week about the well-led review that is being undertaken.  Interviews have been taking place over the last week and I have had a feedback session with the independent review team. 

I'd like to thank people for their support in undertaking this review, which I believe will provide a foundation from which to make lasting change and improvements here at Pennine Care.  I appreciate people's honesty and encourage it.  The findings of the review will be shared with the whole Board of Directors in February and we will then use it to formulate an improvement plan.  This also ties in with the cultural audit that the organisational development team will be undertaking over the next few months, again I have talked about this in my blog before and will provide more detail when the time comes.  

We have been having a major refocus on our cost improvement programme (CIP as you will know it) for the remainder of this year and next financial year.  The good news is that it looks like our deficit at the end of this year will be more like -£5 million as opposed to the -£6.6 million expected.  This is due to the Trust including some additional funding from commissioners in the forecast.  This money has been allocated to alleviate existing pressures within mental health inpatient areas. 

I fully appreciate how difficult it is for staff to make budget reductions now.  We cannot simply top slice budgets any more.  So, I am working with colleagues to develop a new approach for how we will deliver a CIP, which involves bigger change programmes, cross-cutting themes and corporate efficiencies.  It will require a great deal of collaboration and engagement across the Trust and with our partners, so expect to be involved in this at some point. 

As things are really starting to ramp up now, I may not be able to post a blog each and every week but I will aim to provide an update at least every fortnight.  Thank you for continuing to read my blog, I read all of your feedback and comments, which has been really positive.  Please keep them coming! 

Many Thanks
Claire 

E: ceo-penninecare@nhs.net
T: @ClaireMolloy2

My five ways to wellbeing

Earlier this week you will have received a Trust email giving tips on adopting the five ways to wellbeing and as January is typically the time when people endeavour to make healthier choices, I thought I’d share some of the things I do to maintain my own wellbeing and resilience. It’s also timely because this coming Monday is known as ‘blue Monday,’ which is supposed to be the most depressing day of the year!

The five ways to wellbeing are connect, be active, take notice, keep learning and give.  These days we all lead very busy lives and work hard, nowhere more so than in the NHS, so I think it’s really important that we try to take some time to look after ourselves and our wellbeing.  The daily challenges and pressures we face at work and home can really test our personal resilience, so the five ways to wellbeing are thought to provide a good framework for maintaining good mental health.  Here is how I try to adopt them…

1.         Connect

My family is the most important thing to me and I spend as much of my time as possible with them, especially my first granddaughter who was born just before Christmas! Being closer to family was one of the attractions about moving here. Being able to talk and share with them is really important. We all need someone to 'off load' to and to share problems with and I don't know how I would manage without my patient husband who is great at just listening to me rant on occasions! 

2.         Be active 

I try to exercise regularly, although I haven’t been as active as I should be recently. I have a huge passion for climbing and mountaineering and most of my holidays are spent doing this sort of activity. I know it sounds counter intuitive, but for me, I find this much more relaxing than any beach holiday, although occasionally I do wonder whether I shouldn't just be hanging up my boots and taking it easier! My most challenging climb was in the Himalayas a few years ago when I was part of a small team who managed to climb a mountain that hadn’t been attempted before. It was a huge challenge and I spent a lot of the time feeling scared and but it was very rewarding, especially since we managed to get to the top and down safely! One of the things I love about climbing is that your mind has to be completely focused in that moment, instead of thinking about all the others things going on in your life.

3.         Take notice

As you can probably tell, I really enjoy spending time outside and appreciating the beautiful countryside we have. I go walking quite a lot as it is free and relatively hassle free and this provides the chance to explore.  My journey to and from work takes me over Chapel Brow from the high peaks into Charlesworth, and I love that moment in the morning when I reach the top driving over and can see the fantastic views of Manchester and beyond (when it  isn't foggy!) I always pause for a moment to appreciate the view and I’m looking forward to being able to stop there in the summer months and maybe do a walk or a run on the way home.

4.         Keep learning

I’ve certainly been on a learning curve since taking up my new role with Pennine Care and like to continually learn in my professional career.  A few years ago I also learnt to play the piano. It's so hard learning an instrument as an adult, but I can now play Beethoven’s Moonlight Sonata, although rather badly!  I’ve also recently been to a lino-cut printing workshop where I made this fine piece of art…. well I was pleased with it anyway!   It was like potato printing for adults! I’m not particularly a creative person but it was quite relaxing and calming cutting the shapes out, like a form of mindfulness.

5.         Give

Quite a few years ago we decided as a family to stop spending lots of money on fancy Christmas gifts and instead give money to charity. We do a secret Santa so we each get one decent gift but then have a little competition to determine which charity we donate the rest of the money to. It’s a really nice, fun thing to do. 

As part of the Trust’s work on staff wellbeing, we have all been encouraged to make a personal pledge against one of the five ways to wellbeing.  My pledge for this year is that I want to continue to connect with people in the organisation and especially staff on the frontline, and so will be aiming to spend at least one day each month out visiting clinical services and also holding some larger engagement events with staff over the coming months. 

You can make your own pledge here: http://portal/shwbr/Pages/Contact.aspx

I look forward to reading all of your pledges!

Thanks,

Claire

Claire Molloy

Chief Executive

E: ceo-penninecare@nhs.net

T: @ClaireMolloy2

"a year of significant change, challenge and improvement ahead"

Happy New Year to you all.  I hope you were able to have some time with family and friends over the festive period.  Of course the NHS doesn’t close for Christmas, so I’d like to say a big thank you to our staff who were still in work providing patient care.  

It is proving to be a particularly brutal winter and the pressure on the NHS is greater than ever.  I know many of our teams are doing all they can to treat patients at home and in the community to help reduce the pressure on local hospitals.  One of the biggest causes of pressure this year are people with respiratory illnesses and flu, so we can all do our bit by having our flu jab.  Whilst the national average uptake for healthcare staff is 59%, unfortunately our Trust uptake falls short at 44%.  Please do have the vaccination if you haven’t already.  It really does make a difference in preventing the spread of this nasty illness.

The start of the year is the perfect time to refocus and make some resolutions for what we need to change, in life and work.  At Pennine Care we’ve got a year of significant change, challenge and improvement ahead, starting with some intensive work over the next three months.  

Any change or improvement starts with having an honest assessment of where things currently stand. So, it is key that over the next few months we collectively try to crystallise what we think needs to change and how we will go about it.  This applies both on the frontline and across the organisation as a whole. With this in mind, the Board has recently commissioned an independent ‘well-led’ review to be undertaken over January and February as one of the ways of identifying where we need to improve and to provide an objective analysis of how we operate. 

The review will look at several areas including whether we have a credible strategy, our culture, leadership particularly at Executive and Board level, how we learn and improve and how engaged staff are.  The Board already has a sense of some of the areas we need to improve, but as well  as hearing from the Board the review team will also be analysing data and information; visiting some frontline services and interviewing other senior leaders to get a fully rounded picture. This is an opportunity for you to help me and the Board shape what needs to change, so I would encourage everyone involved in this to be as honest and frank as you can.  We are only going to be able to move forward and improve the way we do things if we know how things really are.

At the same time, we are also starting to formulate plans to conduct a cultural audit.  Our organisational culture has a direct impact on how we function, behave and ultimately provide patient care.  I think it is important that we have a comprehensive view of how our current culture is, both positive and negative attributes, so we can then work together to shape a culture that is open, supportive and patient-focused.  Of course we need to involve the whole workforce in this audit, so we will build in information we have previously collected as well as potentially holding a number of CEO-led staff listening events to gather your views and insights. 

So here’s to a productive year ahead and thank you greatly for your continued hard work.

Many Thanks

Claire

E: ceo-penninecare@nhs.net

T: @ClaireMolloy2

Thank you and best wishes for the festive season

As the end of the year approaches it provides an opportunity for reflection, thanks and a look forward.

2017 has been a particularly significant year for Pennine Care with many achievements and challenges along the way.  Some of the most notable things to happen have included posting a financial deficit for the first time; strengthening joint working arrangements with commissioners; moving forward with the CQC/quality improvement plan; mobilising the Manchester Resilience Hub in response to the Manchester Arena attack; implementing the new operating model to create locality groups and combining mental health and specialist, as well as the appointment of a new Chief Executive and Chair.  So it’s been a pretty eventful year! 

Despite the amount of change and challenge facing the organisation as a whole, our staff have continued to work tirelessly to provide care to patients.  This applies to those in clinical roles and enabling support roles.  In fact, staff couldn’t be working harder and many services are running over capacity.  I’ve talked about the need to redress the balance between demand and quality previously and this will continue to be a priority theme into next year. 

When I joined Pennine Care in September, I said that I wanted to refocus on staff engagement because I believe that if we properly look after our staff, we will in turn provide the best care to patients.  From speaking with many of you, there is clearly a great deal of passion and commitment from staff, who put in a lot of discretionary effort, but there is a sense of people being quite tired and weary.  My overall impression is that staff do like working here and there is a strong sense that people are really up for a new approach to take us into the future.  Improving how we support and develop our workforce will also be a key priority for 2018.  

This year we have also held our largest ever giving back campaign to provide those less fortunate with food and gifts over the festive season.  The response from staff has been phenomenal, everyone has been extremely generous.  We raised £150 from the Christmas jumper day, donated 35 Christmas shoeboxes to homeless appeals and made many considerable donations to food banks around the Trust footprint, enough to fill 58 car boots! 

I would like to thank each and every one of you, staff, volunteers and supporters alike, for your continued hard work and commitment over the last 12 months, it hasn’t been an easy journey but there is much to be proud of.  I want to continue to build on our success into the next year and work more closely together across the Trust to overcome the challenges we face. 

I wish you all the very best for the festive season, especially to those working over the Christmas period.  I look forward to working with you all in the New Year.

Many Thanks

Claire 

Claire Molloy
Chief Executive

E: ceo-penninecare@nhs.net

T: @ClaireMolloy2

Delivering on our intent

I’d like to start off by saying thank you to everyone who took the time to read or respond to last week’s blog – it has been viewed nearly 1600 times and I have received direct feedback and comments from around 40 members of staff.  

If you haven’t read it, the post basically talks about how we need to strike a better balance between the capacity and demand on services, so we no longer compromise on quality standards.  Too often our services are being stretched too thinly to meet increasing demands.   It obviously struck a chord with many of you and I am very appreciative of you taking the time in your busy working lives to read the blog and comment. We just have to deliver on this intent now!

As I mentioned, we have started to address these issues with commissioners and a key meeting is being held next week between our executive team and the chief officers from our clinical commissioning groups to discuss the approach we would like to take and to put some stakes in the ground. We need to find ways of supporting our managers and clinical leaders to have some of these conversations too, within a framework but knowing we have your back.  Whilst it may involve complex negotiation, I am determined that we will be driven first and foremost by quality standards that ensure our services are safe.  

Because we know this will involve transformational change, we need to find ways of bringing the leadership of the organisation together to have those difficult discussions about how to tackle our financial challenges in such a way that we don’t compromise quality. To support our collective leadership, I will be holding a workshop next week involving our managing directors and senior leads to agree how we will approach this. As you know, the Board has agreed to run a deficit for this year and next and we know we can’t improve the financial position by simply top slicing budgets further and further. But we do need to explore how we can deliver our quality aspirations in an affordable way.  

The Board and the Council of Governors had a workshop this week to go over some of the Trust’s main priorities.  I have talked about these in my blogs before, but this includes:

• being clearer about our long term strategy; 
• implementing priorities around quality, people, partnerships, money and infrastructure; 
• and changing the way the organisation is run to create a positive culture of learning and improvement.

It was a welcome opportunity to work more closely with our Governors as representatives of people who use of our services and it was helpful to listen to their views.  We had a particular focus on progress on delivering our CQC Improvement Plan and in particular, the need to address mixed sex accommodation issues on our mental health wards. I am keen to ensure we continue to have an open, co-production approach with the Governors, involving them in future service redesign.

Finally, because I had such a good response to the last blog, I am really keen to hear from staff about what other topics you think are important.  Whilst my blog is an opportunity for me to tell you what I’m up to, it is a platform for you to ask for comment or feedback on burning issues.  If you have anything you think staff would like to know more about, do drop me an email to let me know. 

Many thanks

Claire  

Claire Molloy

Chief Executive 

E: ceo-penninecare@nhs.net

@ClaireMolloy2

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 

My week: Things are starting to take shape

I’ve now been in post for a couple of months and things are really starting to take shape.  But I don’t have a grand plan to unveil, that’s something we all need to co-produce together.  

After spending time with board last week, I have this week been part of a strategic planning event involving around 100 of our senior clinical leaders and managers from across the Trust.  It’s the first time in a while people have been brought together on this scale and it was fantastic for me to be able to hear directly from each division about their achievements, successes and future plans. 

I was able to share some of my own early reflections with our collective leaders... there is clearly a great deal of passion and commitment from staff who put in a lot of discretionary effort, but there is a sense of people becoming a bit tired and weary.  Also, whilst Pennine Care has until this year been able to successfully meet its financial savings targets, this has come at some expense to maintaining quality levels, which we need to address.  The devolved operating model is viewed positively in general, although there isn’t a strong sense of an integrated organisational identity.  I’ve also observed that clinical and professional leadership is less obvious within the organisation.  Overall, from the many conversations I’ve had with people, staff do generally like working here and there is a strong sense that people are really up for a new approach to take us into the future, which is great for me.

Taking all of this into account, I have been working with colleagues to start to develop our priorities, which include revising our strategy with a clearer narrative and business plan, as well as focusing on organisational effectiveness, which is about our culture and how we run the trust.  I have also started to work on some early delivery priorities, which are under the general themes of quality, people, partnerships, money and infrastructure.  I’ll share more about all of this soon and plan to come out to test the thinking out with frontline staff too.

I also attended the Joint Negotiating and Consultation Committee away day this week, following on from an informal meeting with Partnership Officer last week.  Again, this was really useful and further cemented the importance of this group in navigating the challenges facing staff and services.  We had an open and frank discussion between Partnership Officers, representatives and managers, with a heavy focus on the future roll of this committee in listening to staff concerns, resolving them and providing a valuable forum to shape our people plan and approach. 

Many Thanks

Claire 

Claire Molloy

Chief Executive 

E: ceo-penninecare@nhs.net

T: @PennineCareNHS