Guest blog and announcement on our future (position paper included)

Today our Board had a challenging discussion about our future strategy; one in which we reflected on our previous aspirations and the changing world in which we find ourselves.   

When we took on community services, we had a vision we could make a real difference to people’s lives. By aligning community and mental health services within the same organisation, we felt local people could truly benefit from a 'whole person' service approach; bringing physical and mental health together.

We wanted to showcase the combined impact that these two complementary 'Cinderella' services could make - to support the hospitals buckling under the strain and, mostly importantly, help change lives. We felt that we could provide a local voice and also a safe haven and nurturing environment for our community services.

We have achieved some great things, particularly around children's and older people services, the two ends of life's full spectrum.  Our physical health services benefited from a psychological perspective and vice versa.

But, for a whole host of reasons, we have not been able to fully realise the vision we had for integrated, whole person care.

Now, with the rise of local care organisations (LCOs), we are seeing strong locality ownership for improvement, with a desire for local providers to be very visible and active within borough-based partnerships. 

While people have worked very hard to do this for both mental health and community services, we have struggled to represent all elements of our portfolio with the same strong voice in each LCO.

And that has brought us to today. With a heavy heart, but a huge dose of realism, the recommendations in the position paper on our future strategy were approved by our board this afternoon.  Click here to read our position paper.

As you know, it proposes that we look at community services developing as part of local care organisations and concentrate our efforts on mental health and learning disability services in their widest sense. Allowing both to extend, enhance and fulfil their potential for the benefit of local people in this changing new world.

It was good to see around 30 people in attendance at the board meeting, nearly all of those staff. We opened up the meeting for public questions on our strategy position paper, which included queries about specific services, next steps and possible future providers.

We understand and respect the different emotions that people are feeling, which include disappointment and worries about the future. And we want to always work and behave with complete integrity and compassion. The questions provided an opportunity for us to talk about close partnerships, strong relationships with commissioners and being a strong local alliance member, as the future is about collaboration.  

This is all about people and we talked about our responsibilities as a board to never do anything detrimental to patient care.

While the Board has approved the direction of travel in principle, we need to gather lots of views before our final strategy goes to our board in December.

It's been a journey to get us to this first stage. I hope that the time many services have been with us has been well spent, but accept that this time may be coming to an end.

We should always do the right things for the right reasons, even if it's hard. And that includes acknowledging we might not be the best organisation to continue providing a service.

So, let's keep talking. We want to hear your views and will be putting plans in place to do this. Let's all help shape the future.

Thank you.

Henry

Dr Henry Ticehurst
Medical Director

Guest Blog

It’s 12 months since I joined Pennine Care as Chair, so I thought it was a good time to write a blog.

So much has happened over the last year, with a lot of work on developing our new strategy, culture and the refreshed vision and values to support this. I’ve also had the opportunity to get out and about and visit many different teams, which is without question the best part of my job. I never cease to be impressed, humbled and full of admiration for what you do, day in and day out.

There’s so much more I want to learn about the services you deliver, how your teams work, and the fantastic people that work here.  But I also think it might be helpful to learn some more about me.

So, I’m taking this opportunity to reveal something about myself.

Something personal which has had a huge impact on my life. Something which will hopefully help those who already know me or will meet me soon – and also those who welcome an open and honest message about understanding and respecting everyone as individuals, whatever our challenges.

It’s also important we all feel safe, comfortable and supported if we open up about personal information. Especially when we work for an organisation such as ours.

You see, I’ve been managing a long term health condition whilst holding down a high profile role

Two years ago I had heart failure.

I hate the word 'failure' to describe my living, beating heart, but when I asked another doctor how he'd describe what happened he called it 'heart inadequacy’ which is worse!

Its sometimes easy to forget the psychological impact of a ‘label’, until its ours to wear.

I was visiting Ghana when it happened. I’ve got diabetes and high blood pressure runs in my family, but I started to take a lot of extra medication on this holiday as I was feeling really rotten.

A few days after I returned home, I woke  one morning and was struggling to breathe. It was scary enough for me to visit my GP, and before I knew it I was in an ambulance rushing to the MRI. I was in hospital for 10 days, and the care was amazing. We all know how wonderful the NHS is and how lucky we are to have it.

I now have to take 14 tablets every day, which I find both stressful and tedious. I line them up in pairs, according to their shape – anything to make it feel less of a daily trial.

Only four out of the 14 have side effects, but they are gruelling side-effects and take their toll. That means, especially with sometimes very long days of meetings, that I can struggle.

My mind is fine, it’s just my body that lets me down, but the drugs do mean that I struggle. And it does get me down.

I tell you this in the spirit of openness and caring about the impact it can have on our family, friends and colleagues and so you have more of an understanding about why sometimes I may appear fazed.

I have four children who worry, my son just wants the doctors to ‘fix me’ my eldest daughter practically moved in when I came out of hospital, my middle and youngest daughters worried for some time whenever I went to the GP in case I ended up in A&E again and my adorable grandchildren (6 & 7) worry about me dying.

We also laugh about it though, as there are plenty of funny moments. My relationship with lifts and stairs, and my reaction to being advised to get a ‘blue badge’ are just a couple they tease me about.

Laughing is a good medicine, but one of the best things is that when needed I can indulge in my ‘guilty pleasure’ TV court shows - Judge Judy, People’s Court, Paternity Court and judge Rinder – without feeling I should be ‘up and about’ busying myself all the time.

So, I’ve opened up my ‘weak’ heart to you all. It’s still bursting with pride to be part of our fantastic organisation.   I just want you to know that my passion for and commitment to the Trust is strong and I will work to ensure that I carry out my role effectively.

Thank you for reading.

Evelyn Asante-Mensah MBE
Chair

The best of times, the worst of times

I can’t believe it’s my one year anniversary!

I remember giving a presentation at last year’s annual general meeting (AGM), when I was just two weeks in post as your new chief executive. When I stood up on Wednesday to talk at this year’s AGM I thought; the days can sometimes be long,  but the years are certainly short!

It was good to update a packed house at the AGM on our key developments over the last 12 months and the work we have been doing on developing greater clarity about the future direction of our organisation; strengthening clinical and professional leadership; our partnership working; and some highlights of the many service developments you have been working on over the last year.  It was also an opportunity for openness and honesty about the challenges ahead, within the current climate of increased demand for services and major financial constraints.

The future of Trafford services

I think it is the novel ‘A Tale of Two Cities’ that starts with the line ‘It was the best of times, it was the worst of times’ and this certainly summed up Wednesday, if not life in general at the moment. 

It started in a very tough way, as that morning our board made the very difficult decision to serve notice on our Trafford community services contract. We genuinely believe that this is doing what is best for the people of Trafford, although we completely recognise how hard this will feel for our staff working in that locality.  

While this decision evoked some strong emotions for us, our board is trying to make strategic decisions about where best we can focus as a trust to have the biggest impact and make the greatest difference to patients. We do care, and sometimes the hard decisions have to be made because we care and because we are not prepared to compromise on quality.  

So, while I know there will be a lot of sadness that our journey in Trafford is coming to an end, I think that this decision opens up the opportunity for a more robust debate about the resourcing of community services. 

We want  our community services to have a strong local champion who is positioned to secure the vital resources needed for innovation and improvement. They deserve that, and we believe that letting go might better help them achieve their potential. We are hopeful that this decision will prove a catalyst for a stronger focus on the financial issues within the health economy. 

As I have noted previously, in all the discussions I have been in, the hugely significant and valuable role that community services provide is seen by everyone, and people appreciate that these services depend on the skilled and committed people who deliver them. 

It’s important to remember that, alongside a lot of work that now needs to take place to ensure a smooth and successful transfer, it’s very much business as usual. We have been so grateful for the strong leadership in our Trafford teams and the mature way staff have engaged in this difficult process. I know that they will be continuing to do everything they can to provide good services during the transition and in the future.

In terms of our overall Trust strategy, just a reminder that we are aiming to finalise it by December, and will engage with you in October and November about what this might mean. As I’ve said many times before, I am totally committed to being as upfront with you, as early as possible, about things.

Lifting spirits with our AGM and Cares Awards

While the decision on Trafford was the worst part of Wednesday, the best part was undoubtedly the AGM and the Cares Awards. The theme over this last year has been excellence in challenging times. 

We’re still striving for that of course, but it’s clear that maintaining spirit and resilience is also emerging as an important theme. Your health and wellbeing is vitally important and we need to support you to cope with the day-to-day pressures of working in a fast moving and demanding environment.

I opened up the Cares Awards talking about spirit and resilience. Our motivational speaker Dr Ed Coats, an adventurer and hospital doctor, then made us laugh, gasp and listen in awe as he spoke about resilience during his Antarctica expedition to the South pole – billed as the toughest endurance race on the planet - with James Cracknell and Ben Fogle.

He was inspirational, but then it was a truly inspirational evening all round. The Manchester Survivors' Choir, made up of children and adults directly affected by the Manchester Arena attack, brought a tear to the eye with their rendition of ‘Rise Up’. And the award videos, showcasing the work of our truly fantastic finalists, made our hearts burst with pride. 

Congratulations to all the divisional winners – it was so uplifting to hear your stories and the impact you are having for people you work with. This year I was part of the judging panel choosing the overall winner; we had such a tough time as the quality of the shortlisted services was outstanding. 

But huge congratulations to the Stockport palliative care dementia liaison service team, our overall winners – a tremendous achievement as there were so many gold star finalists.  

It was such a wonderful way to end the day, and as I drove home that night I felt a mixture of pride, optimism and hope. Pride about our staff, optimism that the difficult decisions being made are the right ones for patients and the teams that care for them, and hope about the future. 

I know these are anxious times, but if the spirit and resilience shown over the last year and at our awards is anything to go by, we have incredible people that can help us get through anything.  

Claire Molloy
Chief executive

Our strength lies in our differences not our similarities

I always enjoy getting out and about meeting teams and chatting about what you do and your experiences. It’s not just a great opportunity to see first-hand the superb work taking place, but I always find it a grounding reminder of what it’s all about and why we are here. Its uplifting to see the level of commitment to making a difference. 

I only wish I had the time to fit more visits into my diary as I do enjoy these so much. It's a big patch we cover, as you know, and I sometimes envy how my hospital colleagues can literally pop into wards to say hello on their way to the canteen. It's been especially difficult to be out and about over the last few weeks as I've needed to attend a lot of meetings and events focused on strategic issues such as partnership working, cultural change and the development of our vision and values.

82 year old star in Oldham

All important stuff and very interesting and enjoyable as its core to the changes we are trying to make. But it was really refreshing to visit staff and service users from the Healthy Young Minds and Rehab and High Support teams in Oldham on Monday where I buried an NHS 70^th time capsule in the garden with them, before having a look around. 

One of the stars I met there was Jill Dodge, an 82 year old receptionist who has been working with the team for 14 years. Yes, it’s not a typo – 82 – and full of positive energy! There are some days, like a lot of you I’m sure, when I feel tired and anticipate the relaxation of retirement with hopefulness (some way off yet!). But meeting Jill, such a wonderful bundle of energy, has made me feel inspired and re-energised - I definitely need a spoonful of whatever she has been having!

It’s was so heartening to see how much we value the experience that Jill brings, and I love that we are not seeing age as a barrier to still being able to make a huge contribution to our local communities. Long may that continue.

Equality and diversity concerns

However, we are not getting our approach to diversity right in all areas. 

I was very concerned to see recent figures highlighting that BME staff in this organisation are less likely to be appointed to senior posts and more likely to be subject to formal conduct and disciplinary processes.  This is incredibly worrying information and we really need to understand what sits behind this and to support changes in a positive way.

The Board will shortly be undertaking a development session dedicated to equality and diversity, as we recognise the importance of this area. We are committed to understanding the experience of staff and people who use our services and, most importantly, to taking action to address areas where we know we aren’t yet getting it right.

This will form an important part of our culture work going forward - looking at what kind of organisation we want to ‘be’ and what we see as important and of value to us. And from mine and the Board’s perspective, a diverse and inclusive workforce greatly enriches us and is definitely something to be valued. 

Wiser, positive, better

So, our challenge is to show, through the narrative we tell about what sort of organisation we want to be, and then through behaviours that reflect this, that we value everyone in the organisation. We want every individual to feel able to participate and achieve their potential. I truly believe that a diverse mix of experience, backgrounds and beliefs leads to better discussions, decisions and outcomes for everyone.

Our strength lies in our differences not our similarities. And that strength will help create a wiser, positive, better organisation.

Best wishes,

Claire Molloy
Chief Executive

Shaping our future

Since I joined our organisation last September, I have been forming a picture regarding our longer term direction of travel. One of the key issues coming from staff in the cultural audit and from our partners is that people aren’t clear on Pennine Care’s strategy and the role we want to play in the local care organisations (LCOs) evolving in each of the boroughs we serve. 

In other words, what sort of organisation do we want to be? What contribution should we be making? And what does this mean for where we are going?

So over the last six months or so, we have been doing work to be clearer about our longer term strategy and to ‘refresh’ our organisational narrative. We have been clear that high quality care and support is at the heart of our approach but, as I have indicated previously, we need to consider what this means in the context of the resources we have and the way care models are changing through the LCO work.

This important stream of work on strategy sits alongside work to change the way the organisation is run to create a more positive, enabling culture; as well as getting on and delivering some of the improvement priorities we know we have now, such as safe staffing, strengthening our informatics, and preparing for CQC inspection in the autumn.

Over the last year I have talked about all of these three areas (Strategy; Culture change; Delivery Priorities) but today I wanted to say a little bit more about how we are developing our strategy.

Over the next few months work in this area is really going to ramp up as we are hoping to have a much clearer strategy by the end of December. We are hoping to have a draft by the end of October so that we can use November and December to engage with people on what this might mean and to help shape any final approach.

In order to get to this place, there are three key pieces of work taking place over the next few months:

1. Commissioning intentions - we are working with CCGs and local authorities to confirm their commissioning intentions going forward with regards to community services. The current contracts we hold for our community services technically end in March 2019 (with the exception of Trafford, for which we agreed a contract extension to March 2020). So, we need to have clarity with our commissioners about what role they see us playing in the provision of community services in the future; and consider the best alignment with developing LCOs 
2. Clinical and financial sustainability - we need to complete the work we have been doing with our commissioners over the last six months on service reviews and how best we can match service offers to the resources we collectively have so that we don’t compromise quality and safety. This work is due to come to a conclusion soon and the outcomes will clearly be helping shape decisions about our strategy going forwards
3. Vision and Values - we are also working on reviewing our vision and values. Regardless of what services we deliver, it’s important that we define what kind of organisation we want to be? I put you, our staff at the heart of this, and more work will follow in the coming months to flesh this out

Building on the last point above, I am keen that we move quickly on this work given its importance. During August we will be holding a number of small workshops with people who’ve already been involved in the cultural audit work to help shape our vision and values.

Once we have a first ‘clay pot’ of these, they will be tested out at bigger events with key leaders across the Trust in September, October and November, and in particular, we want our staff in these events to help shape a supporting behaviours framework. This will be followed by a big event in early December to share more widely – so watch this space for details about the events which should be out shortly.

As I mentioned earlier, the overall intent is to use all this work to set a clear strategy for the Trust to be signed off at the December Board meeting.

I acknowledge that for some time there has been rumour and speculation regarding the Trust’s future and this has created anxiety and uncertainty for staff. I am hoping that the process outlined above will help to crystallise our future direction, although I also acknowledge that in doing so, the potential for change itself creates concerns about what it might mean. This is especially the case in Trafford as we have advised staff and partners that we are doing some specific work with partners to explore the options for the future provision of community services in that locality.

I know that what is happening in Trafford, and wider in some of the discussions people are having through LCO development, could create uncertainty about the future for some people. I am committed to being as upfront with you as early as possible about any proposed changes; and open and transparent in engaging with you on our plans for the future as they evolve and develop.

I would like to reassure you that all partners see the valuable role that our services provide. In every discussion I am part of, there is recognition of the hugely significant value our services play; of the immensely committed staff we have; and of our expertise in delivering a broad range of services. All of this means that I am confident we will continue to have an important role and make a positive contribution in the future.

Best wishes,

Claire Molloy
Chief Executive 

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