Highlights of the Week 28th March 2014

Spring is definitely here in Devon and the beautiful magnolia tree outside the front of the house is just about ready for its full glory.  It covers the view of Dartmoor just behind it, but the (mostly) glorious mornings have led to a concerted effort to get back in to a more regular routine of morning running.

It takes about 20 minutes of hard uphill grind with dog in tow to get to the top of Ugborough Beacon.  It's quicker without him with regular toilet stops (for Jasper!) slowing down the overall progress, but that does mean a less fanatical approach and more time to look over the rolling hills of the South Hams and out to sea.  The really enjoyable part is that the rest of the hour is all downhill and, on a crisp morning, is stunning.

Running is an important part of the management of a busy week for me, ensuring both head and body are in good shape to deal with the pressures and four early mornings this week mean I feel good at the end of the week and not in quite the same "thank Crunchie it's Friday" mood as last week.

Highlights of the Week (@jeclo)

Highlights of the Week 1: Integrated Governance reporting at our Locality Board
We have worked really hard on our integrated governance reporting with each locality in the CCG producing an Integrated Governance Report covering patient safety, finance, performance and other commissioning areas.  Our risk template process pulls the highest risk areas from the risk registers and ensures there is a clear, concise summary in front of the Board.

That sounds fairly dull, but the reality is that across the three Localities and Partnerships there is a real sense that integrated governance, with a strong focus on patient safety and patient experience, is front and centre. 

Stroke performance at Plymouth Hospitals has had a risk template for a while and as a result the Board wanted a "deep dive" this month.  It was good to note some improvements in performance and the work the team are doing to support the Trust in making those changes.  The Board wasn't totally assured, but they were pleased to see the depth of the work that sits behind the summary

Highlights of the Week 2: Plymouth H&WB sign off our BCF and 5-year strategic plan
I do enjoy the Plymouth Health and Wellbeing Board.  It has a wide membership so feels like a very positive discussion.  The Police and Crime Commissioner, sits alongside Plymouth Community Homes or Plymouth Community Healthcare Chief Executives and when discussing the impact of alcohol in the City with the Director of Public Health, this makes for a well informed debate.

Both the Better Care Fund and our strategic plan have been to the H&WB before - we have shared both at an early stage and had an informal 'solution shop' for members on the BCF to explore the potential in some depth.

We have huge ambition around integration and it is hard to capture that within the confines of a Fund that we are focussing at the services that wrap around hospital admission and discharge in the first instance.  What was great to report to the Board was the level of joint working between the CCG and the Council.  We are totally aligned on how we are taking integration and the BCF forward, despite the pressures on our different systems and it does mean that the Board was focussed on the impact for people, rather than on judging our different intent.


Highlights of the Week 3: My first use of our new strengths based appraisal system 
It is not revolutionary, but we have worked hard to back our development work using a strengths based leadership approach, with the ways we work in the CCG.  One aspect of this is to have an appraisal system that takes a strengths focus.

So I sat with Debbie this week and listened to the things that she has excelled at over the last year and that have energised her.  We explored what it was about those projects and achievements that she felt most drew on her strengths and then looked at how she could make more of those in the year to come.  Her objectives are therefore based on making more of her strengths and we managed the whole discussion without any focus on her weaknesses.

It might sound a bit fluffy, but the reality is that of course Debbie touched on the things that haven't gone well - strengths focus doesn't mean problem phobic - but it was much more enjoyable to assess how the things she does well could be used to address them.


Highlights of the Week 4: Individuals at the Centre has a life of its own
I keep tweeting about our Individuals at the Centre programme and the 5 teams who are coming towards the end of their 9 month learning journey.  The finish line is looming and there are working really hard to enjoy their work is getting to the outcomes they had hoped. 

And of course, most are blown away by how far they are exceeding them.

This week we had a member of the public at our Locality Board using a public questions' slot to feedback on an event she had been to earlier in the week - a patient involvement event for people with psoriasis and eczema.  The preceding challenging questions had me prepared for another difficult moment.

But she wanted the Board to know how amazing the event had been, how inspiring the team were who were running it and how impressed she was with their energy and enthusiasm.  As I explained to the Board, this is what can happen if you give people the freedom to come up with ideas for themselves - no senior oversight of direction, just support for their journey and a lot of faith in the process (and some crossing of fingers!)

I also talked to a member of another group who was preparing for her annual appraisal and commented that  she was really looking forward to the section on how she lives out the values of the organisation (a new part of the appraisal paperwork) as she feels like she has a little bird perched on her shoulder called IATC that constantly reminds her.

Priceless!

Highlights of the Week 5: The joys of the open plan office
The CCG office in Plymouth is co-located with Plymouth City Council in a large open plan building. I was no fan of open plan, but it has been amazing for how we work as a team and interact with other staff from the CCG and Council.  It is helped by having technology such as phones that work through headsets on the computer so there are no phones ringing everywhere and no loud conversations.  But it is large enough that the background noise becomes a hubbub rather than distracting.

Most of the time....

This week there have been moments when I have joined in the conversations about new dresses, haircuts, pregnancy, football etc along with up to 30 other people, but the shared laughter across the office as a result is really powerful in terms of what keeps us all together as a team.

We have 3 offices amongst the open plan - designated for me, the Chair and the Locality Chief Finance Officer, but we pretty much don't use them and are usually out in the open plan keeping in touch with how the place feels and the team conversations.

Today was birthday cakes - one of the downsides is there always seems to be cakes around.... perhaps not a downside unless you're running to keep fit.....!

Highlights of the Week 21st March 2014

It has been a tough week.  That is what happens when you are in the middle of the annual contracting process and you get caught between the proverbial rock and a hard place.  In our context, that means an NHS Trust and a CCG both with projected deficit plans for 2014/15 trying to close a gap in expectation on the size of our contract.  I think it is, at its simplest, because there isn't any overlap between our highest offer, all in without any safety net, and the Trust's lowest acceptable number.

We've worked really hard at maintaining the right senior behaviours within those negotiations and I think, broadly speaking, we have managed that - a credit to the values of people on both sides of the table, but it is immensely hard when you are in mediation, leading towards arbitration and trying to make your points, which both sides believe in.  

We need to focus together on delivering the scale of transformation that will bring our local system back in to balance, a place it hasn't been for many years.  We have edged towards that over the last year, but we do need to find a way to get through contract negotiations in tact in order to reset our ambition.

Nancy Kline's "Thinking Environment" is a key part of how we work in our Locality (the Western Locality of NEW Devon covers the city of Plymouth - Britain's 14th largest city and the 4th largest natural harbour in the world! - and the surrounding rural area of South Hams and West Devon) and increasingly across the CCG.  Her ten components provide the space to improve thinking on the basis of "the quality of anything we do relies on the quality of thinking we do first".  We practice hard at keeping to the components and running meetings in that style.  It creates a calm, reflective and purposeful atmosphere which is helpful in a week like this.

One element is to start and finish meetings on a positive (and the blog isn't living up to that!).  Another is to practice the 5:1 ratio of praise and affirmation to criticism - and so after a start that notes the challenging week, on to the 5 positive reflections....

Highlights of the Week (@jeclo)

Highlights of the Week 1: first CCG annual members' meeting. More GPs and practices than we expected and great engagement, plenty to discuss

You plan a members' annual meeting and then wait to see if there is any level of engagement of practices with that kind of event when we are describing a bit about our first year and more about our work ahead.  The sight of extra tables being set up is either a sign of success or a low level of expectation; in reality a bit of both I suspect. 

The world doesn't change as a result of the event, but it does give some reassurance about the general direction we have set with our Clinical Leads and Board members; it also provides some challenge and new perspective which we can use to refine our ideas. 

Our Members seemed happy with the five pillars of our 5-year strategy and were interested in what the support as a Challenged local Health Economy will bring.  We had a really interesting discussion about what co-commissioning primary care would mean for the CCG and Member practices - up for change was a strong view.

Highlights of the Week 2: staff brief-talking about the huge potential for improving care through integration & honestly about staff impact

The CCG is working hard on two streams of integration work, one with Devon County Council and one with Plymouth City Council.  They are both progressing well and this week we were briefing staff in the Western Locality on the work in Plymouth as papers were published for a Council Cabinet. 

The impact of the programme with stated goals of full integration of commissioning (and full integration of provision of community health and social care services) will be profound and completely changes the notion of what a CCG is and it's governance. The prize is worth the level of change and those who came to the staff briefing heard the honest description of the benefits and the potential uncertainty for staff.  The response was reflective and positive - I think most staff share the sense of importance of the task, above what it may mean individually.

Highlights of the Week 3: Individuals at the Centre mentors' catch-up. Seeing where the teams are for 9th May. Sounds fantastic, but scary!

We are just over a month away from the final module of our Individuals at the Centre learning set.  This means in about 5 weeks we will know whether the enthusiasm, tools, techniques and guidance we have offered to five teams in the CCG has resulted in 5 changed and remodelled processes or systems in the organisations together with 28 new change agents. 

The temptation is to forget all the intent we have shown throughout the programme and provide a firmer steer or greater opinion, rather than support for the teams' ideas and work. 

But the call gave us all the reminder about the greater purpose and we are excited about all the great snippets we shared about what the teams are planning. I feel a bit like a worried parent, but I'm sure that the 9th May will be a huge celebration of success. 

Highlights of the Week 4:booked leave to write book in May. Announcing to increase personal commitment! A break to spend every hour working?

I have toyed with writing this book for over a year. If I hadn't rejoined the NHS it was the natural next step in my coaching and development work, based on a process I had been working on with groups and individuals over an 18 month refinement.

It is a 10 part model for thinking about career, job match, CV and interview preparation in a way that allows people to powerfully focus on themselves at their best. It has had great results and featured heavily in the work I was doing around the transition from PCTs to CCGs. 

Having worked with a few people recently using the model again and realising that I need to keep working on the things that bring inspiration to me and those I work with, I have told a few key people that I'm going to take some leave in May to break the back of the writing - doing so will mean I will do it as I can't stand owning up to not achieving a goal I've set for myself!

It will fall in the middle of really intense work on the Challenged Local Health Economy, so I'll be exhausted beforehand and busy afterwards. It still feels like the break - though full of long days locked on to a keyboard - will re-energise, so am just agreeing with the family that I can hideaway for a short period.

Highlights of the Week 5: Friday! (never said it before) but tough week (for all) at work means very much looking forward to York weekend

I am definitely not someone who only works for the weekend - work being the way we earn the money to do the things we really enjoy. I am clear that I want to enjoy every aspect of my life, each day and the work I choose allows me to enjoy my contribution to the society I work in.

But I can't claim to get that balance every day or every week.  Some days at work are incredibly stimulating and enjoyable, better than the weekends laying paving slabs or erecting sheds; others are tough and sometimes even I have to admit that the weekend with the family is the thing that seems to make sense of the week. 

This weekend was spent travelling the 6 hours back up to see old friends in Elvington, near York.  The whole family has loved the move to Devon, but it is lovely to see them reunited with old friends and for me to have some relaxation that can't involve any DIY or running a taxi service.

A 6 hour journey home (hopefully!) will see me ready for the new week ahead....

A bit about me...

I have had some feedback that this blog doesn't contain any backstory ... and in an X-Factor world, the backstory is almost more important than the content.

I rejoined the NHS last April (2013) at the start of NEW Devon CCG, having undertaken some consultancy / development/ interim work with the shadow CCG for the 12 months beforehand.  I hadn't been too interested in the assignment at first - I lived in York and had mostly managed to get home from clients most days.  The prospect of working away for 3 or 4 nights a week wasn't appealing, but the proposition of bringing together Chief Executive expertise with coaching and development emphasis was too good to turn down and it did mean that I was working with a number of different size CCGs, which felt good for the future.

I used to drive down to Devon to work with the largest CCG in the country early in the week and then back home to work with North Lincolnshire, amongst others, with less than 10% of the employees of NEW Devon.

I have now moved to Devon, resettling the family on the edge of Dartmoor in the South Hams and am busy integrating learning from the last 6 years and a passion for coaching and development in to an NHS leadership role.

The world before rejoining the NHS can be found at Atlyric Limited (or at least it can be until that finally closes!)

Highlights of the Week 14th March 2014

I try not to celebrate Fridays; it makes me feel like I only exist for the weekend, when in reality I like to focus on the enjoyment of the whole of the way I choose to balance home and work as aspects that make up my life.  But I am tired this week, so it will be good to relax a bit (although there is a large shed that I need to erect that will test the relaxation piece!) 

I am also four weeks from a holiday and I have been invested in that thinking about how great that will be as a colleague was describing their journey to the airport tomorrow morning.  I do think that anticipation is one of the best parts of holidays.

The five highlights this week on Twitter (@jeclo)

Highlights of the Week 1: GP Members’ Forum-an engaged debate about referral management shows practices are interested in the CCG

It was an interesting day.  We run a forum for the 53 practices in the Western Locality of the CCG every quarter and we get a representative regularly now from over 80% of practices.  We probably had more of a challenge around engagement than the other Localities in the CCG: Northern has a tighter group of just over 20 practices that have worked well together and there are 4 clear sub localities in Eastern that promote really effective engagement.

So we’re always checking whether we get good enough engagement or not and the Members’ Forum is a barometer of that.

This week was a good day.  We run the same event twice – morning and afternoon so that we don’t shut practices, don’t use up all the locums available by trying to get everyone there at once and to give us a good group size to some of the breakout sessions and stalls and stands that we put on.

We did a presentation about our 5-year strategy and our commissioning intentions, but the real engagement, which could be a euphemism for a bit of angst, was around referral management.  The CCG has brought together two really good centres in Plymouth and Devon that have worked slightly differently under one management structure.  Clearly GPs locally are worried about losing what they see as the special character of our local centre.

I love the debate.  We could have done better on the engagement and communication, but the process is sound and involves the Locality Boards and Governing Body making decisions on behalf of their members and in the best interests of patients first and foremost.  But the discussion was exactly what we need to ensure that the Members are not passive about the CCG and our decisions.

Highlights of the Week 2: Working with the Clinical Leadership Group on the next version of the 5-year strategy. Increasing alignment and focus

We have processed the feedback on the first submission of our 5-year strategy and the job on Wednesday morning was to work with the Locality Chairs, Vice Chairs and CCG Chair to improve the description of the kind of system we are trying to create, the challenges we face, the impact on our provision landscape and the way it will feel for patients.

We have 5 key pillars in our strategy

Partnerships to improve health and wellbeing

Integration and Personalisation

General Practice as the organising unit of care

A regulated system of efficient and effective elective care

A safe and efficient urgent care system

It was really interesting to hear everyone’s take on what those pillars stand for and how the NHS would look different as a result.  There is no doubt that the work on integration is top of the pile for us – we are really commited to transforming how health and social care work together, but we also are looking at vertical integration in some parts of our system.

The Clinical Leads group brings together GPs from very different areas and we are addressing some of the real issues for our economy about health inequalities, demography and our ageing population and the need to support local access. It feels like a very positive and purposeful discussion, against a very challenging backdrop.

Highlights of the Week 3: An evening with the CCG Leadership Team to think about how we model our values for our staff.  All of us, all the time

There is a deep irony that we finished an evening of dinner and discussion at 10.30 when one of the main issues for discussion was how we model our values and one of the keenest areas of debate was whether it is ok to be emailing at 10pm – is that the example we want to set for staff?

However, giving up time in a social atmosphere to think about those issues didn’t feel like the kind of work we should be worrying about.

I am passionate about the issue “Leadership by example is not one form of leadership, it is the only form of leadership”.  I buy that.  So I don’t send emails after 6.30pm, before 7.30 or at weekends.  I try not to work in those spaces too, but that is less easy.  Is it ok that I work in the evening, but don’t let others know?  Or is that deception?

I think that managing the impact is important, so if I work because that is a choice I freely make (and for me it is unusual, I prefer to work at a fearsome pace during the day/ week to keep on top of emails and tasks than to work at weekends), but protect others from the impact of that or what may feel like a demand for them to do the same, I think the intent is positive.

I tell people at work and they know that in an emergency they can text or phone me, but I won’t respond to emails.  I hear it back from many people, so the example must be having an impact, positively, on our leadership style (one person said “I hear you delete all emails you get after 6pm – not true, but I quite like the idea that people might think that!)

Highlights of the Week 4: Spending time with one of our Locality Chairs to explore the many areas we align on, rather than the few differences

I sometimes clash with one of our Locality Chairs.  I love fluffy development, time to explore values, behaviours and patterns; he prefers for development to be business focussed and to be “real”.  The development of mission and vision and consideration of whether a vision needs to be a purpose you own or could be aspirational was one area where we sparred a bit recently.

However, we both truly value the other’s contribution and skills so we agreed to sit down this week and work through how to represent the organisation on one side of A4 in a way that we both likeed and felt that the Board and staff would be happy to align behind.  All brought about by the fact that I like this from Plymouth City Council which is up in all their buildings, including in every meeting room where I work. Not flash, just simple, clear and often repeated.

It was a great hour, full of aligning behind what we are trying to achieve and finding out – from resource allocation to referral rates, just how much we agree on.  Time to find more time to do this more often.

Highlights of the Week 5: The emerging strength of the Commissioning Managing Directors meeting. A large CCG needs four localities with one aim

We designed a CCG with over 900,000 population around four commissioning localities and a partnerships Directorate that commissions scale services CCG wide.  So our bottom up design looks like it builds from those four key components.

Increasingly those it is obvious that we need to and do operate as one CCG with local community focus, ownership and accountability.  Our commissioning intentions and strategy are based on all areas working collectively then working out what that means in each local area; last year our commissioning plan was made by pulling four largely separate plans together.  We have made great progress – not easily, but increasingly with the commitment and energy from all parts of the organisation.

One of the key components of that collective effort now is the Commissioning Managing Directors’ Meeting every fortnight where the four of us have space and time to think through the challenges and to work our collective or individual responses, projects and actions.  In a Leadership Team with many issues to focus on and, at its heart, the job of overseeing the effectiveness of the CCG, we didn’t seem to get enough time or in an informal enough way to develop, enhance and improve our thinking.

So, today I finished Friday with a couple of hours sat with the MDs talking about the Better Care Fund, our 5-year strategy, the work on Challenged Health Communites, community contracts, the development of the Planning and Programme Office and a number of other things that came up.  Felt energising on a day that had signing off of paperwork for arbitration in the middle of the day.

Highlights of the Week - 7th March 2014

.... and breathe.....

Great this week to have some space to breathe when things are so hectic with the planning requirements and thinking ahead to what the "Challenged Health Communities" support and ten-week work plan will mean.

I was reminded this week of some work I did with a few GP practices in Yorkshire.  We were looking at appointment systems in relation to availability for patients and efficiency for the practice.  GPs would lament the "extras" that might get tagged on to the end of a day meaning their evening surgery always overran and they never finished on time.  It is really interesting to note what happens if you change the expectation of the finish time by half an hour and then note any times you finish early.  It was really useful for some in helping to get back in control of the constant sense of a work life that was not theirs to control.

This week I've again heard many people describe life as "busy" - in our world it is at this time of year with contract negotiation and planning pressures.  But the reality is that this is the pace of my life and I have got comfortable with it, it is my choice, rather than my burden.  It doesn't mean every day is a joy, or that there aren't days when I don't get finished when I would really want to, but not answering with "busy" as the default answer when asked "How are things?" does have a good effect for me.

The five highlights this week on Twitter (@jeclo)

Highlights of the Week 1: Discussing with our Business Intelligence Team how to work more effectively-so glad we have them in the CCG
I am really pleased as I look at the cross matrix effort that is required for many of our key tasks - from integrated governance to producing our five year strategic plan - that we have our critical business functions within the CCG, rather than in a Commissioning Support Unit.  We have excellent support from Business Intelligence and have some great examples of their work.  We can become a bit spoilt and make ad hoc demands to support individual pieces of work.  This week was about thinking through how we get a bit more strategic about the work and move to a model that is perhaps more like 80% planned work and 20% ad hoc, rather than the inverse, which is probably where we are now.

There is really important work ahead, whether we are scoping the needs for the Better Care Fund or the supporting data for the Challenged Health Communities work, so the timing was good.  We all are aligned about the purpose, lined up behind the CCG's goals.

Highlights of the Week 2: Leadership Team Development Day -School with Pay. Provocative thinking from @timrobson07 about how we live at work
The Leadership Team in the CCG spend a day on development every 6 weeks or so.  I used to facilitate these, building on my years in coaching, facilitation and development before rejoining the NHS and we use a few different facilitators.  This week's session was facilitated by Tim Robson from NSU Media who introduced us to some thinking of his about how work can become like school with pay.  There were interesting paradigms to consider, like Teacher knows best and think about how these analogies may be true for us at work.

We are an organisation under significant pressure with financial challenges at the top of that list.  Days like these are crucial for the Leadership Team to keep a focus on the assured leadership that the system and our staff need and to ensure we retain eyes to the long term, whilst attending to our challenges in the present.

Highlights of the Week 3: Feedback on Strategic Plan - more work to do, but happy with the progress and the team effort to produce quality
I am better at receiving feedback about my work than I used to be.  Given time and application, I am clear that I can produce products of good quality and enjoyed that space in my consulting career.  The amount of work in our strategic and operational plan means it is hard to ensure we have produced the level of quality that we would want, especially given both the extent of our ambition and the challenges that our local system faces.

All in all, the feedback from the Area Team of NHS England was that we need to do more work - we know that, so no problem with receiving helpful views about the areas that we can work on before the 4th of April and ultimately the 20th June when we need to produce further versions of the plans as well as the Better Care Fund submissions.

The role of the Planning and Programme office in support of this production is gaining momentum too and it does feel like we have the systems in place now to notch up the quality for each future versions.  Without breaking my own rules as laid out above, the teams that are co-ordinating the work as well as within each commissioning team are pulling out all the stops to support the effort.

Highlights of the Week 4: Coaching and mentoring sessions with two exciting members of staff. One thing I miss is regular coaching each week
Coaching used to be a core part of a working week.  I might have 3 or 4 coaching sessions in an average week and perhaps on some weeks most of the days would be taken up with development work, both individually and in groups.  I don't have time for anywhere near that amount now and it is one of the things I miss most from my previous life.

I did have a couple of sessions this week with some wonderful young members of staff within the organisation who had felt able to ask for some support; that in itself is a sign that both me the organisation are getting things right.  They are both exciting and I loved talking about their future careers, what they enjoy and where opportunity might lie.

I used to run a programme called Ten Steps to Me that I developed (I own a registered trademark) and it came out of the wrapper in one of the sessions.  I have committed to myself that I am going to write the book of that programme this year and have booked some leave to get that moving. I coach people on the need to move from dreams, where they have little investment in making things happen, to action.  Time for me to reflect on my own lessons!

Highlights of the Week 5: Individuals at the Centre - thinking about how we extend our successful programme for staff in and beyond the CCG
The most enjoyable days over the last 12 months have been those spent working on the Individuals at the Centre programme in the organisation.  No organisation would set out to "put the patient at the periphery of there care, at the margin or our interest", it simply makes no sense.  But there is something that is different from saying things are important and doing something about it.  This programme is part of that process for NEW Devon CCG.

We have run half day workshops for over 50% of our staff with evaluation that I've never seen before, based on bringing brand concepts and a focus on purpose to stimulate thinking (one of my Change Day pledges is to get this number to over 90%).  We have done Leadership Team and Governing Body Development sessions and are running a developmental learning set for nearly 30 staff over 9 months to allow 5 teams to model what excellence of putting individuals at the centre would look like - we'll see in May how brilliantly that has worked.

But today was about thinking past May and over the next 12 months about what the next stage of this programme could be for us and what might it be as a movement beyond our CCG?

If leadership is, in part, about going beyond what people expect you to do and to inspire about things that are of you own creation and initiative, this is one key piece of what keeps me smiling at the end of the week!

Let's Start With Why....

I've been on Twitter for a while. I am relatively active, tweet occasionally and retweet more often.  Somedays I find scrolling through the tweets of those I follow a bit tiresome, whilst others I find little nuggets that I really enjoy.

..... so I'm not a rampant addict, but I'm on the journey to being a regular user.

One of the things I did commit to when I decided to join Twitter was to make sure I tweeted something every week (if I was going to do it, I needed to commit to getting past that awkward "newness" phase).  And in order to be certain of doing what I said I would do, I decided to sit down every Friday evening and tweet five "Highlights of the Week" that encompassed what had been good about my week in the NHS.

I rejoined the NHS in April last year having had six years working for myself as an independent coach, facilitator and consultant on public sector change programmes.  After 15 years in the NHS, I had left in 2007 at a reorganisation, but following a challenging time as an NHS Chief Executive in a PCT with a significant deficit and latterly "on secondment" at the local Strategic Health Authority.  During the latter stages I had the opportunity to reflect on the state of the NHS and how it dealt with people and took on a slightly jaundiced view.

It was a revelation to work for myself and realise that I could work in the public sector without the need to own the sometimes odd and bizarre circumstances that prevail.  Better than that, in my new role, I was often asked to come in and help sought out some of the inconsistencies, unrealistic timescales or seemingly mad requirements and I enjoyed being asked to sort out the mess rather than feel like I was caught up in it.

It was a really soul searching decision to move with the family across the country, give up my successful business and rejoin the NHS, especially at a time of such austerity and challenge.  I made a clear agreement with myself, that I was choosing to re-enter the NHS and I would only make a difference if I stayed positive, optimistic and upbeat.  My leadership is about setting the tone and I am serving no one, least of all myself, if I simply reflect the challenges that we have to face.

So the "Highlights of the Week" commitment delivers on my Twitter ambition, it records 5 positive things I have done in a Leadership role in the local health community and it serves as a weekly reminder to myself of why I'm here in Devon, working for a local Clinical Commissioning Group in a really challenging economy - because good things happen each and every week.

But I struggle to express those 5 great moments from a week in 140 characters and sometimes I feel like I want to explain more about the issues that are behind the bold and brief headlines.  So this blog will give me space to explore more about what it is like working in the NHS at the moment and my reflections on the contribution I'm making to keeping the NHS central to the things we are most proud of in this country.

It will be a story of a Clinical Commissioning Group, the staff I work with, the partners and organisations I work alongside and most importantly how I focus on keeping the individuals we serve at the centre of the work we do.... my biggest "why" in life is because I believe in a fundamental right to equality for all, I do that by working in the public sector using the best of my skills, I just happen, for now, to be the Chief Operating Officer of a Clinical Commissioning Group.