Highlights of the Week - 12th December 2014

It has been a strange week.

It was the week we announced a change to the commissioning policy we had been suggesting in our urgent and necessary measures that would require smokers to quit 8 weeks before elective surgery and for those with a BMI of over 35 to lose weight before having their procedure. Or, as reported, "a U-turn", "backtrack" or "reverse".

Having worked on the measures for some time, we felt there was a good rationale that balanced the benefits to the individual to their own health both to do with general anaesthetic and recovery from surgery and in terms of their longer term health with the financial necessity of the position we are facing both this year and next.

But by Thursday, I was explaining on local BBC evening news that we had taken the decision to encourage, rather than require, people to change these behaviours before their operations.  I and been on the same programme only a week earlier explaining the rationale for the changes and why we thought they were the right idea, so understandably people wanted to know about the shift.

The reality is that we managed to attract a lot of media attention, more than we had been anticipating, especially at a national level and as a result of significant feedback, felt that progressing with the measures as outlined would not get the results we needed with the level of support from whole system.

It leaves us with the need to identify other savings to achieve our financial plan and as we move in to the last quarter of the financial year, this look incredibly challenging. It also means that we need to get staff working on a different approach. I hope our clinical leaders will be able to work to create another programme to deliver the outturn we need.

Highlights of the Week - 12th December 2014 (@jeclo)

Highlights of the Week 1: A new structure for Mondays: lots of meetings, but each with clear purpose
We now have a regular Monday meeting schedule that will carry us through to March which will ensure we attend to both the in-year financial position and planning for next year.  Last year we ran a series of bigger meetings that were successful, but did involve a large number of people.  This year we have tried to break the sessions down in to smaller groups with a clear purpose during the day.  As Chief Operating Officer, I get to attend all of them, so a very well structured day!

We start with Operational Delivery Group 9-11, which is our key Director forum for actions that deliver the in-year financial position and chase down the urgent and necessary measures action plan as well as the delivery of the schemes we set out the start of the year.

The Commissioning Managing Directors' meeting at 11 is a forum to ensure that the MDs are acting consistently and to share information from across the different System Resilience Groups (there are 3 in our CCG) and the two Better Care Funds.

We have a technical planning group at 1pm that will ensure that we hit all the deadlines required for planning - submission of finance information, activity returns, trajectories for key targets and the update of our annual plan - and to make sure that they are consistent.  This co-ordinating activity is vital and something we need to improve on from last year where, with external support both helping and confusing, we didn't manage to meet all expectations.

The Contract Negotiation Oversight Group at 2pm allows us to review the consistency of our approach across the negotiation of all our contracts.  It ensures that we treat providers in a similar way or understand the uniqueness of circumstances and apply ourselves to community, mental health, children's or acute contracts equally.

We finish the day with the Commissioning Intentions Group where we work on the transformation schemes that will deliver the financial plan.  This is critical, but important to maintain energy as we get to the end of a productive, but challenging Monday.

Highlights of the Week 2: Our press office has been really busy, but impressed with how they have responded to the seemingly impossible
We have been inundated with interest in the urgent and necessary measures we have proposed, which have attracted national and local political as well as media interest.  This has meant an incredibly busy time for the press office in the CCG dealing with the requests for statements, interviews and appearances.  

They have responded really well and it feels like we have been able to give a clear message about what we have been doing.

Towards the end of the week, the message shifted as we took the decision to change our advice on the requirement for people to seek support to lose weight or quit smoking prior to elective surgery, but again, they managed their part of this well and, however difficult, we responded to the further round of interest.

It isn't an easy task, but we have a duty to communicate as clearly as possible and they are a vital team to allow us to do that to the best of our ability.

Highlights of the Week 3: @NEWDevonCCG Western Locality GP Members' Forum-real willingness to work with us on the financial challenges
We spent Tuesday talking to our member practices in the Western Locality of the CCG about the urgent and necessary measures we were taking.  We need to be able to carry our members with us as we try to implement changes to the way elective care is offered, so this was an important moment.  Clearly all the actions we are proposing have been worked up by clinical leads in the CCG so there is good clinical evidence and advice that supports our proposals, but testing this with the wider group of GPs who need to implement on a daily basis in surgery is vital.

We run the forum twice on the same day to allow practices to attend either a morning or afternoon session and that way we usually get over 85% of our 52 practices attending at some point.

There were plenty of questions about the measures we have articulated - requiring people to quit smoking for 8 weeks or to lose weight if their BMI is above 35 prior to routine surgery are the most well reported, but there is a longer list - though a general sense of this being a necessary, if not welcomed move.  The practices understood the scale of our financial challenge and the need for us to take action that would lead to a real change in referral processes.

We described the Macro Marginal Analysis approach that we have adopted, building on work by Professor Cam Donaldson and Charlotte Williamson.  This looks at the treatments that add less value to people, based on best evidence and is how we identify areas like second hearing aids or shoulder surgery as issues we should review.

It felt like we achieved good understanding and left with an optimism that we would be able to implement the changes.

Highlights of the Week 4: The Planning and Programme Office Christmas Meal: first one I've been to in ages...
The small and perfectly formed Planning and Programme Office Team based in Exeter are a key part of supporting the work I lead as Chief Operating Officer.  They are the hub and co-ordinating force for a lot of our activity, including planning, assurance, financial recovery and project tracking.

It was the Christmas meal this week and, after several years working on my own, it was great to be back in the office christmas party swing. (I will miss the Locality's party this year for the second year running, due to a diary that places me in the wrong place at the wrong time).

A good way to end the week and to say thank-you to a team that are often unnoticed in the organisation, but bring a real professionalism and dedication to an often thankless task.  Clearly, it would breach protocol to divulge any more details, but safe to say that there was an appropriate moment to make my excuses and head home, leaving those with age on their side, to continue their celebrations.

Highlights of the Week 5: It only takes one meeting to remind me why I do this job; lots of exciting opportunities to offer better services more locally
When I use to battle a golf course each week, there was a saying that it isn't the 80+ average shots that would bring you back the next week - the combination of hooked drives, balls landing in bunkers, duffed chips or woeful putts - it was the one fantastic, glorious shot, that would see you loading up the car on a cold Sunday morning at 6.30 to have another go.  As the ball left the club and arrowed towards the green with the clean sound of a perfect strike, the feeling was addictive. 

So in a week when there were plenty of challenges, there was one meeting that allowed me to explore the opportunities that primary care has to take forward new initiatives and how we can work as a CCG to make that happen.  Sat with a GP and members of the CCG and practice team we were able to consider ideas, create new thinking and look at how patients could get better care more efficiently and effectively.

One great shot; I'll be back next week.

You can read other blogs related to the work of the Western Locality of NEW Devon CCG

About our workplan: Western Locality Workplan

About our Locality business: Western Locality Business

Jerry Clough is Chief Operating Officer for Northern, Eastern and Western Devon Clinical Commissioning Group.  He is also Locality Managing Director for the Western Locality of the CCG covering Plymouth and the surrounding areas of South Hams and West Devon.

Previously Jerry has been a Chief Executive and Finance Director in the NHS before spending several years running his own business driving programmes of change and delivering executive coaching and team and Board development.

Highlights of the Week - 5th December 2014

We have a new cafe in the reception area of Windsor House in Plymouth where I work (at least it is my home  base, but I spend as much time elsewhere, particularly Exeter, as there).  It is a very  small little unit in  the corner of quite a large space, but it does make a much bigger impact than its size.  The reception area is quite an attractive space - relatively modern, bright and airy - but it could feel a bit souless (outside the Christmas carols or sporadic ceremonies).  Now there are the wafting smells of fresh latte, paninis and soup drifting across the atrium, it all feels a bit more inviting.  I haven't used it much - two or three lunch time soup stops - but I do feel better for it being there and there does seem to be a good trade.

It reminds me of the importance of an entrance.  When I was in York the public main entrance to York District Hospital was transformed by using money generated from selling concession space to a number of high street outlets to change the whole layout and feel of the first space that the public enter.  It was very grim before they began and utterly unrecognisable by the time they had finished, with a large light and open waiting area accessed via a number of patient access desks. I thought it was a great piece of design and a good way to generate the capital required to fund the development.

Even more noteworthy for me, though, was the impact that the shops themselves made on my sense of the environment (I used to walk through the reception area frequently for meetings and only on a couple of occasions as a patient).  The presence of a large Costa coffee shop and a modern and an inviting news outlet alongside a flower shop made me feel much more at ease and that the building was likely to house higher quality services than it previously had done.

And, of course, we all know that effect - the importance of the first few impressions, but if I expect my care to be better, the reality is that my rating of what then happens is likely to be higher; I live my life by my own perceptions of quality, more often than objective fact.

And that all means that, in some small way, I am a little bit more optimistic about work each day when I am greeted with the smell of roasting coffee in the morning and that has got to be good!

Highlights of the Week - 5th December 2014 (@jeclo)

Highlights of the Week 1: Every Monday morning, Operational Delivery Group, real signs of improvement and grip
The Operational Delivery Group is the two hour meeting that kicks off each week that focuses on the financial recovery plan and delivery of key pieces of our workplan across the CCG.  It will never go down as the most motivating and uplifting way to begin another 5 days at work, but it is starting to get a rhythm and moving beyond the moment of good intent to show real delivery.

It is one of several meetings that the Area Team of NHS England now attend to gain greater assurance about our work on our financial plan, both for this year and next, so it also has that external feel of monitoring: we need to get it right.

This week we had a reduced list of outstanding actions, fewer comments about things we are not able to report on and, for the first time, a complete report that allows us to see the impact of all the many initiatives that we are taking forward.

So, not the joyous, uplifting highlight, but a huge sense of progress and on reaching a level of professionalism that we are more proud of.

Highlights of the Week 2: @NEWDevonCCG Governing Body meeting ; less pages more focus on strategy and action
You can't measure quality by the number of pages... but if there are over 900 pages of papers for a Board meeting, you can assume that it will long and a bit of a test of concentration and endurance. This month we had reduced from last month's mammoth set to a more manageable size and there was better focus because of that.

It is a difficult compromise, a lot of the papers were about policies and procedures that we needed to have in place to ensure that our decisions followed due process, but I think that there is also a chance that something important doesn't receive the prominence it needs.

So the meeting this month had a good balance and we approved elements of key strategic direction, such as the next stage of integration work with Plymouth City Council; had a range of detailed discussions on aspects of our recovery plan and the urgent and necessary measures we are proposing; and we paid die attention to key quality, safety and performance issues.

All in all, a sign of us attending to the right issues.

Highlights of the Week 3: Area Team Assurance Meeting went as well as billed. Focus on achievements as well as challenges

Last week I trailed the quality of the preparation work for the Area Team quarter 2 assurance meeting between the CCG and NHS England, noting the excellent suite of documents that we had pulled together against the key lines of enquiry.

The meeting this week was a robust, but constructive session that allowed us to describe some of the many positive things we have achieved over the last 3 months in amongst the major issue of the struggle to hit our financial plan targets that rightly dominates the Area Team's requirement for assurance.

Our Urgent and Necessary Measures form a key part of the discussion and they have attracted a significant amount of media and therefore system interest and we are able to think carefully about the approach we have adopted.


Highlights of the Week 4: Plymouth Pride Awards: an evening celebrating some wonderful achievements with friends in Plymouth

I was delighted to be a guest of Plymouth City Council at the Pride of Plymouth awards this week. 

It was a wonderful evening that celebrated the commitment that many have made to their community within the city in a number of different categories.  There were stories that were inspirational, for example about fostering or fundraising as well as those that were incredibly touching, such as servicemen overcoming injury or those living with cancer.

Then, of course, there were the children. I am sure that being a parent has changed how I view stories about children who have done amazing things or face significant challenges in their lives, but fortunately we were saved from some of them not receiving the ultimate accolade as all the finalists were jointly awarded the winning prize!

Highlights of the Week 5: A first chat on a sofa in the Spotlight studio-it is hard to stay focussed on the core message for individuals

Anyone who has seen the footage of my outing on Spotlight to explain our urgent and necessary measures, especially those that focus on impact on people who smoke or have a body mass index of over 35, would not expect this to be a highlight; it ended with a relatively intense pursuit of a question about whether we intending to have any measures aimed at those who drink or abuse drugs.

We have been clear that we want to be open and transparent about the message and to focus on how they will affect individuals.  We haven't tried to hide behind a series of crafted overly positive messages and our duty is to explain precisely and clearly.

We had agreed with Spotlight that this piece will be a deeper analysis of the issues that have led to the implementation of the measures. It is important not to get drawn in to simple answers, but to ensure we give a very clear message about who will be impacted and how.  But with time short, answers get interrupted and I am cast as evasive.

It is a highlight, not because the moment itself is enjoyable or that I think I've done an overly good job, but the response to many who saw it has been positive about our intent and what I was trying to explain.

If nothing else, there are now a group of people who I live near who have an idea about what I do for a living, the weekend on the sideline at the kids' football was full of their feedback!

You can read other blogs related to the work of the Western Locality of NEW Devon CCG

About our workplan: Western Locality Workplan

About our Locality business: Western Locality Business

Jerry Clough is Chief Operating Officer for Northern, Eastern and Western Devon Clinical Commissioning Group.  He is also Locality Managing Director for the Western Locality of the CCG covering Plymouth and the surrounding areas of South Hams and West Devon.

Previously Jerry has been a Chief Executive and Finance Director in the NHS before spending several years running his own business driving programmes of change and delivering executive coaching and team and Board development.

Highlights of the Week - 28th November 2014

I play cricket - or more accurately, for a number of years I used to play cricket to an impressively average standard.  I have now retired, though there is a nagging suspicion that a few games for a local village team last year might turn in to something more substantial this year.  There are plenty around Keynsham (near Bristol), the Eden Valley in Cumbria and in North Yorkshire who will attest to the fact that the world is not missing much and no one has anything to fear about a sudden return.

I have had moments on a cricket field where I have been nervous or suddenly had the experience of waking up to the fact that this is a game played with a hard ball that can hurt, but the fear of injury has never got beyond a few broken noses, fingers or in my case thumb.  The news this week of the tragic death of Phil Hughes, an Australian test cricketer, after being hit by a bouncer during a game of cricket is therefore a complete shock.

There is something about this kind of incident, especially in a game where it is completely unexpected, that I do find really impacts on me.  The social media viral collection of photos of cricket bats in his memory have been touching and poigniant and do go to show that the tradgedy has touched people from all round the world.

My faith in medicine is clear - I went to bed with the news that he was in critical condition in hospital and my certain expectation was that he would recover, it happens so often in situations like Michael Schumacher's, that I simply thought that the wonderful medical care and attention he would be receiving would find a way to save hime.  I woke up to the news that he had died which I couldn't quite comprehend.

The wonders of modern medical care are all around us - from stories of premature babies thriving to the high profile accidents - and it sets our expectations.  This week was a reminder that, in many ways my body and mind are fragile and, in sending condolences to the family who are suffering this week, I am very lucky with the health I have.

Highlights of the Week - 28th November 2014 (@jeclo)

Highlights of the Week 1: £1.4m from the Transformation Challenge Award-another marker for our joint work with @PlymouthCC
It is always good to be successful in bidding for money, even better if it is a result of working in partnership and even better still if it supports the core purpose that we are working on.  So really pleased that we have secured some funding that will help with the transition costs for our integration programmes and delighted that, whilst we struggle financially, there will be some resource that allows progress to be maintained.

Not that this money solves all of the challenges - we are getting to the point now where we are starting to feel the real operational risks; the risk register is moving from the worry of the strategic intent and making the big agreements to the detailed implementation of IT systems, payment mechanisms and VAT.  But we have a real will to resolve issues and the joint commitment is really powerful as the challenges crystalise.

Highlights of the Week 2: Strengths based appraisal; what could be better than an hour and a half talking about me?
There are plenty of challenges around and the extent to which we are meeting them places a long shadow over any review of performance, team or personal.  We are committed to a strengths based approach and that does make a difference to the nature of the conversation.  So there is a reflection on the year that has gone, that would be fairly typical of any appraisal, but the identification of the areas where things have not gone to plan or where the outcomes haven't been at the level we would have wanted is different.  The focus moves to the learning from those issues and the way that you will use your strengths over the next 12 months, rather than dwelling on deficits and inadequacies.

There is a lot for me to work on and I recognise the areas where I can make a bigger impact or alter the way in which I behave to produce better results, but it is certainly useful to go in to an appraisal just a few days after receiving an award!

Highlights of the Week 3: Area Team Assurance Meeting preparation-lots of KLOEs, but a robust process to pull all our information together
We have had a week of returns-more than usual that arrive on a Thrusday with a deadline for close of play on Friday included, this week, to set out our intended use of the private sector to help with the referral to treatment challenge and whether we have done everything we can on the dementia diagnosis rate target.  But we were already working on a complex return on payment for additional activity in tranche 1 and 2 of the additional funding for referral to treatment times that consumed a signficant amount of finance and business intelligence resource.

We have received a report about our transformation schemes and management of savings that questions our level of resource in business intelligence and the need to focus it on recovery activity more directly.  We agree with the concept, but it isn't easy to see how we make that happen when the emails with CAPITAL LETTER DEADLINES appear.

But in amongst all of that, we needed to produce a response to the key lines of enquiry in advance of our quarterly assurance meeting next week.  And the programme office, contracting, finance, commissioning and business intelligence teams have all worked really well together to produce what I think (I'll let you know the feedback next week!) is a comprehensive and high quality set of papers. Or, put slightly differently, it is what I wanted us to produce, rather than me having to cover over gaps in a meeting for a return that we knew wasn't complete.

Highlights of the Week 4: Individuals at the Centre 2 Mentor call-is anything happening out there? Hold your nerve @timrobson07
We have 16 teams embarking on a new set of projects to drive forward tansformation of care pathways under the Individuals at the Centre 2 banner - the second year of our methodology of change.  The process encourages the groups to become self managing teams and therefore the role of the mentors is to support and coach, but not to direct, even though they are members of the leadership team who are desperate to make the programme an even bigger success than last year.

We had a mentor call to check-in with progress and the feedback was mostly that mentors haven't heard much from their teams and there wasn't a clear sense of any momentum gathering.  

We concluded that we needed to believe in the process-all the data we get is learning and teams need to take responsibility for themselves.  We can nudge and encourage (we send out a nudge every week - here is this week's), 

but we do need the teams to feel the increase in urgency if they are two weeks away from the next module without a lot of action to showcase.  In is clearly much more natural for us to intervene, spotting progress behind plan and to direct the improvement effort, but that won't help in the long term and it isn't the learning we want in this programme.

So the message was to hold your nerve; the programme will deliver!

Highlights of the Week 5: Western Locality Board working strategically - integration and orthopaedics transformation to the fore
Another Locality Board that dealt with our in-year financial challenge and the integrated risk process that details the actions we are taking to mitigate issues such as stroke, A&E peformance, communciations with general practice and the follow-up backlog, but also focussed on major strategic decisions.

In particular this month we had a detailed review of our orthopaedic transformation, which places conservative management at the centre of the pathway with surgery seen as a failure; it is ambitious, offers a better outcome for patients and delivers on our vision to move resources towards prevention.  Crucially, the whole pathway has been based on clinical leadership, involved all providers in our system and has had public and HealthWatch input.

Integration marked the next step in the programme with a recommendation to the Governing Body next week to approve the high level design of integrated commissioning with Plymouth City Council. Sometimes, we definitely get the right balance of attending to the now and working towards the future.


And so to the weekend and to enjoy time with the family, all fit and healthy; plenty to be thankful for. 

You can read other blogs related to the work of the Western Locality of NEW Devon CCG

About our workplan: Western Locality Workplan

About our Locality business: Western Locality Business

Jerry Clough is Chief Operating Officer for Northern, Eastern and Western Devon Clinical Commissioning Group.  He is also Locality Managing Director for the Western Locality of the CCG covering Plymouth and the surrounding areas of South Hams and West Devon.

Previously Jerry has been a Chief Executive and Finance Director in the NHS before spending several years running his own business driving programmes of change and delivering executive coaching and team and Board development.

Highlights of the Week - 21st November 2014

It was the NHS Leadership South West Awards this week - an evening in Bristol to celebrate with those who had been shortlisted in one of the nine categories that were being presented.  I was delighted to have been nominated by different people in the CCG for the "Inspirational Leader of the Year" award, though more than a little embarrassed when repeating those words out loud.

It was great to be at an event where so many colleagues from around the region were being recognised for their contributions and with many from Devon, there was plenty to cheer.  Some of those appear as highlights below, but I was delighted at the end of the night to be presented with the award; the first time ever that I've been in that "and the winner is...." pause as envelope is opened situation.

And it does mean a lot; it means a lot personally - most importantly that people that know me well felt enough about our work to have nominated me - and it does matter to an organisation that has many challenges at the moment and where it can feel like the world is lining up to comment on and critique our decisions, leadership and processes.  So with plenty of humility, really pleased.

And no long thank-you speeches; so what would I have said (in bullet point form). Thanks to:

• Rebecca Harriott and Ann James for convincing me of the benefits of moving to the South West;
• Paula for taking the decision to move half-way across the country and the children for making that such a wonderful success;
• The CCG for allowing me the space to lead and manage in a way that plays to my strengths;
• The team and the staff in the CCG for the dedication, commitment and expertise they show;
• My father who instilled in me the importance of the lesson that the quality of society should be judged by its ability to look after those most in need and to play a part in that mission.

Highlights of the Week - 21st November 2014 (@jeclo)

Highlights of the Week 1: @JoeTeape Development Champion of the Year at @southwestleader Awards - rewarding clear commitment
Really delighted for Joe.  You can learn a lot about people from Twitter and Joe tweets about team development and Finance staff development regularly, alongside his pride in the NHS, Derriford hospital and the staff that work there. 

We are often on the opposite sides of difficult contract discussions and sometimes that leads to heated exchanges or very different perspectives on issues.  I was thinking, as I was sitting at the awards, how the system can lead experienced and able leaders in to conflict.  Our job is to rise above the transactional disagreements and focus on the bigger picture and I think largely we do that well in Plymouth.

But I have never doubted that Joe is working towards the same end as I am - delivering the highest quality of care we can to the largest number of people, within the resources we have available - so delighted for his award.

Highlights of the Week 2: Project Search @phnt_nhs wins NHS Leader of Inclusivity @southwestleader Awards - inspirational!
I hadn't heard of Project Search before the awards night, but it was a really inspirational moment seeing the work the team had done to create paid employment opportunities for young adults with a learning difficulty within Derriford Hospital.

It goes to show that in reality I get to find out very little of what goes on in the large hospital that we commission from and that there are some truly wonderful things that go on there.  Read a bit more here

Highlights of the Week 3: Sam Cush @Devon CCGVideos wins AHCM NHS Communicator of the Year - watch some of his work https://www.youtube.com/user/NEWDevonCCG
We have some fantastic videos on our YouTube channel (Link to channel homepage) and almost all of them are the work of Sam Cush, who is fantastic.  It is not just the framing or the lighting or the sound that matters, it is the ability to find a way to get the message across and Sam is fantastic at that. To be rewarded with the Association of Healthare Communications and Marketing award is fantastic and shows what potential Sam has for the future.

If you haven't (how can that be?) seen any of his work, some of my favourites are:

9 Protected Characteristics

Marilyn's Story

Winter Friends Pledge

And, of course, do watch this latest one about our integration journey in Plymouth: Integration Video

Highlights of the Week 4: Leadership Team Evening Meal - time to talk about other than work; vital with challenges this size
As we were sitting at the end of the meal deciding how to split the bill, I reflected on the fact that we probably don't do this enough as a Leadership Team; we don't get the time to talk about things other than the crucial and urgent decisions we need to make to run the organisation more effectively.

So, at the expense of a late night, it was really valuable to spend a few hours in a nice environment just chatting and sharing stories.  Inevitably there was plenty of discussion about work issues too (sad isn't it that we would always get drawn back to those topics), but even then it was an chance to reflect from a different perspective.

The team recognises the spotlight we are under, but this was a moment to take a bit of time out.

Highlights of the Week 5: Emerging signs that primary care is ready to engage in a new challenge-it is critical to a sustainable future 
If our system is to become sustainable, we need primary care to be ready to forge a new future at the heart of the health and social care community.  It is always hard to see how we transform the urgent care system that I work in by ensuring that 50+ independent GP practices all do something consistently, but unless we solve that challenge we will have hospitals that buckle under the weight of expectation that builds up in a community.

This is partly about general practice working at scale, but it is also about practices with the ability to benefit and risk share on the creation of new models of care.  We need practices who are willing and able to respond to some of the opportunities we create, but more we need practices who are creating the future and coming to us with ideas.  The perfect solution would be a scheme that creates commissioning savings by increasing the number of patients able to access the care they need within the practice or community team, that also helps general practices to become more sustainable.

We are working on a set of "offer and asks" for primary care - this is what we can offer in terms of resources, support and finance, in return we are asking for a partnership to manage risk and to generate savings to move towards sustainability.  This will be a large part of our commissioning plan over the next few months, we do now need practices ready to pick up the opportunity.

Maybe one day we can win an award for primary care innovation with one of our practices?

You can read other blogs related to the work of the Western Locality of NEW Devon CCG

About our workplan: Western Locality Workplan

About our Locality business: Western Locality Business

Jerry Clough is Chief Operating Officer for Northern, Eastern and Western Devon Clinical Commissioning Group.  He is also Locality Managing Director for the Western Locality of the CCG covering Plymouth and the surrounding areas of South Hams and West Devon.

Previously Jerry has been a Chief Executive and Finance Director in the NHS before spending several years running his own business driving programmes of change and delivering executive coaching and team and Board development.

Highlights of the Week - 14th November 2014

There is nothing as simple as taking turns; something we teach children from a very early age is the importance of everyone getting a chance and giving each person an opportunity by going one at a time.  However, I was struck again this week about the profound impact that a tiny bit of enforced turn taking can have on a group of highly developed, intelligent, genuine and caring people.

I have mentioned several times the use we make of Nancy Kline's Thinking Environment - a set of 10 principles that can create a space in which people can do their very best thinking, in order that they will then individually and collectively come up with their highest quality decisions and actions.  The principles are not in themselves complicated, but they do require practice.  For example, setting a rule that it is important to pay attention to the person who is speaking without interruptions is about as simple as it could get, but how many times are you really paying full attention in meetings, listening and seeking to understand the point of view of the speaker?  And how often are you waiting to jump in with the point that you have already formed?

The Thinking Environment has a set of conditions for effective meetings and one of those is "thinking rounds" the notion that the group is set a clear question to consider and then each person in turn, without interruption and with everyone else attentive, gives their perspective - or in other words, we take turns.  Everyone gets a voice (you don't have to talk, you can simply pass on your turn if you have nothing to add) and there is no battle for space.  In particular, there is no domination by louder individuals and there is a calm balance to the meeting.

We had a workshop this week to think about how integration may impact on the structure and operation of the CCG.  Everyone in the Governing Body is interested in the discussion, particularly me, I have a lot invested in our work in Plymouth, but there is a danger that 2 or 3 of us, usual suspects, will overpower.  Instead, with a bit of simple facilitation, we heard from everyone and had a much higher quality discussion as a result.

Sometimes the most profound ideas are simple and things we already know.

Highlights of the Week - 14th November 2014 (@jeclo)

Highlights of the Week 1: We're at Plympton Library - it is exactly where we need to be and perfect for our needs
Every penny counts and more importantly everyone in the organisation having a role to play in financial recovery and feeling involved is vital.  So counting the savings around venue costs, hospitality and other running costs is great attention for the business management and admin teams and we are making real progress.

So we found ourselves in a meeting at Plympton Library this week- a room big enough for our needs and a whole lot cheaper than a hotel booking.  We can't solve our financial problems on running costs (we are already over £2 million under our target), but another £500 in the right direction helps.  And there is something about being in our community, sharing the 2 minute silence with other library users, that helps to ground and remind about what we are here to achieve.

Highlights of the Week 2: Integration discussion @NEWDevonCCG Governing Body-it's happening everywhere, how do we live with different speeds?
Fantastic news this week as the Cabinet of Plymouth City Council passed a set of resolutions marking the next phase of agreement about how we intend to work together on integration.

We cover Devon and Plymouth local authorities and if we move towards integrated commissioning in one part of our CCG then it will impact on how the whole organisation runs.  We spent some time this week with the Governing Body exploring how we can move at different paces and, indeed, have different solutions within the same strategic intent; in short how do we promote integrated commissioning with Plymouth whilst working in a different way with Devon County Council.

Clearly it is not straightforward as we need to be consistent for our staff.  But if you start with the purpose - we are doing this because we are clear that integrating commissioning is a key element of driving forward the integration of service delivery and that in turn is about providing better and more joined up services - in fact the integration of commissioning only makes sense to the extent that it impacts on individuals - then it is an issue we need to resolve positively, rather than a barrier.

So we were finding ways to make this work and hopefully that leads us to a successful resolution in December about our next steps.

Highlights of the Week 3: We are taking some really challenging decisions; but hurrying slowly and making sure we get it right
Another week on and more consideration of the range of options that we are considering to help improve the financial position that we are facing.  I have been in turnaround situations before and it is easy to race to a set op decisions in the heat of the moment and then live with the implications later.

We are trying to take a measured and evidence-based view and the more we discuss what this might mean, the more people are having open discussions about whether many of the treatments we pay for and carry out really add value.  The process we are using, based on a marginal analysis approach used by Professor Cam Donaldson, gives us a rigour to the method and ensures we aren't caught in the pressure of the moment.

I have been impressed by how our clinicians have responded to the challenge - it isn't easy for those in the CCG as they represent a far wider membership who will deal with the impact on any decisions in more complex conversations in consulting rooms over the following months or years - but they recognise that not everything we do is equally valuable.

Highlights of the Week 4: IATC2 - more people in the room from outside the CCG; great to be spreading the learning
I ran a session this week to describe our Individuals at the Centre approach to a new group - setting out the importance of living the statements that you write on the wall on in documents - for us a vision that is "Healthy people living health lives in healthy communities" and a way of working by putting "Individuals at the centre"; in summary either "be it, change it or take it down".  In other words, don't have appealing strap lines that you have no intention or ability to deliver - understand what you are doing to get there or change what you say.

The great thing in the session this week (we have now got to over 75% of our staff in the CCG with an initial half day workshop over the last 18 months) was that there were more people from outside the CCG than our own staff.  We have attracted a team from South Devon and Torbay CCG which is great and within the partnership approach to the projects in the second year of the programme, we had colleagues from one of our local mental health providers, from a care home provider and from Plymouth City Council.

It is encouraging, not only that those people were there and interested, but that our staff when given the opportunity to think about projects for themselves naturally choose to look for a range of partners to deliver - integration has a macro and a micro face.


Highlights of the Week 5: A non searchable YouTube video, but delighted with the online support to our programme http://youtu.be/10Z6yVrc-K8

Have a look here IATC2, Module 1
We need to find increasingly efficient ways of engaging staff and in turning the second year of the IATC programme to an ambition of 15 teams we need options that don't rely on face-to-face contact that would impact on other business delivery.

So online messages are part of the answer.  We expect two change agents in each team to spread the message, but they are supported by online material with the content of the sessions, "nudges" that we send out every Friday reminding all the team of key headlines and then a few short videos that summarise key ideas from the programme, from either Tim Robson (from nowshowup.com who is co-running the programme) or me.

They aren't private, so appear on YouTube as the easiest way to share them, but are non-searchable as they are not primarily intended for a wide audience.  I think this one is really good and will support the teams as they work.


It will certainly encourage them to do some high quality thinking first, before they rush to action - Thinking Environment via a nudge?

You can read other blogs related to the work of the Western Locality of NEW Devon CCG

About our workplan: Western Locality Workplan

About our Locality business: Western Locality Business

Jerry Clough is Chief Operating Officer for Northern, Eastern and Western Devon Clinical Commissioning Group.  He is also Locality Managing Director for the Western Locality of the CCG covering Plymouth and the surrounding areas of South Hams and West Devon.

Previously Jerry has been a Chief Executive and Finance Director in the NHS before spending several years running his own business driving programmes of change and delivering executive coaching and team and Board development.

Highlights of the Week - 7th November 2014

I finished the week talking about "CLANG" - winning ways to mental health and wellbeing - as a result of being given a pen with one of those pull out information sheets cleverly contained with in it.

It lists the five actions that we could all take to improve our mental wellbeing and in that respect I suppose it sits alongside advice about diet, exercise, smoking and alcohol that impact on our physical health.

CLANG stands for:

Connect - link up with people around you

Learn - explore something new

Active - discover an activity you enjoy

Notice - be curious about the world you live in

Give - share something with others

It was a really useful reminder for me, served up in a pen format, of the importance of working to maintain mental wellness in the same way that I pay attention to maintaining physical fitness.  My mother suffered from mental health problems since before I was born up until she died.  Experiencing that as a child, young adult and then as her next of kin left me with a profound sense of the importance of understanding that my mental wellness is not something to be taken for granted.

And talking about that and sharing experience is part of how I stay well - alongside running and other physical activity.  I have recently given up alcohol for (an intended) 6 months.  I know the next 6 months will be pressured and stressful at work and that relying on a glass of wine or two or more at the end of the day will be hugely counterproductive.  So I'll run and walk the dog instead, but most importantly, looking forward at the prospect, rather than waiting until I am deep in the mire, is crucial.

Of course giving up alcohol is also about weight and physical fitness, but I don't think there is a necessity to draw a line between the two as both are important.  Good behaviours in diet, exercise and alcohol will have dual benefits.

6 weeks in and I feel good; a few pounds lighter and clear on work priorities, ready for another week.

Highlights of the Week - 7th November 2014 (@jeclo)

Highlights of the Week 1: @NEWDevonCCG Governing Body in Barnstaple and focussed on the key issues we face

It is not a short drive to Barnstaple from where I live in South West Devon, but we are a big CCG and if the Governing Body is going to meet in different parts of its patch, there will be some travelling to be done.  I loaded up three passengers (the CCG cost saving drive is alive and well) and set off. It does feel important that we do remember the diverse communities that we are responsible for and moving the Governing Body meeting around is part of that.  

It was a long meeting - that can't possibly be a highlight - but given the importance of our financial recovery plan and the actions that the Governing Body needs to be aware of or approve, it was necessarily covering a lot of ground both in the public and private sections.

And just to add to the sense of the importance of our discussions, we heard part way through about the question Ben Bradshaw asked David Cameron at Prime Minister's questions about our financial challenge and actions proposed.

But it did feel like we were doing what needed to be done and, however complex and challenging, the Governing Body discussed, debated and agreed a set of measures to improve our year end position.  So not a highlight in terms of length or the activity, but was purposeful and important.

Highlights of the Week 2: Meeting with @SteveWaite_PCH from @PlymouthHealth - exciting times and lots of energy for the path ahead

We don't manage to catch up as often as I would like, but it was good to sit down with Steve Waite, Chief Executive at Plymouth Community Healthcare CIC this week and talk about the range of issues that we are both working on.  Keeping a senior dialogue is clearly important; often it is the unwritten tone behind emails that is helpful or the briefing on connected issues that will make the difference.

Plymouth Community Healthcare CIC have just been announced as our preferred provider for community services in Plymouth and South Hams & West Devon and their work on the integration of services with the local authority in Plymouth is a key component of our strategy.

No earth shattering decisions, no deals of any magnitude, but a clarity on our joint expectations that will help to guide future discussions.

Highlights of the Week 3: A copy of Strengths Focused Leadership arrives - a book with lots of ideas and a clear philosophy

Kathy Toogood and Mike Roarty's new book Strengths Focused Leadership arrived in the post this week and it looks fantastic.  I have read a draft copy as the work we have done in the Western Locality of the CCG with Strengths over the last 18 months forms a short case study, so I know that the content is great, but it is always good when the cover looks enticing.

I am a complete convert to strengths focussed leadership and couldn't recommend it highly enough.  It isn't about pretending all the world is rosy, but in solving the problems we have, isn't it better to try and use the strengths we have, rather than worrying about the skills we lack or the things we are weaker at?

I'm no salesman, but if you ever fancy an understanding of Strengths with a clear account of how to implement in day-to-day practice, you could follow the link.....Amazon - Strengths Focussed Leadership

Highlights of the Week 4:  Catching up with @JanSobieraj about all things leadership and the state of the NHS

I have met Jan fleetingly a couple of times over the years in our roles in Yorkshire, but I have never sat down face-to-face and chewed the cud about the state of the NHS and Leadership.  So Jan's trip to the South West this week were an opportunity to share views of the NHS from very different perspectives.

It was really enjoyable to hear about Jan's work on Leadership at the NHS Leadership Academy - we explored how their work impacts at a CCG level on a day-to-day basis, equally Jan was keen to hear my perspective on how working in a CCG feels and the bits of NHS policy that help or hinder our work.

We both recognised some of the shortfalls in system design and how we are working to overcome different issues.  Although we are in very different roles, it was encouraging that are perspectives and indeed some of our ideas about solutions were not a million miles apart.

Highlights of the Week 5: Plymouth Health and Wellbeing Board Solution Shop on mental health.  Feels like a positive H&WB mode

The Health and Wellbeing Board in Plymouth should really be pleased with some of the processes and mechanisms that it has put in place to discharge its responsibility.  It has a much wider membership than most with only a few local councillors and an overwhelming majority of partners and stakeholders.  Other than meeting formally in the Council building, it couldn't do much to feel less like a  Council Committee.  

Solution shops are another defining feature - Health and Wellbeing Board members meeting with a range of interested people and groups around a particular issue with the disucssion led by non Board members.  This week's discussion was on mental health and was interesting and valuable.  I found myself discussing how (fictitious) Bob might experience issues in his life within Plymouth and when he would need support from an informal network and when from statutory services.

The discussions were engaged and drew on the experiences of users and particularly those who work in charities and community organisations supporting people with mental health issues.  We did spend some time talking about the importance of talking about mental wellness as well as mental health issues.  

We recognised that improvements would be because of a range of actions and that NHS services alone were not the answer, but when needed, they do need to be responsive and of the right quality.

  

You can read other blogs related to the work of the Western Locality of NEW Devon CCG

About our workplan: Western Locality Workplan

About our Locality business: Western Locality Business

Jerry Clough is Chief Operating Officer for Northern, Eastern and Western Devon Clinical Commissioning Group.  He is also Locality Managing Director for the Western Locality of the CCG covering Plymouth and the surrounding areas of South Hams and West Devon.

Previously Jerry has been a Chief Executive and Finance Director in the NHS before spending several years running his own business driving programmes of change and delivering executive coaching and team and Board development.

Highlights of the Week - 31st October 2014

An undeniably interesting week and one in which our local issues got more of a national and press airing.  We have made a lot of our financial issues directly public this week as a result of informing stakeholders about the "urgent and necessary measures" we need to put in place in order to attempt to hit our financial plan.  This shows a need to find around £14 million of additional savings by the year end - a huge number, even if the turnover for those months will be around £500 million.

The measures include providing a new elective pathway for people with a BMI of over 35 who would previously have had surgery as a usual treatment for their orthopaedic condition; we are now looking to ensure that they are offered weight management initially in order that they benefit more from the surgery or, as is already the case for some, opt to have no surgery as once they have lost weight, their pain reduces and mobility improves.  Elective orthopaedic surgery for people with BMI of over 35 provides limited benefits for some, there are risks and our proposals are in line with NICE guidance, but that doesn't stop the idea raising concerns and comments.  We are also looking for people to have given up smoking for 6 weeks prior to surgery in order to improve their outcomes.

Within the expected local debate we now know that our financial challenge is big enough to recieve national attention and so Simon Stevens was asked a question about our proposals at the Health Select Committee at the start of the week.  He expressed some reservation and the media interest continued. And then, of course, it got a mention in Roy Lilley's blog.

Which all adds pressure to those who are trying to find the right solutions to a huge challenge for which there are no easy answers. It is not the most uplifting of tasks to be sorting through a list of ideas to determine which ones are acceptable and which aren't, but it is necessary that somebody does.  Our Turnaround Director will start next week - a sign of the next phase in escalation and hope that gives us some further support, but we can expect more detailed scrutiny and challenge ahead.

Highlights of the Week - 31st October 2014 (@jeclo)

Highlights of the Week 1: Locality Board is focussed on understanding issues and making decisions on commissioning, finance and integration
We are working to ensure that whilst we are in financial recovery we are clear about how to be most efficient in our "business as usual" processes.  This includes being clear about the role of the Locality Board and whether it needs to meet monthly or perhaps slightly less frequently.

This month, though, showed the importance of the clinical leadership that it provides within the Locality.  There was a hugely engaged discussion on financial recovery and the measures we will need to take over the next few months. Members rightly questioned from a clinical and quality perspective, but were supportive of the proposals.

We were reviewing a key set of actions around a key commissioning decision and the Board were clear about the prinicples and management actions suggested as well as supporting the conclusions that they were presented with.

And they are clear about the imperatives of integration; we have an opportunity in Plymouth to create something that will have lasting impact and they are prepared to think through how things would need to change in terms of their own role in order to deliver those benefits.

All in all, it felt like clinical leadership in action with some key issues to address.

Highlights of the Week 2: Individuals at the Centre 2 launches: 16 teams with ambition to improve the way we work of key projects
It was great to be back at the start of our Indiviudals tat the Centre programme for the first module of the 2014/15 programme that will run through to June next year.

We have scaled up this year with 16 teams compared to 5 last year, so our ambition is huge.  The teams are represented at each for the four modules by 2 change agents who then are responsbile for taking the ideas back in to their project teams and inspiring progress over the weeks between the modules.

So the programme takes 16 project outlines and looks to support their development and delivery by exposing them to some developmental thinking around the purpose of their work and their ambition.

Fantastic success last year, so looking for many more exciting stories to tell this year.

Highlights of the Week 3: Money is central to IATC2; but we can have the discussion and ensure focus without losing the impact of all that we are trying to achieve
And clearly this year the context for the programme is difference.  At a time when we have targeted a further £750,000 of savings from our running costs (on top of our projected underspend of £2 million) we need to be clear about the value that any time away from the core financial recovery work gives.

So we spent a good proportion of the day thinking through how each project will impact on the financial position of the CCG. It was heartening that all our staff were very much energised by that discssion and, far from being the moment that killed all the optimism, it was the point at which the projects becaame real and their delivery even more important.

Highlights of the Week 4: Integration seminar looks at the impact on Devon of our proposals in Plymouth. One CCG with two local authorities
Integration makes yet another appearance in the blog and, as most will know, we are making fantastic progress with our work in partnership with Plymouth City Council with a dual ambition about integration of both delivery and commissioning by March 2015. 

In an organisation like ours where under a third of our population is covered by the footprint of the City Council, this does beg the question, "What about everyone else?" and in our context, what about all those people who are covered by Devon County Council.

At one level, the decisions taken in one area are discrete and there is no real need for the Local Authorities to have an overly close working relationship, but, for us, the decsion in any part of our organisation has an impact elsewhere.

For example, we will struggle to have a governance and decision making structure in one part of our organisation that is different from the rest, so there is a constitutional issue if we alter how the Locality is governed to move towards a Joint Strategic Commissioniong Board.  Equally, if we link a proportion of staff to a new commissioning unit in Plymouth, there is an impact on our internal business support services that impacts large parts of the CCG.

This workshop gave those learders from across the CCG a chance to look at the issues and think through the implications.  Some of us have been exposed to this each and every day for the last year, but clearly people outside of Plymouth haven't.  Getting everyone to the same level of understanding is important as we are nearing another key deicsion point and we need to ensure due dilliegnece.  The session pointed to the challenges, but gave us the clear sense of the questions we need to answer over the next few weeks, so hoepfully we arrive at the next Governing Body meeting with a clear recommendation.
 
Highlights of the Week 5: Professor Clough on Woman's Hour http://bbc.in/1p9AOHk Dementia and cinema - fantastic!
Not often that my father's work and mine overlap, despite the fact that he has been a social work academic at Bristol and Lancaster Universities for most of his career. We share plenty of similar stories, but not many direct connections.  His last piece of work with Age Concern in Lancaster before he finally retires (well, we will wait and see as he is still very much active in his early seventies) has been about dementia and isolation and one of the projects they have been experimenting with is about creating dementia friendly screenings at a local cinimea designed for couples and families to attend.

They have been very successful and have attracted the interest of Woman's Hour and so the 11 minutes of this episode explore the project.  At a time when the press is full of stories about the issues of social isolation, this feels very uplifting and optimistic.  I'm a dementia friend and so keen to explore these types of initiative and very pleased to listen to these wise words!

 

You can read other blogs related to the work of the Western Locality of NEW Devon CCG

About our workplan: Western Locality Workplan

About our Locality business: Western Locality Business

Jerry Clough is Chief Operating Officer for Northern, Eastern and Western Devon Clinical Commissioning Group.  He is also Locality Managing Director for the Western Locality of the CCG covering Plymouth and the surrounding areas of South Hams and West Devon.

Previously Jerry has been a Chief Executive and Finance Director in the NHS before spending several years running his own business driving programmes of change and delivering executive coaching and team and Board development.