Being a great place to work in challenging times

A few weeks ago the Health Service Journal and Nursing Times unveiled their list of the Best Places to Work in Healthcare – and I’m proud to say that Pennine Care made the list.  

The list is hailed as a celebration of NHS organisations that have worked hard to promote great staff engagement and create an environment where people can enjoy their work.  Using data compiled from the national NHS staff survey, an independent research company called Best Companies Group identified the top 100 trusts and 20 clinical commissioning groups from across the UK.

The list looks at results in seven key areas that affect an employee’s experience of the workplace including leadership and planning, culture and communication, job satisfaction, work environment, relationship with supervisor, training, development and resources and employee engagement and satisfaction.

Making the list is a fantastic achievement for the Trust and I’d like to personally thank all of our staff for working together to make this a great place to work, even when faced with considerable challenges and pressures.

But we’ve still got a long way to go before we can truly say we are performing well in all of these areas and that all 6,000 staff have a positive experience of working here.   Perhaps this is a big aspiration considering the difficulties we face as the NHS, but it’s something that we must keep striving for.  

The national NHS Staff Survey provides us with an annual indicator of staff satisfaction levels at Pennine Care – some key headlines from last year’s survey are: 

• 89% of staff agree that their role makes a difference to patients
• 85% said they had received an appraisal within the last 12 months, but only 38% said this was well structured 
• 90% of staff believe the Trust provides equal opportunities for career progression or promotion
• 63% said they would be happy with the standard of care provided by the trust if a friend of family needed treatment
• 55% of staff said they would recommend Pennine Care as a place to work
• Our overall engagement score out of a maximum of 5 is 3.72

The things we scored particularly well on are staff working extra hours, staff experiencing physical violence or harm, staff witnessing incidents and staff experiencing bullying or harassment.   The areas we need to work on are staff reporting incidents, the frequency and quality of appraisals and staff feeling pressured to return to work after illness.

The full results of last year’s NHS Staff Survey can be found online.

Although we are doing ok on the whole, there is a great deal more we can do to make Pennine Care a great place to work for everyone. I fully recognise that staff are working tremendously hard, faced with increasing demands, financial pressures and constant change.  All of which can impact your experience as an employee. 

Something worth noting is that the national NHS Staff Survey only recognises categories for acute trusts, acute specialist trusts, community trusts, mental health trusts and clinical commissioning groups.  They do not currently have a category for integrated trusts such as Pennine Care, so we have to fall in to one of the categories and historically we are listed under mental health.  I know this isn’t ideal and we are pushing for the categories to be reviewed so they reflect the more modern arrangements of the NHS but it is not something that is currently within our control.  

We launched our first challenge on the Spark system to ask for your ideas for how we can improve the experience of our staff, which generated 35 initial ideas that are going to be explored and taken forward.  But we need to keep listening to what’s important to our staff and what will really make a difference to your experience of working at Pennine Care, no matter how big or small. 

We only had a response rate of 32% in the last NHS Staff Survey so to make the results more meaningful and representative we need everyone to be taking part. The next survey is due out in September, so please do take some time to complete it.  

It would be brilliant to stay in the Best Places to Work list, who knows we could even win it in the future. 

Thanks 
Michael 

National direction set

The NHS Confederation last week published a letter to the Prime Minister, David Cameron, to urge the Government to provide political will and financial backing to secure the future of hard pressed NHS services.  This was co-signed by 50 leaders in healthcare, including me.

The publication of the letter coincided with a major speech from Mr Cameron (link) and Chief Executive of NHS England, Simon Stevens (link).   

The overarching themes from these speeches was further commitment to implement the Five Year Forward View, making a 7-day NHS a reality, greater focus on healthy lifestyles and prevention and treating mental health with equal importance as physical health.  The Government has pledged to provide the NHS with an additional £8 billion in funding by 2020, but this is in the context of the NHS still needing to find £22 billion in efficiency savings. 

The level of change and challenge facing the NHS will continue to be significant, but we now have a clear sense of direction and purpose at a national level, guided by the Five Year Forward View.  On a more regional level, Greater Manchester is progressing plans for the devolution of health and social care from central government to the city region.  

At a Trust level, Pennine Care continues to be a high performer in terms of both quality and finance.  However, we still need to achieve £47.5 million in efficiency savings over the next five years to contribute to the overall NHS target of £22 billion.  This will be tough at times but we must ensure that the care and safety of our patients and the wellbeing of our staff are at the forefront of any changes we make.  We are now engaging with our staff widely on developing plans for the future and I would encourage all of you to get involved. 

I would encourage you to read these when you can as it will help to give you a sense of direction for the NHS over the next five years.  We will of course provide regular updates about how these changes will impact our frontline staff as it becomes clear. 

Thank you

Michael 

Video blog Q&A - April 2015

My first video blog (or vlog as they are also known I am told) is now ready for viewing!  

Thank you to the members of staff who sent in questions, I have tried to summarise and answer them in this video, but there were quite a few so there will be another video blog coming soon too.  

It's the first time I have done a video blog and was a bit hesitant about being on camera, but hopefully it helps to answer some of your queries. 

In this Q&A I talk about what the Five Year Forward View means for us at Pennine Care, how we are supporting hospital pressures, why partnership working is so important, what whole person care means to me, integration of community and mental health services and what's the one thing I would like us to focus on as a Trust. 

It's only seven minutes, so not too long.  I would really like to hear your feedback and further questions. This is all part of building our communication and engagement with staff and partners so we can plan together for the future.

Thank you,

Michael 

In the vanguard of new ways of delivering care

I thought I would do a quick blog to tell you about the latest developments with the NHS England Five Year Forward View or 5YFV as it’s now affectionately known. 

You may have read that NHS England are now looking to develop vanguard sites as part of a 'new models of care programme'.  This is being led by Samantha Jones at NHS England, with the intention of providing a ‘proving ground’ in a number of areas, accelerating development of integrated care.   

The vanguard sites then become templates from which the rest of England learns. This spread and share approach is intended to address the challenges we face in health and social care at pace and scale. Sounds straightforward enough but England faces a challenging five years ahead.

There is a detailed document online about how the 5YFV will be put into action, but look at page 9, 3.3 if you don’t have time to read the whole document, but it is worth a full read

I read through the criteria for applying to be a vanguard site, you had to apply against one of four categories - multispecialty community providers (MCPs); integrated primary and acute care systems (PACS); additional approaches to creating viable smaller hospitals and models of enhanced health in care homes.

I couldn’t see how we fit into any category. I knew we would be part of submissions in at least three of the towns we serve, as part of the partnerships in those towns. However, because I feel we are to an extent uniquely placed as an organisation and because we are pushing so much to transform and advance care, I put one in anyway on behalf of the Trust. To our surprise we were short listed to attend workshops for a final selection process.

I think the staff in Pennine Care should see this as an achievement in itself, 269 areas applied and this was short listed down to just 63. So yesterday Katy Calvin-Thomas, Henry Ticehurst, Richard Spearing and I went down to London to present to the third and final day of the workshops. 

Here is our original submission - please do read this in particular as I think it captures where we are up to as an organisation. It also shows our latest thinking and just how exciting the challenge is we face. Yes exciting. I think we are truly in the vanguard of new ways of providing care. That’s why I put the application in and it was great to be shortlisted.

I’d be surprised if we were selected to go right through to be a vanguard site, as our submission didn’t easily fit. Also, I didn’t think our ‘pitch’ (a seven minute presentation) went very well. I became a bit tongue-tied and nervous trying to squeeze a broad ambitious agenda into a few sound bites. Katy, Henry and Richard rescued it well and I recovered for the question and answer bit. 

I am sharing my experience, which was personally a bit embarrassing, because I think it goes with working outside of our comfort zone. In Pennine Care, many of our staff and leaders are working outside of their comfort zone, working hard under pressure and really pushing the delivery of new and different services. I am grateful for all the work and success to date, its making a real difference to improving care and helping people live as independently and empowered as possible.

Nothing ventured, nothing gained I suppose. And whilst we might not become a first wave vanguard site, we still have an important role to play informing the agenda for new models of care and also the new Devolution Manchester work developing care out of hospital for the city region.

As we always say though, the single most important agenda is getting it right in Pennine Care, that's with partners and working well with staff and patients to deliver new integrated models of care. After yesterday, listening to some really excellent presentations, I know we are definitely on the right tracks and in some areas ahead of the game. Our staff can rightly feel proud of what they are achieving in the pursuit of improving the health outcomes of the communities we serve.

I do think that NHS England and the new models of care programme should be congratulated for the approach taken to securing vanguard sites. There was some criticism of the process, around how the voting worked, whether it was a fair approach but it was a lot fairer than years gone by, when decisions were made behind closed doors and within networks that weren’t accessible. 

I spoke with Samantha Jones afterwards and she was open and interested in the work we are doing in Pennine Care. NHS England Chief Executive, Simon Stevens, sat and chatted through our challenge with Richard Spearing. Jackie Lynton Head of Transformation at NHS Improving Quality wants to support our work on diversity and Rob Webster, Chief Executive of the NHS Confederation, has shown great support to the Trust. We are in a more open, transparent and involving era, the playing field is ever more level and I think we should applaud the positives in that.

Coming up next time, a video blog (or vlog), where I expand more on the challenges we face going forward. 

I miss my comfort zone!

Michael 

New Year, New Challenges, New Opportunities

As we approach the end of 2014 and look forward to 2015, I thought I’d write a blog ahead of the New Year.

I hope everyone who celebrates Christmas enjoyed their seasonal festivities.  Whilst Christmas can be a great time for friends and families to get together, it can also be a struggle for those going through a tough time, bringing back difficult memories or adding to a sense of isolation for some.

Pennine Care is a 24/7, 365 days-a-year provider and many of our staff will have worked over Christmas to ensure those who rely on our services received the care they needed.
I want to acknowledge those staff who keep services operating, whilst Christmas and New Year is taken off by many.  The care we provide is critical for so many people and amongst all the festivities it’s easy for some to forget that NHS staff work day and night throughout the season. So a big thank you and much appreciation to Pennine Care staff and the partner staff we work with.

The NHS England Five Year Forward View
Well it’s been a year (just about) since I took up post as Chief Executive. I have thoroughly enjoyed it and I am grateful for the great support I have had from Trust staff, partner organisations and wider leaders in the NHS. It has been incredibly rewarding, at times really tough, but I am still as pleased and as proud to be doing the job one year on.

If anything, I am more proud than ever. Recently NHS England published its Five Year Forward View and guidance on implementation. If you read this you will see a strong endorsement for the strategy we have been pursuing, with partners, for approaching two years now. 

Here is a snapshot from the Health Service Journal (HSJ) describing the guidance:
The guidance, The Forward View into Action, says those sites chosen to be in the “vanguard” must already have a record of “tangible progress” to new ways of working over the past year and positive relationships between commissioners and providers.
The selected areas will receive investment from the transformation fund, announced earlier this month as part of the chancellor’s autumn statement.
A support programme will be co-developed rapidly with the initial sites which aims to “blend the provision of technical expertise with peer learning, and removal of barriers to change”, the document said.

In particular it says areas must have “realistic ambitions for activity diversion initiatives”.
It added: “Unless and until it is clear that demand has reduced, we strongly advise system resilience groups not to switch off additional winter capacity for urgent and emergency care.”
The guidance was published jointly by NHS England, Monitor, the NHS Trust Development Authority, Public Health England, Health Education England and the Care Quality Commission.

The key new requirements and initiatives set out in the document are:

• clinical commissioning groups must increase their spend on mental health by at least as much as the increase in their allocation;
• new commissioning for quality and innovation payments for treatment of sepsis and acute kidney injury, which replaces the requirement to report patient safety thermometer and friends and family trust data, will become part of the national contract;
• a new CQUIN on improving urgent and emergency care;
• a “revitalised” national quality board to review the current state of quality of care and barriers to delivery of high quality care;
• a new workforce advisory board, chaired by Health Education England with senior membership from across the system, to develop a health and care workforce with the skills to support the implementation of new models of care;
• providers and commissioners to agree plans to make further progress towards seven day working; and
• CCGs and providers to agree plans to improve antibiotics prescribing in secondary and primary care.

Simon Stevens, chief executive of NHS England, said: “Today we are allocating extra cash for towns, cities and villages across England to help the local NHS meet the rising demands and changing needs of the patients we’re all here to serve.

 

“Frontline nurses, doctors and other staff are working incredibly hard, including over this holiday period, but with a growing population and an aging population it’s clear the health service can’t just keep running to catch up. Instead we need to begin to radically reshape the way we care for patients, which is why there is such widespread support and enthusiasm for the NHS Five Year Forward View.”

What it means for Pennine Care?

I don’t know whether we will go forward to be part of the ‘vanguard’ schemes. It’s not my decision anymore, and that’s a sign of the progress we have made. We have shifted from the old fashioned ‘sovereignty’ of Foundation Trusts and moved to place-based delivery. So we now work alongside partners and build local service delivery through local partnership boards.

The six towns we work in are each at different stages of development, but in my view there is a common sense of direction.  Therefore, if we were to go forward and submit an expression of interest, it would be a decision made by the partnerships with commissioners.

Who is in these partnerships?  Pennine Care, the local authority or social care provider, the Acute Trust, the third sector and importantly a strong relationship with primary care. We also see partnerships growing to include housing and links to employment.

If the partnerships thought we should submit an expression of interest to be a ‘vanguard’ site, I think we would be in a good position to be selected. The criteria say applications should be from those with a track record of already developing these models of care. NHS England describes these models (in our case) as Multiple Specialty Community Providers, which very much reflects the type of partnerships we have been forming over the last one to two years.

Critically, the models for implementation must demonstrate genuine diversion activity – that is, the diversion of patient care into the community and away from acute trusts. I am pleased, impressed and keen to share the diversion work we have been building for two years. Across the Trust we now provide RAID services (Rapid Assessment Interface and Discharge) or mental health liaison services for the acute hospitals. 

In Trafford, we have developed a community enhanced care service for physical health presentations. Both have been developed where commissioners have really backed schemes to deliver diversion.

Both of these schemes have been evaluated; RAID independently by the University of Chester and the evaluation of the Trafford service has been jointly signed-off by Trafford Clinical Commissioning Group and Pennine Care. 

Both demonstrate significant diversion activity and we intend to share these service models across Greater Manchester and wider. I believe they should form a key foundation for models of care outside of hospital.

I will talk more on service models in future blogs. One key theme amongst all of the above is change; significant change and change at scale. I am pleased to say Pennine Care staff have embraced this challenge and we are making great strides forward to deliver community based redesign of services.
Financial pressures

During the Party Political Conference season, and through lobbying of the political parties and the Department of Health by the NHS Confederation, NHS Providers and many of the Colleges, the financial pressures on the NHS were finally debated. Plus there is additional money being made available.

I personally don’t think additional money will substantially change the £45 million efficiency target Pennine Care has. We still face significant redesign challenges and any money should only pump prime change. We will never be able to shore up the current system; it’s unaffordable and pretty much everyone now agrees that.

However, we have yet to see the money challenge and the NHS Five Year Forward View put together as one clear plan. I think this is work we need to lead locally, as there will never be a top down magic bullet for this challenge. We have to manage redesign plus savings. It’s not ‘do more with less’, as some have said. It is ‘create different with less’ and optimise resources through better partnership working.

In summary the NHS still faces a significant financial challenge and we mustn’t let the forthcoming election cloud our thinking or slow our decision making. Plans and savings still need taking forward.

In the early part of 2015, Pennine Care  will commence large scale engagement with our staff, to discuss, consult and plan together on future challenges. Please do connect with this discussion; it will be our largest ever planned engagement.

I understand that It can be difficult to engage positively with plans for change when these changes lead to worries about job security. So I thought I would end this blog, where I started my first one a year ago, talking about money, challenges of change and job security, and the risks of redundancies.

When I have been out on service visits over the last few years, questions on job security have been high on the agenda of staff. This is entirely understandable. More than a few years ago, I was always very upbeat as we very rarely made anyone redundant. In the years since then, the levels of savings required has risen and the impact of year on year savings has moved us towards far more redesign and significant changes to services and the jobs our staff do.

Pennine Care’s staff , Staff Side representatives and organisations have worked closely together to deliver these savings year on year. Last year was no exception; we delivered over £7 million of savings (Cost Improvement Plans or CIPs, as they are known in the NHS). Going forward we face more than £8 million of CIPs every year for five years. Who knows, additional investment may soften this - I hope so -  but either way we face a substantial challenge.

£8 million, on average, is the equivalent to around 220 job posts. That means, in theory if we only made the savings through pay, we have to lose 1,000 jobs over 5 years. With redesign you may also need to reduce further to introduce new roles.

In terms of job security, it may make stark reading, but I think we need to take a measured look at this and I hope that by doing so, I can give staff some reassurance.

Firstly, whilst we do have to make these savings, we are committed and determined, along with our Staff Side partners, to keep staff in jobs and avoid redundancies wherever possible.
Each year, we actually lose around 8% of staff a year through turnover (such as retirement and moving to different jobs), which equates to just under 500 staff. It’s an over simplification but if we didn’t recruit to the posts where people leave we could still recruit 280 staff and achieve the CIP.

So yes, there is a risk we will have to make redundancies due to savings, but as you can see, that risk is very much lessened by natural turnover each year.

The CIPs and the need to change the way we deliver services does mean far reaching change - to achieve £8 million of CIPs will mean formally going through cases for change, consulting on changes to people’s posts, redeployment and yes, at times, redundancy. But against a backdrop of 500 staff going every year, it does make the challenge somewhat more achievable without large scale redundancy.

As I was writing this I thought I would revisit the redundancy figures for 2014/15. We had to make over £7 million of CIPs this year. How many compulsory redundancies did we make?
Seven.

I agree that’s seven too many, but it’s not 200. We also made 17 redundancies through voluntary agreements. That’s 24 in total, still a much lower figure than you might imagine when first considering the several million pounds worth of CIPs we have to make.

If staff ask me a question on job security on my next service visit, I will say it isn’t like it was. The need for change is ever pressing and the impact on roles from redesign will be there for some time to come. However, there is still a good deal of job security and far more in Pennine Care (where we have stable, well-managed finances) than in some other public sectors and other parts of the NHS.

I hope this gives some assurance to the Trust’s staff and I can give my personal reassurance that we remain determined to keep as many people in work as we possibly can during 2015.

I would hope with relative job security you will engage in the conversations we are planning in the New Year to discuss the challenges ahead. The more engagement we have with staff and the more people contribute their ideas, the more we can lower the risk of redundancies together. That’s because, in my view, we will make the best plans based on the views and thoughts of staff who work in services every day.

I really do hope that gives some reassurance as we move into 2015.

Finally, I would like to thank each and every one of our staff in Pennine Care for all their hard work, commitment and dedication to delivering the best possible patient care in the communities we serve, and wish them all the very best for 2015 - Happy New Year.

The importance of the flu jab

Please read this important 'guest' blog from our Medical Director Dr Henry Ticehurst.

As Medical Director for the Trust, I want to reinforce why it is vital for every member of staff to have the flu vaccine.

I had my flu vaccination on October 13. If you haven’t had it yet, this is a message from me to ask you to do so.

The rationale for the vaccination is clear and it has a strong evidence base.

Influenza is a nasty illness and, for normally healthy people, it can confine you to bed for some time. This in itself has massive potential effects on the services we run – we all know it doesn’t take too many colleagues to go off sick before we get in to some real difficulties.  But for those we treat - especially those with long-term conditions, the frail elderly and the young - it can be fatal.

We have a target of 75 per cent staff take-up. This is a national target and, again, it is not an arbitrary target.  It is set to afford our community maximum protection to ensure any spread is contained. So I am asking you to please be one of those 75 per cent.

You have all received details of vaccination sessions in your borough, along with instructions on how to let us know if you receive your vaccinations elsewhere.  

I know you are very busy but I’d urge you to have your flu jab to keep yourself, the people you work with and our service users in the best of health this flu season.

Staff can find more information about the flu campaign, including a list of sessions and a consent form on the intranet here.

So, to summarise, did I have severe side effects? Well, no, because you can’t get flu from the vaccine. A few snuffles, but to be honest I’ve had worse man-flu!

--

I hope Henry's note will prompt you to get your flu jab if you haven't yet. If you have, thank you, it really does make a difference. And don't forget if you're like me, with a son with asthma and elderly parents, it protects your family too. 

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.