A look back at the last year

It was great to take some time to reflect on our achievements from the past year at the Trust’s Annual General Meeting (AGM) earlier this month.  It was my first AGM as Chief Executive and I was really proud of what we have achieved as a Trust.  When you see it all together it really hits home.  

I want to say thank you to all our staff who work tirelessly providing care despite the challenging times we are in, looking after people's mental and physical health and supporting patients, people and families to meet their health and social care needs. 

Nearly six thousand dedicated staff work tirelessly to look after people with health and social care needs. And behind each and every of those contacts is a story of helping somebody young or old, patient or carer, who is vulnerable, in pain, suffering, and in need of our help. The work we do is important and makes a difference - it touches the lives of thousands of people every day. 

Community services highlights 

2013/14 was a highly successful year for our community services.  We secured the contract for Trafford community services and we retained the contract for something like 96% of the community services in Oldham.  These are just two big examples that show time and again that Pennine Care is the partner of choice for Greater Manchester when it comes to running community and mental health services.  It shows a big tick against the work of our staff in the community for their care, compassion and expertise.

Overall it shows a direction of travel to care outside of hospital.  For patients it means your care is more often in your home or closer to your home. We are also building in self-care programmes, educating people on the condition they have.  In my view, care at home is more personal, more dignified and it puts the patient at the centre of their care aiming to empower them to take control in the way care is planned with them.

Mental health highlights 

Because of our long standing background of providing mental health services it means we have a strong connection with communities.  It also means we are psychologically-minded, which is often underestimated in providing good modern healthcare.  I think by and large we provide excellent mental health services and since 2002 when the Trust was formed I believe the care has increased in quality year on year. 

Patients now get more timely care, better access to psychological therapies, reduced waits if you attend A&E, better mental health support on medical wards if you are in hospital with dementia or confusion and if you come into hospital with a mental illness the wards where patients stay are of a much higher quality than 10 years ago.

Keeping care in the community 

Care outside of hospital won’t just happen, we have to make a case for it to happen.  If we are to transform care from long standing pathways that end in hospital, to care pathways that keep people out of hospital we have to be able to demonstrate that what we do works.

Increasingly now we are seeing the metrics, the data that shows we can deflect care away from hospitals and provide care in community settings.

Look at these figures - if you are assessed by our RAID team you are six times less likely to be admitted to an acute hospital.  The University of Chester study on this has shown a potential £3.3 million savings could be realised from the deflected activity.

Similarly, in Trafford where the CCG have invested in an urgent enhanced care team, we are seeing that people are less likely to be admitted, more likely to be cared for outside of hospital, accessing more timely community treatments, and potentially deflecting £1 million of activity away from hospital. 

Better care more cost effective, in or near to people’s homes.


Staff engagement 
We want Pennine Care to be a great place to work. Often we are, sometimes we are not. We have become a better employer but we must do more. Over the last year we have had good close engagement with many of our staff. I’ve tried to live up to my commitment to being open and transparent with a regular blog and tweets.

We have established a new occupational health service with a staff wellbeing service, a more psychologically minded offer for support to our staff. Stress is one of the key reasons for absence from the workplace and we must make sure as a mindful employer we provide the right care and support for our staff doing busy and at times stressful work.

Over the next year we intend to get closer to our staff than ever before.  If we are to meet the challenges ahead we have to work well together, the Board, managers, clinicians, support staff everyone making a contribution to build and deliver plans for our long term future. 


There’s so much to be proud of and many exciting and at times difficult challenges ahead. As your Chief Executive I am proud and grateful for the opportunity to be leading this Trust as we go forward.

This short animation captures some of the key stats and facts about the Trust from last year: 

Thank you. 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Thank you et Merci Beaucoup

Since I launched my blog back in April, I'm pleased to say that it has now received more than 5,700 views.  Whether that’s a glance through, a thorough read, received well or otherwise - a big thank you for taking the time to read it.

I hope my posts are helpful, especially for staff to keep in touch with my thoughts and where we are up to with current challenges and developments within the Trust.   

I have had mostly very positive feedback on the blog, from emails, comments posted on the blog, twitter and even a chat by the water cooler.  All feedback is welcome and I hope it encourages discussion within teams.

There has only been one or two negative comments, these are still welcome, we can only lead effectively if we hear the good and the not so good.  

These are challenging times and we are having to make changes, save money and at times make redundancies.  I know this can make it difficult and add pressure at work, I am aware of it and one of our strategic goals is for Pennine Care to be a great place to work.  

But as well as talking about these issues on my blog, I also want to use it as a way of highlighting the good work that I see happening around the Trust every day.  Despite the challenges, we mustn't forget to celebrate success.    

I am still really keen to hear your thoughts about the blog - either post a comment, send me a Tweet or email. 

PARIS  

The use of French within this post is my seamless link to talk about the roll out of PARIS, our new digital care record system.  Given we are going through organisational change, pretty much constantly somewhere in the Trust, I am so impressed with how staff have received the new system. 

Despite busy jobs, service changes and increasing demands, when I have met teams everyone has been committed to making the new system work. I think that’s because everyone knows it will improve patient care and ultimately how we work to deliver care. There have been some challenges, glitches and things we haven’t got right and staff have told me when I have visited. We need to hear when things aren't working so we can fix it and learn from it.

I just wanted to say thank you, or merci beaucoup, to all our staff on implementing the new system and for being so welcoming when I have come out to meet teams as they get to grips with the new system.  It's great to see large paper files being closed and consigned to the archives. The system will improve care, provide a platform for mobile working, but it will also surely save thousands upon thousands as we become a paper-light organisation.

Finally, I was really tickled to hear how the Community Mental Health Team at Sudden Resource Centre had launched PARIS in their service. I understand the office was aromatic with the smell of coffee, staff wore stripy Parisian tops, strings of onions around their necks and no doubt one or two "Allo Allo" style accents here and there (younger staff may want to Google Allo Allo or tune into Gold on your TV!). Well done to the team - I’m on the lookout for photographs of your first day with PARIS! 

Rugby League is leading health and wellbeing

We recently held an event at SalfordRed Devils ground in support of the charity, Rugby League Cares (RLC) and the great work of the charitable foundations across rugby league. The event was supported by Pennine Care, the Red Devils Foundation and the One Medical Group.

In Pennine Care, we believe health and wellbeing work is most successful when it is delivered in communities, in ways that make sense to local people. All too often we promote healthy messages, or health professionals tell people to stop smoking, drink less or lose weight, without truly thinking through how hard it can be to stop or change something to improve your health.

Rugby League Cares and the charitable foundations of rugby league’s professional clubs and State of Mind promote health and wellbeing – with a difference. Firstly, they know their communities and their communities know them. It opens doors and rugby league fans will listen to ambassadors from their clubs, maybe more than they would their GP. Secondly, to quote one of the speakers at the event, Professor Alan White, “there’s more to sport than sport”. Sport reaches people and communities in a unique way the NHS could never replicate.

Mike Farrar and Professor White spoke at the event about this. There’s more on sport and health here and here. 

There is an emerging evidence base for sport and how it promotes physical activity and improves health. We don’t do enough to promote this. It is this link that led me to be interested in working with rugby league partners to bring together the event, which aimed to launch the idea of ‘A Year of Health and Wellbeing in Rugby League’.

I was fortunate enough to open the event with my own personal experience and it went something like this…

“In welcoming everyone today, rather than talking about health policy or the work of the NHS, I just wanted to share a personal reflection on how the great game of rugby league positively influences people’s lives.

This is Mick, known to some as Michael, in the Army he was called Mac. I call him Dad. There he is barbecuing aged 88. Dad’s a lifelong Leeds Rugby League, now Leeds Rhinos, fan. He was at a very famous final in 1968 to see Leeds win a very close game in difficult wet conditions.

As I grew up, from a an early age he would take me to many Leeds games at Headingly and as a tradition we would go on Boxing Day to watch Leeds play at home. Dad’s love of rugby league and many sports rubbed off on me. He would talk about how fit players were and how important it was to look after your health. He encouraged me to be active, to play sport and to play team games. I played rugby through school and beyond. 


I'm convinced that Dad’s love of Leeds rugby league and the sport in general was a key reason I had such a positive experience of sport as young boy and as a young man.

Terry Flannagan, Chair of Rugby League Cares, talks about how people benefit immensely from their experience of rugby league. I definitely did.

The work of Rugby League Cares and the professional clubs’ charities and foundations understand communities, rugby league communities, like the one I grew up in, and they know how to bring the game and its positive image into people's lives to influence and improve health and wellbeing. Their work and their contribution is often unheralded. Hopefully we can shine a light more on their great work.

As Terry says the foundations are champions helping hundreds of thousands of people to lead healthier and wealthier lives. Rugby League Cares, the foundations and the ground breaking mental health work of State of Mind are ambassadors for the game and ambassadors for better health in rugby leagues game and its communities.

Whenever health is mentioned we usually think of the NHS. Health isn't the NHS. Health is something we own, our health and something the NHS plays a part in. But in talking too much about the NHS we talk too little about the difference the foundations, State of Mind and others can make and do make to people's health and wellbeing. Today is about bringing their work to the front more. I believe we the NHS can do more to promote and support their great work and the benefits of that will pay for themselves.

I think we should think of today in two ways, as a celebration of what's already been achieved and as a challenge for 2015 to achieve even more.”

The event went very well and there was a real energy about the possibilities of promoting health through rugby league’s connection with its grassroots communities.

I found something really interesting during the day and the notion has stayed with me since. It links to these lines from my opening welcome; ‘Whenever health is mentioned we usually think of the NHS. Health isn't the NHS.’

A number of people came up to me and said that comment had really struck a chord with them. As one person said to me, “If there’s one message I will take from today it’s that health is my health, not something the NHS will sort out when I get ill, but something for me to look after. I’m responsible for my health and to sort it out before I get a heart attack, not wait for the NHS to fix something after I have one.”

I think we do, all too often, think of health as the NHS. This is symptomatic of the dependency model we have created over many decades. The NHS is a provider of healthcare, to people who need support when their health deteriorates or when we can protect against illness, for example immunisation.

Health isn’t the NHS, it is something we experience, we literally live and breathe it every day. We can’t control our health entirely, some accidents and illnesses can’t be foreseen or prevented, but we can improve our health significantly by taking as much responsibility for it as we can.

In trying to shine a light on Rugby League Cares, the Clubs’ Foundations and State of Mind at this recent event, we made a small attempt to nudge our collective thinking away from health is the NHS. The work of these charities (look them up) is phenomenal and they reach hundreds of thousands of people every year, helping people make better health decisions and get more active. They do a lot for small amounts of investment, so they are good value too.

If we are to provide care outside of hospital, if we are to provide health and wellbeing support that communities engage with, then the solution won’t be the NHS. It has a part to play, a very important role. However, the NHS has to work with and embrace partners and together we have to build a very different health offer. One that gives health back to people and moves it away from the dependency model of the NHS.

Leading by example

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

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

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

“Dear colleagues,

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

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

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

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

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

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

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

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

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. 

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