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

Well-led review and CIPs

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

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

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

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

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

Many Thanks
Claire 

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

My five ways to wellbeing

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

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

1.         Connect

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

2.         Be active 

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

3.         Take notice

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

4.         Keep learning

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

5.         Give

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

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

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

I look forward to reading all of your pledges!

Thanks,

Claire

Claire Molloy

Chief Executive

E: ceo-penninecare@nhs.net

T: @ClaireMolloy2

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

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

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

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

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

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

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

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

Many Thanks

Claire

E: ceo-penninecare@nhs.net

T: @ClaireMolloy2

Thank you and best wishes for the festive season

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

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

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

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

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

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

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

Many Thanks

Claire 

Claire Molloy
Chief Executive

E: ceo-penninecare@nhs.net

T: @ClaireMolloy2

Delivering on our intent

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

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

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

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

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

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

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

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

Many thanks

Claire  

Claire Molloy

Chief Executive 

E: ceo-penninecare@nhs.net

@ClaireMolloy2