Culture does not make people, people make culture

I have talked a lot about cultural change in previous blogs and we held our first cultural change steering group a couple of weeks ago which was really positive.

I am very grateful to everyone who has volunteered to be part of this journey and we had a great meeting with a mix of people from services who I feel will be key in championing this change, together with people in positions of influence such as organisational development who can help us change the way we work in support of our approach.

I really enjoyed the meeting and thought there was a real buzz in the room with insightful views and great ideas, and I’m excited about what we can achieve by working together.

Changing culture

Changing culture is sometimes a hard topic to pin down and someone in the group eloquently described culture like clouds not clocks, in that it’s more complex and ever changing than simply putting mechanical parts together.

However, there are examples that help identify the key things we need to pay attention to, in order to really impact on culture. Being clear on our vision and our values and what’s important to us, and then demonstrating that in the way we all act and behave is pretty near the top.   

Cultural audit

At the meeting we were updated on the cultural audit work that took place earlier this year. The purpose of this work was to establish a baseline of our current culture and what it’s like working in this organisation now, so that we know where to focus work on improvement and can measure whether things are improving.

The audit gathered views from across the organisation at all levels, from information we already know such as staff surveys; and also through some specific staff workshops, staff drop-ins and questionnaires.  This feedback is being considered under some important themes, including vision & values, goals and performance, support & compassion, learning & innovation, teamwork, and leadership. You told us what we are doing well, and what we need to work on.

I wanted to share the key headline findings with you, so they are now available on the intranet. Click here to view them. (Please note you have to be on a device connected to our network to view this).

We are listening

Thank you for your feedback. We are listening and this rich information will not go into a black hole. It’s already been shared with the board, together with the findings from the well-led review. But most importantly, it is starting to shape the actions that we need to take as part of our first organisational development plan, a first draft of which was shared with the Board this week.

This is an evolving plan, as cultural change won’t happen overnight. It’s definitely more of a marathon than a sprint! But we will get there together.

Values and behaviours

The cultural steering group will support the Board in overseeing our culture journey but, as importantly, they will lead a number of specific pieces of work such as the on-going development of our values and supporting behaviours framework, which will be one of the key things we start very soon.

We have some great values already that work well in defining the sort of care and relationship we want with people who use our services. But I don’t think they work so well in defining how we treat each other as colleagues and in shaping the sort of environment we would all want to work within. So watch this space for more information on how to be involved in shaping these going forwards.

The most powerful bit of cultural change happens when these values are really clear and well understood and people bring them to life through their everyday behaviour. 

In other words, culture does not make people, people make culture.

Posting comments

I know that some people have been frustrated that their comments haven’t been posted or replied to previously. Huge apologies for this, but please note going forward we will be posting comments received and I am now able to directly respond them.

Happy 70th Birthday to the NHS

With the NHS 70^th Birthday now upon us, I have been reflecting back on my career and how privileged I’ve been to spend over 25 years working for such a well-loved institution and with such amazing people.

I joined the NHS as part of their national graduate management training scheme. While I believe I would have ended up working within health and care services regardless; had circumstances been different, I could have ended up following a very different career path.

I originally undertook a degree in pharmacology at Leeds University.  I probably saw myself working in some sort of clinical or scientific role in the future.

However, I met my husband at university who was just recovering from cancer and chemotherapy treatment.  Despite being told he couldn’t have children as a result of the treatment, we found out he could in the final year of my degree!!

So, instead of sitting final exams, I had our daughter.  I decided that, given this change in my life, ‘in for a penny in for a pound’ and had my son a year or so later. Due to this, my life course changed somewhat and any personal career was put on hold for a while.   

While my children were growing up, I pondered on what I wanted to do with my career. When they started school, I went back to university and undertook a degree in business as a mature student.  

When it came to thinking about jobs after I had finished my degree, I decided I wanted to combine my interest in science and business and to work for an employer that really valued difference and diversity.  As a mature student with two young children, I obviously didn’t fit the typical graduate mould, so this was really important.

When I saw the NHS graduate trainee scheme it was a complete fit and I have not looked back. I’ve had such a good time over the last 25 years – I definitely made the best career choice.

NHS values

I have been very lucky to end up doing a job that I love and where I can make a difference, in an organisation whose values so closely match my own. 

During my first interview to get on the graduate training scheme, I was asked about my values.  I really struggled to describe what they were, even though I knew instinctively the NHS reflected what I felt in my heart.

It’s only as I have worked in the NHS over the years that I have really been able to articulate these.  They very much align to those I believe most of us have within our own Trust – care, compassion, spirit and determination, fairness, diversity and equality.

The latter really stands out to me when it comes to the NHS. Its inception made sure that everyone could receive high quality healthcare, regardless of their income or status.

The values are what attracted me to the NHS and have kept me working in the NHS.

Caring for our NHS

It struck me recently that the NHS really is getting older; you could say it’s reaching pensioner status, to coin a phrase.  However, it’s only a pensioner if it has a limited lifetime and I don’t think that is the case.

Despite the many challenges, I am confident that the NHS still has many, many years in it and lots of promise.  All it needs is continued love and attention, just like a lot of us in our advancing years!  

This is why it’s so important that we are having these difficult discussions about safeguarding its future. 

The NHS is hugely precious, important and valued and we need to work together to decide how to best look after it.  If we work together, including leaders, staff and the public,  I firmly believe it will survive long into the future.

NHS ethos

I recently had a terrible customer service experience.  I spent hours trying to resolve a problem, which involved endless phone calls, being passed around, having to tell my story multiple times and broken promises from the company. 

I found myself comparing it to the NHS and realising just how different our ethos is. If a patient has a problem, they can generally speak to the right person fairly easily and quickly.  That person will care, listen and do everything they can to make things better.

Most importantly we keep striving to deliver a fantastic service, even when we don’t get it right and things get tricky. 

We do get it right most of the time and I’m in the privileged position of seeing many examples of this.  We receive a lot of compliments, about 20 to 30 every few weeks, and I try to read every single one. They make me so proud.

The number of compliments always outweighs the number of complaints tenfold.  This, along with our consistently high Friends and Family Test score, really drives home that sense of just how often we do get it right.

We know that we do get it wrong sometimes, but it’s a small proportion of the overall good care and support provided and we are absolutely committed to learning and improving.

A big thank you

I’d like to end this birthday blog by thanking every single member of staff for the fantastic job that you do.  I know some days you’ll come into work and feel under pressure and undervalued; but you get on with it and give 100% regardless. 

You give such a lot of yourself to patients and you don’t do it for the monetary rewards. You do it because you genuinely care about patients and want to do your absolute best for them. 

I’m extremely thankful and proud to work in the NHS.  There wouldn’t be an NHS without you and you are the reason it will not just survive, but thrive!

I hope you’ll all be able to take some time out of your busy schedule to attend one of the many NHS 70 events that are taking place across the Trust.  Full details are provided on the staff intranet.

Finally, here’s to the next 70 years of our wonderful NHS!

Best wishes,

Claire Molloy
Chief Executive

A national focus on the future

I have spent the last couple of days at the national NHS Confederation conference, which was held in Manchester.

This is an annual event, bringing together clinical and managerial leads from health and social care organisations across the country to hear latest policy updates and local developments and to network with colleagues.

I generally try to go to these every couple of years and in recent years, the mood has generally been a bit low.  However, I thought there was a notable difference this year, as the mood was more upbeat and positive.

There has been much in the media about the financial challenges of the NHS and it looks as if this is now being taken seriously at a national level.

Key speakers:

We heard from Jeremy Hunt, Secretary of State for Health and Social Care and Simon Stevens, Chief Executive of NHS England about how this is being taken forward. 

They spoke about how negotiations are well developed on the long-term funding of the NHS and that there is likely to be an announcement in the next week or so, to coincide with the NHS 70^th birthday. 

They also spoke about how a long-term plan for the NHS will be developed over the summer through a co-production approach with health and care organisations and the public.

Although it wasn’t clear exactly how this was going to be undertaken, there was a clear intent for there to be another ‘Five/Ten Year Forward View’ or ‘NHS Plan’ by the autumn with clear priorities.

There were also a number of other key messages that are particularly relevant to us and give some clues about what is likely to be in this long term plan.

The importance of mental health services

The importance of mental health and community services was a massive feature of the conference. The importance of mental health as everyone’s business was spoken about in most forums and there was a key note speech and panel debate on the main stage of the conference, for the first time I can remember.

Simon Stevens spoke about mental health forming a key focus of any long term plan, and in particular, highlighted the need to continue improving services and support for children and young people.

Helpfully, he talked about the need to work with wider sectors, including digital platform companies.  This recognised that health and care organisations aren’t able, on their own, to address the needs of children in such an age of complex social media.

Community services supporting out of hospital care:

Simon also stressed the important part that community services play, together with social care and primary care, in supporting out of hospital care.

Interestingly, he spoke about how the term ‘out of hospital’ care is not a great description of the breadth and value of the support and services provided. 

He feels that we need to develop a different language and move beyond referring to services simply as ‘in hospital’ and ‘out of hospital’.  I wholly agree with this as it still tends to view care seen through an acute lens, when we know that the vast majority of people cared for in community settings rarely require hospital care. 

Improving efficiency:

You may have picked up in the national media about the work that Lord Carter has been undertaking on behalf of NHS Improvement to review efficiency, firstly in hospitals, but more recently in mental health and community services.

Over the last 18 months he has been working with a range of mental health and community NHS organisations and his report was published last month.  Click here to access a copy.

This review looked at how mental health and community trusts operate, what ‘good’ looks like, what approaches to improving productivity and efficiency are already in place and what opportunities there are to further build on this. In other words, are we all doing things in the best possible way and what opportunities are there to deliver the best care, at the best cost?

This was a particularly important piece of work and I heard at the conference the key findings and how the learning was being shared.

One particularly impactful finding from this review was that on average (from the organisations they worked with) a community nurse is only able to spend about 88 days in a year on direct patient care. Excluding leave, it seems people have to spend huge amounts of time either travelling, dealing with poor systems for accessing and recording information, or overly bureaucratic admin processes.

Undoubtedly some of this admin and travelling is essential, but it’s also clear that significant work needs to be done to improve systems and to work in new and innovative ways. 

Positively, improvement work is underway on our IT systems; examples include the Paris electronic patient record, the wide scale roll out of mobile working and the use of innovative technology, such as Omnijoin.  You can read a great example of how a service benefited from Omnijoin here.

And I know that we are also doing work to look at the caseloads of our community nurses and our community mental health teams, so this will help identify our own stats. But we will need to find ways of creating more manageable caseloads and more time for direct care if we are to realise the vision for more care in ‘out of hospital’ services.

Staff health and wellbeing:

Given the above, unsurprisingly, discussions about staff health and wellbeing featured largely.  Niall Dickson, Chair of the NHS Confederation, talked about ‘the plug in the workforce being as important as the tap’ – in other words we need to focus as heavily on keeping the people we have, as we do on bringing more people into services.  

This was backed up by Health Education England which highlighted that, despite increasing training for staff across specialities and professions, this increase was being outrun by people leaving the service – and not simply because they were due  to retire. We are losing staff from the NHS because they are making a choice to go.

People who work in health and care are hugely committed and every number in these statistics is a person who has not felt able to continue working for the NHS.

This makes me feel sad at the loss to the NHS of those individuals and for whatever reason has made them feel they need to leave; but also motivated to try and make a difference. And this really emphasises for me the importance of staff health and wellbeing and the challenge to all of us to create a positive working environment.

I have said previously about how important this is to me.  I firmly believe that if we get it right for our staff, we will get it right for the people who use our services. I am passionate about this as a priority. 

As an organisation that has expertise in mental health, we should be better able than most to make a real difference to our staff mental health and wellbeing.

I am really keen to understand why people leave our organisation and would welcome some really open and honest conversations about this.  If we know what the real issues are, we can do our utmost to resolve them.

We already undertake exit interviews with staff who are leaving - however this comes right at the end.  I want us to be having these conversations early on, before staff even consider leaving.

As a starting point I would really like to know what the top three reasons are for people leaving our organisation, so we can start by tackling the big problems. I am more than aware that a significant issue affecting most staff is pressure and demand; and tackling this is a major priority for us.

However, there may be other things we are less aware of.

I have written previously about the work we are doing to better understand our culture and to create a more just and learning culture.  I know some of you will have had the opportunity to attend the workshops we have held or complete the cultural audit survey. I am also just about to write to staff who have expressed an interest in supporting this improvement journey, regarding next steps. 

I will be holding the first meeting of our Cultural Improvement Group in July and staff health and wellbeing will be one of the many conversations we have.  I am really interested in learning how we can create a more positive workplace environment and retain the great staff we have.

Even if you are not involved in the group, I’d still really like to hear your feedback and suggestions for improvement.  You can contact me on 0161 716 3006 or at 

claire.molloy1@nhs.net

Claire Molloy
Chief Executive

Leading and Changing

We have held a number of important events in the last few weeks which are helping to define our new ways of leading and engaging with you.

We launched our first collective leadership forum on 1 May which brought together our 40 or so most senior clinical, professional and managerial leaders from across our corporate and operational teams.

The aim of this forum is to bring people together to share information about our Trust and Greater Manchester as a whole in order to shape our future strategy and collectively tackle problems.

From my perspective, it was a really positive event. I was able to feedback on the headlines from the recently completed well-led review and talk about our priorities going into 2018/19. We also took a look at a draft of a revised Trust Quality Strategy which we are currently refreshing and took on board a lot of feedback about how to frame this in a way that could more easily engage staff.

I am sure these events are going to be helpful in sharing ideas, shaping our future, and creating a stronger sense of shared leadership. We will be meeting every 6-8 weeks with the next meeting scheduled towards the end of June. I would expect people attending these to be sharing key information that is discussed there with their teams, so please flag up with your managers if this isn’t happening.

Following this collective leadership event, we also held the second of our business planning events (the first one being in November) on 16 May. This was a much larger event, with over 100 attendees. I am sorry I wasn’t able to make this, but the feedback I have received so far is that this was a really valuable session.

We focused the session on the development of our culture and values and one of the themes that seems to have emerged was that our values do not fully resonate with staff. We need to do more work to understand why and if this translates across frontline staff?

So, I’d really appreciate your views on this and would encourage you to attend our culture conversation event at Hyde Town Hall on 14 June if you can or to complete the cultural audit that has been sent out recently. Please see the intranet for further details.

All of your views and feedback gathered will be really valuable in helping us build a clear picture of the current culture and how we want it to change. I am very keen that by early summer we have a clear vision and plan for addressing the improvements necessary and can start to really motor on them.

In previous blogs, I have mentioned the clinical presence visits I have been keen to set up. I am pleased to say we now have a programme agreed, thanks to Jackie Stewart who has worked on this. On the first Wednesday of every month, all EDs will be going on all day visits to clinical services – we will be expanding this to corporate services in due course, but I hope that getting out and about will improve our visibility.

The feedback and key themes from these clinical presence visits, alongside feedback from the existing non-Executive Director and governor visits, will all feed into the new Trust Management Board I am setting up, which meets for the first time at the end of June, and then onto Trust Board. This should really help strengthen the line of sight between our front line services and the Board, and hopefully ensure the Board develops a much stronger sense of the reality of working in this organisation and what we can do to support staff, and through them people who use our services, more effectively.

Finally, I would like to end by saying thank you to Jackie Stewart, who this week returns to her role as Managing Director, Mental Health and Specialist Services. Jackie has had a huge impact in her interim role as Executive Director of Nursing and Healthcare Professionals and under her leadership we have made a lot of progress in areas such as safe staffing and mixed sex accommodation. I have enjoyed working with her very much and she leaves very big shoes to fill. But I know Clare Parker, who joins us as Executive Director of Nursing, Healthcare Professionals and Quality Governance, will rise to this challenge and you will no doubt be seeing more of Clare over the next few weeks as she settles into the role and gets out and about meeting people.

Claire Molloy
Chief Executive

Shining a spotlight on our nurses

Tomorrow (12 May) is International Nurses’ Day.  We wanted to take this opportunity to recognise the enormous contribution of our nurses and personally share our gratitude.

We are not forgetting other professionals; our allied health professionals, social care staff, doctors, dental colleagues, domestics, support staff and many others all play a vital and valuable role.

However, this annual celebration of Florence Nightingale’s birthday is a prime opportunity to shine a spotlight on our nurses, who make up a large proportion of our workforce. 

In fact, there are just under 1,700 whole time equivalent qualified nursing staff employed by the Trust, along with many others in a nursing-related role.

While recognising that patient care needs to come first, we encourage you to take some time out of your busy day to attend the special event at Ashton Masonic Hall; even if just for a short time.  A range of free prizes and health, wellbeing and pamper activities are on offer, along with two Schwartz rounds.  Refreshments will also be provided. Full details are provided on the staff intranet.

During our visits to services and through feedback and updates we receive, we are humbled by your hard work, commitment and dedication.

We are fully aware of the challenges you are facing on a daily basis. Your determination to overcome these challenges for the benefit of the patients and communities you serve, makes the work you do all the more admirable. 

Time and again you demonstrate resilience through your willingness to be flexible, adaptable, to learn and to never give up.  The many examples of staff going the extra mile during the bad weather in March were prime examples of this.

Your input is essential in ensuring the Trust is able to grow from strength to strength and continue to meet the needs of patients into the future.  This is particularly important as we navigate the changes that are being implemented in our local boroughs and across Greater Manchester.

Our dedicated professional forums are key in ensuring your voices are heard, but we are also keen to get out and visit as many services as possible.  This allows us to speak to you and find out first-hand the issues you face; not to mention learn about your successes. 

As there are so many services in the Trust, it’s difficult to visit every single one – however, we are committed to visiting as many as possible.  If you would like one of us to visit your service, please contact Karen Hamer at k.hamer@nhs.net  or Nicola Grimley at nicolagrimley@nhs.net

Finally, on behalf of the Board, may we thank you once again for your ongoing hard work and commitment.  Keep up the great work!

Claire Molloy Chief Executive

Jackie Stewart Executive Director, Nursing and Healthcare professionals (interim)

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