Highlights of the Week - 25th April 2014

No blog last week... holiday time and a wonderful week skiing with the family.  This is the perfect holiday for the 5 of us as everyone looks forward to it equally and shares the enjoyment (less of "do we have to go to the beach again" kind of moments)

The highlights of last week would have been Family, Space & Emptiness, Mountains, Sun and Fun & Chilling, which in 5 pictures looks something like....

We have been skiing at Easter for a few years, so have gone back to Tignes, where the height almost guarantees snow, even in the middle of April and didn't disappoint this year.  I still can't quite get to grips with the heat (t-shirt high in the mountains at lunch time) with the activity of skiing, but it suits us more than the better snow you might get in February that often comes with cloud, cold and twice as many people on the slopes. 

So suitably refreshed and ready to be back at work this week!

Highlights of the Week - 25th April 2014 (@jeclo)

Highlights of the Week 1: Plymouth Health and Wellbeing Board Solution Shop: Systems Leadership & Alcohol - how have we done?

The Plymouth Health and Wellbeing Board does meet formally to carry out its important business, but has placed emphasis, from the outset, on having a wide membership, not acting like a "traditional council committee" and injecting development space in to its work.

This week we were hearing how the external support to experiment in using a Systems Leadership approach to a particular project - the delivery of the Plymouth Alcohol strategy - was working.

The facilitation was excellent and expertly delivered some hard hitting and key messages from the those charged with the delivery of the strategy.  It seems like we aren't connecting well enough between the senior leaders at the Health and Wellbeing Board and our teams trying to implement; It felt to me like we aren't quite "walking the talk" and the messages for us were profound.

We spent an afternoon thinking carefully about that and what it meant for the more general work of the Board.  We have a way forward that will ensure we listen really carefully to what the team has to say and respond with action.  What was hugely encouraging was the sense that we are going to keep working on this together as a leadership community and get to the right outcome for the city.

Highlights of the Week 2: Another member of staff reflecting on the joys of living with an empty inbox - a coaching success

It is hugely annoying to post a highlight of the week as "finishing the week with an empty inbox" - I know the antibodies it can create!  But having coached many people over the last few years on how to get to a daily state of empty inbox and lived in that mode, it is now the way things routinely are for me (and is definitely a positive kick that allows me to focus each day).

I had spent some time with a member of staff a few weeks ago who was really struggling to see the right way forward and progress anything meaningfully, because of the sheer amount of work that she had on, characterised by the number of emails in her inbox (hundreds).  We talked about how this could be different and the benefits of being able to prioritise each day without the fear of what might be lurking, either opened or unopened, in the electronic post.

She went away sceptical, but determined.  And today she came back in a different frame of mind, feeling much more in control and recounting how she has been able to really get to grips with things as a result of believing that it would be possible and then making it happen.

It reminds me that I have promised to run a workshop for staff on "Why I choose the inbox I have" and I have committed with my PA to get some dates in to do that a few times over the next couple of months.

Highlights of the Week 3: The Chief Officer Leadership Group of the Challenged Local Health Economy Programme - an emerging sense of joint action

We are three weeks in to the intensive support for the programme of work as a Challenged Local Health Economy, having been identified as one of eleven such communities nationally.

That means that on Monday the first checkpoint report went off to the national team which detailed the joint local understanding of the extent of the challenge.  It feels like we have progressed well with that, with the Directors of Finance group working hard on determining the financial challenge we face over the next 5 years and support from PWC synthesising information from interviews, public health reports and performance metrics to present a rounded view. 

The geography of NEW Devon CCG does not constitute a natural health and social care community as it spans three acute trust footprints and two local authorities.  The boundary was chosen because GPs felt that this was the size of area that would be needed to address the issues we were facing and so we are starting the journey of creating a programme of work across the area for the first time.  

It feels slower than I suspect it does in other areas where there are already natural communities that have been working together for many years, but it does feel like the chance of finding a strategic solution are better than they have been previously and the Chief Officer Leadership Group - covering 12 health and social care organisations - has met three times in a month; a sign of some real commitment to a health community wide solution to the challenges we are collectively facing.

Highlights of the Week 4: A clear Locality Workplan will be the cornerstone of our effort this year - and there is real sense of progress

The Locality workplan - the distillation of our QIPP transformation work and other workstreams - will be at the heart of our work in Western Devon for the next 12 months and beyond.  It will be critical to the success of the Financial recovery plan too - we are facing huge financial challenges and we have to ensure all our commissioner QIPP plans come to fruition.

We had a broadly block contract with our main acute provider last year so the imperative around the Locality plan wasn't as pressing.  We have to up our game this year and part of the rationale for reorganising our commissioning team was to ensure we are fit for that challenge.

We have a new lead for the workplan and cleared some space for her to get focussed over the next few weeks.  There feels a really good energy around the work and I am more optimistic that we will deliver on our ambitions in the Locality - the contract under performed in volume and value terms last year and we need to make sure we manage that again.  So on returning from leave I am impressed with the energy and looking forward to seeing the results and turing plans in to reality.

Highlights of the Week 5: A hour spent helping someone to prepare for an interview feels like some of the best use of time

I really enjoy being asked for input, coaching and advice from members of staff who aren't put off by the introverted exterior and demanding encouragements to action they often hear me utter.  The question is often framed as "you won't have time, but....", but I hardly ever turn down those who ask; my ego is easily stroked!

This week it was to spend an hour doing a mock interview with someone who is desperate to further their commitment to the NHS by taking on a new role, staying within our CCG.  It is clearly not about me, but I had a great time - there is something in the energy and intensity about the ambition to serve that I love hearing about from anyone who is driven in that way.  

Not a perfect performance, but as I was once told, the purpose of rehearsal is to be perfect on show night, not in the warm up and the feedback will hopefully help them to be at their very best next time out.  

And I guess it is a reminder to choose to put things in the diary that will end up as a highlight of my week....!

Highlights of the Week - 11th April 2014

I would avoid next week's blog if I were you, unless you want to read about the joys of skiing in the sunshine with the family.  This week was therefore about ensuring that progress continues with all the major work within the CCG and left in a neat state before heading off.

We are still concluding contracts (negotiating on some, agreeing heads of terms on others and moving towards signing final contracts on others, though less of these); working hard on the financial plan that doesn't yet square up in terms of the risk we will be carrying as an organisation to meet our agreed control total; completing a programme structure for how we will deliver all the schemes that add together to form the basis of the financial plan; and are in week 2 of the 11 week intensive support around the Challenged Health Economy work.

We struggle to meet all those demands when they arrive together at this time of year and, of course, underspending on running costs is one element of our financial recovery plan, so additional resources to address the issues impacts directly on the chances of success; but I know this story will be familiar to many.

One of the elements of a governance review of the CCG a couple of months ago was a commentary about the wisdom of entering last financial year without any reserves or contingencies.  The report noted that this wasn't robust or good governance.  As we look to make sense of this year's plan, it is hard to see how we won't be in that position again - is that bad governance, bad leadership or an artefact of the position we find ourselves in?

Anyway, nearly time to ski, so....

Highlights of the Week - 11th April 2014 (@jeclo)

Highlights of the Week 1: Strengths based leadership day with the Western Locality Senior Leadership Team

As trailed last week, our strengths based leadership day, facilitated by Mike Roarty from Clearly Inspired, was a hugely enjoyable and positive experience.  The photo shows how the 7 strengths from each of the 16 members of the team (half clinical) are distributed across the different quadrants and facets.

So our team has more strengths in the relational quadrant (4 of my 7 are in the execution section), but the really interesting perspective was to compare this to our previous version of the diagnostic in December 2012.  We had clearer areas of similarity then - the picture was more "spiky" (about a third of the team has changed in that time and individual's profiles may also have altered) and overall the picture now looks more balanced.

We spent the afternoon looking at how this applied to the critical work plan delivery we have ahead of us (workstreams such as integration, elective care, urgent care, primary care and system configuration) and how we would best work to deliver that using this new information.  

The team felt in good order and ready for the challenge ahead!

Highlights of the Week 2: Meeting with Kelichi Nnoaham, new Director of Public Health in Plymouth.  Discussing how we move forward in partnership

We haven't had a substantive Director of Public Health in Plymouth for a while and it was great to meet up with Kelichi as he came to the end of his second week in post.  We have spoken a few times and each time it felt like we had good alignment on our views of the joint purpose, but this was a time to test that out.

There are many challenges.  Public Health outcomes in Plymouth are poor; in comparison to other areas of the CCG in Devon, they are really poor.  Public Health funding in Plymouth is way below other comparable authorities and the City Council is working hard with Public Health England to try and address the anomaly.  And the Public Health team (based in the same building as we are) have seen a number of people leave to join Public Health England as that infrastructure is established.

It was a good first discussion with a commitment to further action and to ensure that Kelichi gets a prominent role in some of the local architecture to make sure that the issues for the population in the City are well represented.  We talked about how the CCG needs to be accountable for delivery for some parts of the DPH's portfolio and how Public Health will be vital in helping us to determine how we scale our services to be affordable and sustainable.  It was a positive first meeting and look forward to more ahead.

Highlights of the Week 3: It is lovely to get a thank-you and to hear about the difference that you've made to someone

This lovely card arrived in the post.  It is a thank-you for some coaching that helped the individual move forward and reconnect with what they felt to be important.

It does remind me that saying thank-you is important. I don't need much feedback to keep me upright, but I do sill love it and it is great to know that the energy I try and devote still to coaching and development is appreciated.

I have gone from a world of many coaching clients and sessions each week, to occasional sessions with a few individuals.  It is the thing I miss most about my years creating and running my business, so I do enjoy even more the time I still mark out and reserve to spending time on development activities



Highlights of the Week 4: Our Urgent Care Partnership 1 year on.  A story of success, improved relationships and realism about the challenge ahead
I Chair the Urgent Care Partnership in the Western Locality - the urgent care system that surrounds and encompasses Plymouth Hospitals. The team put a lot of effort in to ensuring this works successfully and a little over a year after we formed we spent a bit of time at the meeting this week reflecting on the progress we have made.

We are under no illusions- we know we have had an easy winter; we know that the mild weather and lack of infections combined to do all they could to offer us the best chance of success and even then we have had several moments of really significant pressure. But against that backdrop Plymouth Hospitals are the third best performing A&E against the 4 hour target this winter.

I'm not sure that single measure captures enough of the complexity of the system, but what is relevant is that after some time struggling to hit the target and being seen as poorly performing in comparison to other Trusts, they have managed to improve their performance at a time when others were really struggling.  The hospital deserves real praise for that - an awful lot of hard work from staff with determined clinical and managerial leadership.  

It is though also testament to the workings of the wider system and the way partners have discussed the right solutions and then delivered against the agreed direction.  Additional money has helped, but I do think the element of determination is the most critical.

The feedback was good - our urgent care dashboard is a stunning way to capture what is going on in the system and to predict as well as reflect on the demand pressures we face - and all members felt we had made really good progress.  We recognised that next winter will almost certainly present greater climate and infection issues and we need to spend the next few months ramping up our responses to be ready that, but some thanks to the team for the work that has brought us here.

Highlights of the Week 5: Finally I'm in print...well almost, my words in a book, but they are not the important ones to read! Well done @timrobson7

At the front of Showing Up by Tim Robson you will find these profound words.  Nice to be asked and delighted to read a proof of the book and link that to the work Tim has been doing with us on the Individuals at the Centre programme.

It has made a real difference to many people in the organisation and we have used some of the concepts consistently over the last 12 months.

In this book, I particularly have reflected on the School with Pay paradigms pondered on how similar work is to school (just with added pay).  The metaphor works well and has helped to reframe a couple of the ways that we work.

So almost a shameless plug for someone else's book, but trying to grab some of the limelight at the same time!

Highlights of the Week - 4th April 2014

I do my best to avoid being bombarded by news each week, which isn't easy if you spend a lot of time in the car.  I did get in to a habit of downloading and listening to a lot of audio books whilst I was doing consultancy miles - up and down the motorway from York to Lincoln or Nottingham or Plymouth.  That felt like such a benefit; there are lots of books that scare me with their size, but on audio with hours to spare, they become a real joy and I would never have tackled 1Q84, The Children's Book, Wolf Hall or Bring up the Bodies any other way.

But now, with an hour here and an hour there, I've settled on a range of podcasts.  And that means, at the moment that I'm living the dream as a Liverpool fan in the company of The Anfield Wrap, contemplating films with Kermode and Mayo and deciding which Desert Island Discs are worthy of a listen (some great, some don't help a tired driver!)

And so my Farage vs Clegg debate has been limited to what I choose to digest on the BBC News app and I can flick past the daily stories of gloom or doom.  So whilst it won't appear as a Highlight of the Week, not listening to the news is definitely part of what helps to keep positive each week!

Highlights of the Week (@jeclo)

Highlights of the Week 1: Time spent with the 22ours development group always gives a wealth of mental stimulation, new ideas and reflection
When I was working in coaching and development, I needed a space to meet with like minded people, share ideas and develop new approaches.  I contacted some friends and through them some further colleagues and we ended up creating 22ours - a development group (wittily titled because we meet 3 or 4 times a year for 22 hours and the space is created by us, for us).

We met in Newbury this week.  When we first met we learnt about each other, talked about what we did and what might be a better way.  Now we can reflect on three authors - the publication of one book, the next one due in the Autumn and a third about half written - new companies and, for me, a career change to apply lots of the learning.  I got space to reflect on what life is like for me and, specifically, how I manage stress at difficult times.  Came back exhausted after 22 hours of stimulation, but ready for the rest of the week.

Highlights of the Week 2:Agreeing new ways to work with my senior team-positive discussions focussed on maximising impact, not keeping roles
"Let's focus on strengths, let's focus on impact and let's make sure we are thinking about the future, not the past".  All sounds simple, but a year in, I'm asking the senior team in the Locality to think about changing reporting lines, their portfolios or who they directly manage.

They have risen to the challenge, noting when they recognise that they have a reaction that isn't helping the discussion and ensuring we get to a great outcome.  There are times when they don't get what they need from me - one of them told me this week that they were worried that appraisal would be another time when I expected them to reflect on their own work and resolve problems, when what they wanted was direct feedback on their work (which they did get, fortunately) - but this time I did give them lots of reflection, my views on the issues and then invited them to think about how we could do better in the year ahead.

I was reflecting on "if it ain't broke, don't fix it", but thinking every year about how we flex and change to improve what we do feels important and ultimately more fulfilling.  As I carry out new roles in the CCG and have a wider focus, it is really important that we know we are fully aligned in the right direction.

Highlights of the Week 3: Working with PwC to ensure that our Programme Office has right capability & capacity for the work ahead (it does!)
Spring is outside, the sun on the moor, the Facebook picture of my wife and youngest son on the beach drinking beer and enjoying the first day of the holiday (not the most helpful as I'm in the second conference call of the day and eighth meeting), but in the CCG it doesn't quite feel the same.

We put everything we had in to the most professional commissioning framework possible, publishing 23 modules of information to all of our providers from the end of November through to March.  We then intensified the effort in order to turn the 28 commissioning intentions in the framework in to contractable schemes - a lot of energy from finance, business intelligence and commissioning.  We have produced several drafts of a 5 year strategy and 2 year operating plan and worked with two local authorities and providers on the production of two Better Care Fund submissions.

Then we got on to contracting and have worked with 6 major providers to agree contracts, resulting in mediation, arbitration, external support and some still outstanding.  We have also faced up to our financial difficulties with financial recovery failing to stop us reporting a deficit last year and working to agree a deficit plan for the year ahead with all the incredible amount of work and scrutiny involved across the whole CCG.

So it is not surprising that people are looking forward to emerging spring-like in to April.

And then PwC have arrived for a 10-week, intensive support programme as we are one of the 11 "Challenged Local Health Economies".  We are grateful for the support, but it is not an easy task to encourage staff that this is really the big push now, with implementation of the joint plan to follow.

But that is what we have been doing and our Programme Office has responded really well.  It is a tough job in the organisation that gets little praise, but we have worked with PwC to ensure that they are happy that we have the capacity and capability in place to deliver.  We will need support to complete the plan and implement, but we are set for the programme ahead.  One week in and things are on track.  Let's hope there is a highlight every week!

Highlights of the Week 4: A brief look at my StrengthScope report gives great feedback about how the team see the best bits of me at work
This feels a bit like stealing a highlight from next week as I looked at my strengths report for our Leadership Team Development Day next Tuesday (it will most probably be in next Friday).  We have used the individual and team assessment before, but are revisiting as the team has changed and things move over time.

I said last week that strengths based appraisal was really valuable and the whole personal and team strengths approach lands well for me.  Everyone will have 7 strengths using this particular diagnostic, but what is interesting is how I think I use them and how that compares to the experience of the team around me.

It clearly isn't a process aimed to bring you down, but it was great as I prepared for the session to get feedback from others and to see which bits of me land well.  You can guarantee that the day next week will have some more challenging feedback as we encourage all the team members to fully explore themselves and their colleagues, but setting the positive frame will hopefully mean we do that from the right viewpoint.

Highlights of the Week 5:"Board to Board" with @PlymouthHealth and @plymouthcc focussing on progress over last year & opportunities ahead
The CCG has had a couple of Board to Boards with Plymouth Community Healthcare over the past year or so; a period which has seen us move from focussing on really significant quality issues to noting the progress that is being made on delivering the services we want to see to keep people "safe, well and at home".

Given the journey we are now on, it felt really important to have Plymouth City Council in the room with us.  They have just approved the outline business case for our joint work on  the integration journey as part of their overall transformation programme, so this was a great moment to consider what impact this would have over the next couple of years and the long-term vision.

We have a really high expectation of what the community interest company will need to deliver this year if we are going to achieve our goals around the urgent care system and we were able to jointly reflect on the difficult, but mature discussions we have had that have left both parties feeling upbeat about the challenge.

The Board process - the presence of those from outside the direct management relationships - definitely adds a different dimension and we left even more committed than we had been previously.  The vision is strong and the joint intent evident.


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