A fine balancing act...

The last few weeks have brought into sharp focus just how challenging it is balancing quality and money as we have been finalising contract negotiations with our commissioners and setting budgets for the next year.

It’s clear that we’re still facing financial difficulties, with a predicted deficit of around £11m going into the new financial year. However, our Board recognises the need to continue to invest in our services despite this, and have made some key decisions to invest in quality improvement in areas such as safer staffing and Information Management &Technology. 
We have had some challenging discussions with commissioners over the last few months, but I am pleased to say we have reached agreement on a number of areas which I see as really positive: 

• We have secured an additional £2m funding towards safer staffing on our mental health wards
• Commissioners have agreed to fund our enhanced capacity mental health beds – these are additional beds over and above those agreed in our block contract that have been open but unfunded for a number of years 
• We have agreed to extend our community services contract with Trafford for another two years, with an agreed risk sharing agreement
• We are receiving transformation funds to support the development of mental health and community services in areas such as core 24 and out of hospital models

Although we have finished 2017/18 with a deficit, I am pleased that we have finished in a better position than planned with a c£4m deficit rather than £6-7m deficit as predicted at the start of the year. This would not have been possible without the efforts of all of you, our staff, and so thank you. It isn’t easy working in public services at the moment, but I am as ever, grateful for your continued commitment and hard work. I would also like to say thank you to the finance team as it’s always a challenging time of year managing the year end accounts and I recognise just how much hard work has gone into this.  

Maintaining and improving quality in times of reducing resources is incredibly difficult, but I have been struck by your hard work and diligence in continuing to provide great care and support on some of the visits I have undertaken recently.

Our Chair - Evelyn and I recently visited the Health & Wellbeing College and we were inspired by the stories of students there who have turned their life around and gone on to find work or further training. The college’s recovery-focused courses support people to recognise their potential and make the most of their talents and resources, through self-management. A real example of how we make a difference to the communities we serve. 

We both also visited Community Services in Bury and visited a number of different teams. Again, we were struck by how hard everyone is working to deliver good care but also recognised just what a high degree of stress and strain increasing demand is placing on individuals. Services in Bury seem to benefit from very strong team working which appeared to help teams cope with this, but it was still a concern for us. 

And we heard from the Oldham West Community Integrated Team at a recent Board meeting and we were all struck by the strength of their partnership working and the impact this was having on people’s lives as demonstrated in the patient stories they shared. These showed patients receiving a more timely and efficient service, and this integrated way of working is one I am keen to see develop across other areas.

My apologies to the HMR Mental Health services for not being able to get to your away day last week, but am hoping to get to the next one. 

So, my thanks to all of you trying to keep quality first and foremost in your services despite the challenging financial environment, and we will continue to do our best to create an environment where this continues to be possible. 

Claire Molloy
Chief Executive

Working together to make improvements

As it has been just over six months since I joined Pennine Care, I thought it would be a good opportunity to share my thoughts after a period of listening, talking to staff and taking stock of where we are in conjunction with the Board.

I have previously spoken about an independent Well-Led Review in my blog which was commissioned by the Board and took place in January and February. This review looked 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 findings of the review were shared with Board towards the end of March and only by honestly assessing where we are can we truly enable meaningful changes and improvement to happen.

The findings provide a clear indication of what we’re doing well as an organisation but have also highlighted areas of improvement we need to focus on. The detailed findings will be used to develop an Organisational Development (OD) Improvement Plan of how we need to change the way the organisation is run to place the delivery of high quality, compassionate and continually improving care at the heart of everything we do. I am very keen that we provide an opportunity for staff to be involved in the development of our plans so that we can shape our future direction together. As part of getting that robust diagnostic of what we need to improve, we will also be conducting a cultural audit with staff to focus on how we do things at the Trust, what our values mean to us and what the Pennine Care way should be. Please look out for further updates on this in the near future.

Next steps

To support this important agenda I am looking to work with key clinical and managerial leaders and staff in a range of ways:

·       Trust Management Board: A new formal monthly business meeting will replace the current Executive Director Performance meetings from May onwards. This group will bring the Exec Directors together with representation from our managing directors, corporate heads and clinical leads to discuss organisational strategy and performance. Invites will be going out soon.

·       Collective Leadership Group: I will be establishing a new monthly informal forum comprising of our 40-50 senior managerial, clinical and professional leaders to help shape and influence the Trust’s direction of travel. We are planning a ‘launch’ of this group in early May.

·         Trust-wide Strategic Planning Days: Twice a year we will be holding a bigger workshop similar to the one held in November for a broad range of approximately 100+ staff to ensure team leaders are kept up to date on what is happening and have an opportunity to shape how we work.

·         Staff Reference Group: The existing staff engagement group will be expanded to include a good representation from across our services, managers and front line staff – some of whom I’ve identified on my visits to services who have been keen to be involved. This group will support me in overseeing the development of our OD Improvement Plan and work around our values and organisational culture. I am currently finalising arrangements and will be in touch very shortly with people who want to be involved to confirm how we take this forward.

How you can get involved

It’s important that we develop our areas for improvement in partnership with you, our staff, and there are a number of ways you can get involved:

·         Participate in our organisational culture engagement – we want to hear from you to gain a full perspective on the organisation so that we can strive towards improving things. Staff will have an opportunity to share their thoughts at focus groups or through the Go Engage surveys. Please look out for further updates.

·         Raise any thoughts or comments through your senior managers or leaders so that they can be fed into the above groups.

·         Let me know if you are interested in being involved in our staff engagement work or joining the Staff Reference Group. We will find a way to involve you, whether this is by way of a virtual network or other means. I can be contacted on:
ceo-penninecare@nhs.net

I look forward to updating you on developments.

Thank you for your continued support and contribution.

Claire Molloy

Chief Executive

A focus on engagement...

At the start of the year I mentioned that we were beginning a period of significant change, challenge and improvement and I am pleased to see some of this is beginning to take shape.

I have mentioned the Well-Led Review in previous blogs and that any change or improvement starts with having an honest assessment of where things currently stand. The review has looked 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. We are hoping to share some of the themes that have come out of this work during April, so watch this space.

The Board held a development session on the 19 March focusing on the initial outcomes of the review and how to address some of the challenges. This review will form part of a broader diagnostic about where we are as an organisation.

Together with other sources of information, we are hoping that by the end of May we should have a comprehensive view of what’s good and not so good here at the Trust and areas of improvement to focus on.

I am keen though that this is a partnership with you, our staff. This shouldn’t just be led by the Board, or Senior Leaders. I want to know what you think about working in Pennine Care? This will make sure we have a rounded perspective on the organisation.

We already have tools in place to measure staff engagement and temperature check where we’re at – Go Engage is a key part of this. I would like to say how sorry I am that I missed the celebration event last week due to illness, it was great however to hear some of the fabulous stories of how teams were able to improve engagement scores within their work areas by implementing tools to improve aspects of engagement such as communication, team building and feedback. The next Go Engage survey will be out in April, so please do take the time to fill this in.

In addition to these mechanisms I am also keen we do some specific work to engage with staff. So, I will be working closely with Fiona Ibberson from the Organisational Development team to set up some focus groups with staff looking at our values within the organisation and how much they resonate with staff.  Very importantly, I want to know if people see our values being translated in the way people behave and undertake some work on the sort of behaviours we really want to see.

We will also be undertaking a cultural audit – this will be in the form of a questionnaire, but will be different to the staff survey. This will focus on the way we do things at the Trust, “We are what we do”. I want to know the way we do things and why?

We already have a staff engagement group, but I am looking to build on this to establish a small group (15-20 people) to work directly with me on this. I have already identified some people through my visits to services that are keen to be involved but this is an open invite to be involved in this work, to shape our future direction. I am looking to ensure we have a good representation from across our services and mix of managers and more front line staff. If I get more people than needed, I will expand this group to an informal network and find ways of engaging you in this work.

If you’d like to be involved, please email me: Claire.molloy1@nhs.net And I will obviously use this blog to update you on this work going forward.

Finally, thank you to those of you who are working over the bank holiday but I hope that everyone gets to spend some time enjoying the lovely sunny weather we are expecting!!!

Claire Molloy
Chief Executive

You are our eyes and ears

Some of you may have picked up the announcement this week about the results of the NHS Staff Survey. 

This has been running since 2003 and asks NHS staff in England about their experiences of working for the NHS.

The survey provides essential information to national stakeholders and employers (such as us) about the staff experience across the NHS in England.

This year, almost 32 per cent of you completed your survey which is lower than the average of 45 per cent. I appreciate this has been a challenging time for many of our services, but the information you provide in this survey really does make a difference to the way we structure our services and provide care and support. 

In our results for this year, I am pleased to see that the percentage of you agreeing that your role makes a difference to patients and service users is high. I am keen that we put our service users at the heart of what we do going forward. Last week proved how far you are prepared to go to deliver on our promises to provide care to those in our communities – I am still in awe of all your efforts.

Secondly, it is heartening to see that the percentage of staff experiencing physical violence, and the percentage of staff experiencing discrimination in work in the last 12 months is low. In a mental health and specialist trust, such as ourselves, often the instances of violence are higher than we’d like, due to the complex nature of our vulnerable patients. If you do experience violence, please do report it as soon as possible.

There are things we need to improve on. The percentage of staff working extra hours is higher than we’d like. We do have flexi-time and overtime policies and I would encourage you to speak to your manager if you feel your workload is unmanageable. 

You also told us that a lot of you have attended work in the last three months, despite feeling unwell, due to pressure from managers, colleagues, or yourself. And that the percentage of you feeling unwell due to work related stress in the last 12 months is high. This must stop. If you are unwell, you are unwell and we do not expect you to attend work. Your health and wellbeing is important to us. 

We have the Staff Wellbeing service which I would encourage all of you to use if needed and our Wellbeing Wednesday emails are full of tips to help you balance work and life – the latest one came out this week. I know your commitment is very high, but we all need a break at times. 

Lastly, the percentage of you reporting most recent experience of harassment, bullying or abuse is high. This is not nice to read. I don’t want anyone to come to work and feel intimidated. Our HR colleagues are working on a new campaign focusing on respect in the workplace. This will recognise our diverse workforce and aims to tackle bullying and discrimination. In the meantime, if you experience anything you aren’t happy about, please report it to your manager, or if you don’t feel you can, please contact our Freedom to Speak Up Guardian, Lisa Ryder.

You are the eyes and ears of our organisation; we rely on you to tell us when things aren’t working. Please don’t feel afraid to speak up. My door is always open.
In the meantime we will be working through the survey in more detail with our teams and will be seeing what more we can do to address the concerns this raises. I’ll share more on this at a later date. 

Claire

Beast from the East is no match for our staff

As we come to the end of a very challenging (and cold) week, on behalf of the Board, we want to extend our deepest gratitude to our staff; not just our frontline clinical staff, but those who provide support behind the scenes to keep services running.

We have been in awe of how you have braved the elements to make sure patients continue to receive the care they need and deserve.  Your dedication, commitment and concern for patients is inspirational.

We know just how difficult it has been for many of you to travel from a to b; particularly those who live or work in more remote locations.

There have been some amazing examples of staff going above and beyond.  We have heard how some mental health ward staff stayed over at work, to make sure they could cover their next shift.  Other staff have worked a longer shift to cover for colleagues who were running late due to the weather.

We have seen photos of community staff knee deep in snow, but keeping their spirits up by sharing amusing anecdotes about slipping and sliding into snow drifts.  We have heard stories about staff abandoning their cars and walking miles to make sure they reached their next patient.   

Our estates staff have been working hard to keep our health centres and office bases safe; no doubt many of you will be sporting aching muscles from all the grit and snow that has been shovelled.  

What is apparent from all of these stories, along with feedback from managers, is what absolute heroes you all are.  This is true all year around, but your tenacity is even more evident when faced with a difficult situation.  

Your fantastic work was noted by the Board during this week’s meeting and has been formally noted in the minutes.  The Manchester Evening News has also been in touch with our Communications Team for some stories and photos.  Click here to read the article.  We've also been approach by Key 103 and Heart FM.

You should be hugely proud of yourselves – the Beast from the East is no match for you!

In view of all this great work, it seems quite appropriate that nominations for our CARES Awards 2018 open on Monday (5 March).  These are an opportunity to recognise and celebrate our services, teams and individuals who uphold our CARES values and to share learning and best practice across the Trust.

Look out for more information on Monday.  We’ve no doubt there will be many inspirational entries.

Finally, while the snow and ice continues, please stay safe and take care of yourself and others.  You can find lots of advice on the Trust website at www.penninecare.nhs.uk/staywell 

Take care and thank you again.

Claire Molloy
Chief Executive 

Evelyn Asante-Mensah OBE
Chair

What is our North Star?

For those of you who have worked in the NHS for some years, you will recall it is just over 5 years since the publication of the Francis Report. Published in 2013, this report was the

culmination of a public inquiry into serious failings at Mid Staffordshire NHS Foundation Trust.

The damning report detailed first and foremost the appalling suffering of many patients. This was primarily caused by a serious failure on the part of the provider Trust Board, which didn’t listen sufficiently to its patients and staff or take action to address quality failings.

Also in the news over the last few weeks has been the report of the Independent Review undertaken by Sir Bill Kirkup outlining widespread failings surrounding community health services at Liverpool NHS Community Health Care. The findings make depressing reading as they highlight once more the dreadful impact for people of a disproportionate focus on the prioritisation of cost improvement plans over quality and patient safety; and the stress and adverse consequences for staff who tried to raise their concerns.   

As a number of key publications have done in the national media, this latest story calls into question just what has changed over the last five years? I have been ruminating on how we here at Pennine Care can avoid some of the mistakes highlighted in the report, especially given our challenging financial position. Of course, we all need to ensure we do everything we can to reduce waste and stop doing things that don’t add value. But how we do ensure that we do this in a way that doesn’t unintentionally impact on quality?

With this in mind, I think there are three key areas we need to focus on to mitigate this risk:

1) First and foremost we need to be clear on what guides us – what is our North Star? We should always place the development of high quality, compassionate and continually improving care and support at the heart of everything we do

2) Secondly, we need to ensure that any proposals to change services or reduce costs are always properly assessed for their impact. And not just with regard to each scheme but collectively. I keep saying that it’s like losing weight – a pound seems like a small amount, but if you keep losing a pound every week, pretty soon you are going to be in serious trouble! So, we must assess risk properly and produce Quality Impact Assessments to ensure any savings proposed are done so with a robust consideration of the impact on quality and safety

3) Finally, building on the Francis Report, we need to create a culture where people feel able to tell someone if quality is being compromised. You are our eyes and ears of this organisation and if you see things you’re not happy about, you should not be afraid to speak up. And if you hear or see stories of people who have been penalised for doing so, this is not acceptable and I want to know about it and understand why to ensure it doesn’t happen again. Our Freedom to Speak up Guardian (Lisa) is always on hand to listen if you don’t feel able to raise concerns with your managers.

I want to end this blog on a high and to say how pleased I am that our ‘Fluperheroes’ have worked so hard to ensure we are in the top 5 most improved Trusts in the Country for vaccination rates – well done! We are just a handful of people short of our 60% target, so if you haven’t had your vaccine yet, please see the intranet for details of how to get this done.

I’m always keen to hear your thoughts, so do email ceo-penninecare@nhs.net with any feedback.

Claire Molloy

Chief Executive

A couple of weeks with a focus on partnership working

Over the past couple of weeks, I have been meeting with partners to discuss our service contracts and plans for next year. We’re really getting down into the nitty gritty now of what we can and can’t do and we will hopefully be crystallising some joint decisions over the next few weeks or so.

I have been flagging with commissioners the implications of funding for some of our critical improvements, such as safe staffing, and what the potential consequences are if money isn’t forthcoming. I have talked previously about the need to ensure our service offer matches the resources we are being given and we have an important workshop on 20 February to try to reach some agreements about a number of key areas. We would then be taking these to our Board on 28 February to agree our Trusts approach. So watch this space for further updates.

This week, I also met with colleagues from the Northern Care Alliance, which is collaboration between a number of NHS Foundation Trusts currently bringing together five local hospitals, 2,000 beds, specialist and acute services, a range of community services, and over 17,000 staff from Salford Royal NHS Foundation Trust and The Pennine Acute Hospitals NHS Trust.

We discussed potential opportunities for Pennine Care to work collaboratively with the Alliance and spent some time sharing each other’s agenda’s and looking for ways we could work more closely together, particularly on Out of Hospital’ models and Urgent care pathways. This could, for example, include some joint posts going forward. 

We haven’t agreed anything specific at the moment, but it was a productive and friendly meeting and we have agreed a follow up session soon to explore what some of these opportunities might look like in a bit more detail. We will ensure colleagues in our locality teams are kept engaged in this and I will continue to keep you informed of progress on this key piece of work.

One thing that has struck me this week on a visit to HMR community services is the spirit of our staff and their ‘can do’ attitude. It’s been a difficult six months for the team and services there, with a lack of Managing Director until very recently and ever increasing demands on their services. But they have really stepped up to the plate and continued to provide the level of service our patients expect and deserve. They have established good relationships with our partners and demonstrated some great examples of cross borough working, which I think is fantastic. Well done everyone!

I appreciate that there’s a lot of change going on at the moment, and I have picked up some anxiety and concerns from you all about what this might mean. The implication of our financial position and what services we will be able to provide in the future is no doubt a worry to many of you. I also know that when money is tight people worry about what it might mean for them personally. 

Through our Partnership Officers at our JNCC meeting this week I have picked up some concern that some of the engagement we have been doing recently, for example on our Mental Health Strategy and case-loads within Community Mental Health services, is creating some anxiety for people about what it means. 

Can I just offer some reassurance that this engagement comes from a very positive place of recognising just how much pressure our services are under and trying to seek your views about we should do to try to address these pressures. We have hugely caring and skilled staff and we need to do everything we can to retain people. 

The improvements we most need to make are about reducing the stress and strain on our staff not about reducing our workforce. So please be reassured, I am committed to keeping you engaged and informed in how we can improve things, and will continue to engage with you on a personal level and via our leadership teams.

And on the subject of engagement, I would encourage you all to participate in the Go Engage surveys which take place across the Trust once a quarter; these help me and the Board to understand what it feels like for you working here. The next one is due out very soon and there is a celebration event of the teams who have engaged in this programme in March which I am very much looking forward to attending. No doubt details about this will follow shortly.

I’m always keen to hear your thoughts, so do email ceo-penninecare@nhs.net with any feedback.

Many Thanks,

Claire
Chief Executive