Highlights of the Week - 25th July 2014

The summer holidays have started, the schools are out and it has been welcomed in many parts, but particularly in Devon, with a week of wall-to-wall sunshine.  

We will have visitors from all over - York, Cumbria, Malawi - and, other than when we are away, they will be with us each week through to September.  It is great to welcome people to to the South West and to show them some of the beautiful country around.  This week, given the weather, that has been a selection of beaches for our guests.

Not that I've been making those trips; my week has been hot and sticky in different meeting rooms, trying to concentrate as the temperature soars.  One particular venue we use has a conference room above the swimming pool complex of a holiday park.  The room is really good value, but it does mean that some of time is spent listening or watching kids cooling off outside, which can be off-putting!

I have been out in the early morning sun with the dog, so there is no complaint about the weather or indeed the knowledge that the rest of my family are on holiday.  But it is hard, even when there are more than 5 great highlights each week, not to feel at least a bit of a pang when I get a text in the middle of a workshop saying "I'm swimming in the sea - glorious".  What's the text back?

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

Highlights of the Week 1: An interview that shows we are on the right track with development and direction
Sometimes interviewing is really enjoyable.  It was this week.  We interviewed for a post in the Programme Office and the successful candidate, who already works in that team, performed excellently.

We have worked really hard on helping the Programme Office to get a sense of clear identity and purpose and not to feel like they are at the beck and call of the rest of the CCG. The interview centred on questions around the role of the team both in financial recovery within the CCG and with the work of our "NHS Futures" programme that follows on from the 11 week intensive programme under the Financially Challenged Health Economy banner.

So a great moment to reflect on our journey of development as an organisation, noticing the small steps of encouragement amongst the huge challenges, but more importantly, fantastic for the individual and their growth and development in the role.

Highlights of the Week 2: Planned Care Summit-looking at all the options we have to make the system affordable and sustainable
We have held two summits within the CCG this week and the first of those was on planned care. There is a wisdom that you would want a system that invests well in planned care and therefore spends less on urgent care because this would be an indication that disease is well managed.  To some degree, that is what our system looks like, though the reality is that we spend too much in total, compared to our allocation and our job is to make the position sustainable.

Lots of clinicians in the room for the discussion and really encouraging to see the contribution from our lead GPs from across the different areas of the CCG.  We discussed the challenge and looked at how we might move forward with a long-term strategy within the NHS Futures programme-all organisations in the health and social care system working towards common goals.

The focus was also on the immediate and the short term and the difficult actions we need to take in order to deliver our financial position this year. Those discussions are not easy, but we do recognise our responsibility and there was good attention to the task.

There are many balances here, for example, the need to press ahead to achieve referral to treatment targets, but we did confirm a number of actions that we will press forward with and talk to providers about over the next few weeks.

Highlights of the Week 3: The new CCG Executive meeting makes time for strategy, operational delivery and assurance
We have had reviews of governance within the CCG-it is an inevitable consequence of being in deficit as people want to check that the position isn't driven by poor management processes, but it is also part of our desire to review, learn and improve.

The CCG Executive has replaced the Leadership Team meeting in the CCG and binds the clinicians from across all localities far more closely in to the key discussions that affect the whole of the organisation.

This week, the agenda invited us to work to three different tasks: 

• Strategy-ensuring that we are managing our 9 programmes of strategic change in the organisation that link to the NHS Futures programme.  This week we reviewed the initiation documents, checked scope and confirmed purpose to ensure we are aligned to take this work forward with partners
• Operational delivery-monitoring the in-year financial position and reviewing the workplan tracker that shows where we are with the delivery of the projects that aim to give the right level of commissioner savings
• Assurance-a review of the different aspects of the CCG and making sure that all members are aware of the governance, risk, patient safety & quality or performance issues that are the most important for us to be monitoring.

Not a perfect meeting - how many are? - but definitely a step in the right direction and with an even greater focus on action orientation we will get to a really effective engine for the CCG.

Highlights of the Week 4: Continuing Health Care Summit-a difficult challenge to manage our growth, but it is all of our responsibility 

We've seen significant growth in our CHC spend over the last few years. In keeping with many other CCGs, especially those around us, there have been rises of 9%, 9% and 20% over the last few years, without the impact of retrospective claims.  We are one of the highest spending CCGs in the country (in the top 20 for both number of cases and cost) and are also high in the South West, which does see some of the bigger numbers nationally.

It is a hard budget to manage.  We make the payments, but the assessments are nationally described and carried out by our local providers, so it can feel like we are simply the banker to the system.  We clearly are closely involved, we run high cost panels and work to ensure that the system is operating effectively and in the way we expect it to.

The task at the Summit was to get a group of people together, with clear clinical leadership, to take a fresh look.  What more could we be doing this year?  What is our strategy and how could the system be different in years to come?  In essence, to move from a situation where we pay the bills that arrive to one that feels like we have a system that we have commissioned.

We didn't solve all of the issues in one go, but we certainly made progress, we rigorously tested our current thinking and assumptions and came up with some new ideas and actions.

Highlights of the Week 5: Lots of 5 minute conversations that keep things moving in the right direction

When I get in the car in the mornings, there is a moment when I have to concentrate hard to remember which direction I'm heading off in first; right will take me off towards our base in Plymouth, left to Exeter, workshops or further afield.  Increasingly that changes day to day as the Chief Operating Officer role requires me to work across the whole CCG. I think it is true for all in the Leadership team too, as we need collective strategy and delivery more than ever now.

So increasingly it is the 5 minute telephone calls or quick emails that I need to rely on, rather than being physically present and this week has been a particular test of what can be achieved through brief interaction with a number of things to co-ordinate, a diary that needed to change each day and an impending holiday meaning that things must be completed by next Friday.

But it has felt purposeful.  I have got used to coaching on the phone and via FaceTime or Skype, having initially resisted as I like to be sat face-to-face with someone for those kind of sessions.  All it does take is concentration and not trying to replace a meeting where I concentrate with a quick conversation when I'm trying to buy a sandwich for lunch. 

One more week to a holiday.  I'll have highlights next week, but then will be offline.  I'm looking for a guest from within the CCG to share their highlights here for two weeks.  Let's see who reads to this point and takes up that offer!

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 - 18th July 2014

Today our eldest heads off for a month long-long trip to Tanzania.  It is an educational and charitable expedition where she will work for 3 weeks on various projects ending with some relaxation to finish.

It has been a long time coming as she has spent the last 18 months gathering the money to go through a range of different fund raising activities - santa fun runs, cake sales, car boot sales, sponsored events and babysitting to name a few.

The rest of the family are off on our summer holidays for a couple of weeks while she is away and, with different people visiting us in Devon, there was only one window to fit that in.  Somewhere in my careful and precise planning I have managed to lose the exact calculation so I have recently had to explain to both my daughter and wife that, following  being away for 4 weeks and an exhausting journey, our 15 year old will arrive home almost a full day before we do....

All is sorted and she will be collected and well looked after by the neighbours, but it has led to a barrage of sarcasm and humour amongst friends and relatives.  Despite preferences for looking at the big picture, I'm usually very good at attending to detail when I need to, so not quite sure how this has happened. 

But there is no use crying over split milk; learn and move on - which, for today, will mostly be about dealing with the excitement and no doubt a few tears as she jets off on her amazing adventure.

Highlights of the Week - 18th July 2014 (@jeclo)

Highlights of the Week 1: Better Care Fund is confusing, but great energy to use it as a lever on our integration journey
We held a workshop on Monday within the CCG to collect together where we are with 2 Better Care Funds (Devon and Plymouth) and to be clear about our overarching narrative and next steps.

It is a moving target - new guidance, a new programme approach at the Centre and all the political chatter about the wisdom of the policy and its deliverability.  I have described here before how it is really hard to see from a local perspective how you move blocks of money around successfully from hospital care to social and community services under payment by results rules, especially where hospitals are running at high levels of occupancy.

It is not defeatist - I do think we can invest to find ways to offer different models that keep more people safe, well and at home - but it is a need for realism when we look at the best way to progress in a challenged financial environment.

The workshop was really positive though, linking back our work on BCF with our overarching 5 year strategy and particularly our journey towards integration with both local authorities. More conversations now with Council colleagues about plans and to make sure we spend more time talking to all providers about how we change the urgent care systems.  This needs to be a key element of our wider work on system affordability.


Highlights of the Week 2: Talking to Ben Gowland at Nene CCG about the shared challenges in different places: helpful and encouraging
Some of the benefit of attending the NHS Confederation annual conference is about the connections, networking and links that can be made there. This week I spoke to Ben Gowland, Chief Officer at Nene Clinical Commissioning Group, following an introduction made through a mutual contact at the conference.

Nene, like NEW Devon, are a financial challenged health economy, so the discussion was centred on how our respective joint work is progressing. The layout and landscape is different, but the issues are the same and it was incredibly helpful to hear about their journey, how they had overcome some of the challenges we are facing and for both of us to reflect on the fact that there are other areas where the pressures and issues feel similar.

We discussed Programme Directors, programme management arrangements, the role of national bodies - NHS England, Monitor and the NHS Trust Development Authority - and the role of commissioning in system recovery.  Most of all though, we talked about the need to create and maintain positive relationships with all local stakeholders and to keep everyone aligned around the shared vision.


Highlights of the Week 3: Chief Officer Leadership Group takes some steps forward. Hard, but a complex joint programme won't be easy
A week on and the work on the Financially Challenged Health Economy in Devon and Plymouth takes another step forward.  Some steps seem smaller than others and this week felt a bit like we were repeating some discussions that we have had previously.  But keeping everyone on the same page is vital and we did make real progress with finalising different elements of the programme architecture.

This week we got agreement for all Chief Executives in the room to sponsor key programmes of work.  By the next time we sit down, we will have a fully populated and completed programme and will be able to begin the delivery phase.  There was undoubtedly frustration at how long some processes are taking and we do need to reflect on how to push forward with greater pace, but there are 15 organisations involved and it is important that we keep all of them together with a shared purpose.


Highlights of the Week 4: Response to a performance challenge steals too much time, but the team produces real quality
Nationally there has been a dip in performance around the 2 week-wait breast cancer target and we have two trusts within NEW Devon that have had particular performance challenges. It was the subject of discussion at our Governing Body this week and there was both clear concern and a requirement to see action to improve.

The Trusts have seen an increase in demand, perhaps due in part to national awareness campaigns and a storyline in Eastenders and have not been able to flex capacity to deal with the additional activity.

We have felt as a commissioner that we have tracked this issue and dealt appropriately with the response of the Trusts.  It is clearly not the outcome we want - achieving key performance targets is important - but we have held good discussions about prioritising scarce resources to those in most clinical need, even if this means that other targets struggle.

However, when something gets to a national level, the demand for explanation and information can become intense and require a huge amount of staff time and energy to respond to. This can be one of the most dispiriting parts of he job, but the team responded really well this week and by the end it feels like we have produced a really high quality set of information and used the time to recheck the robustness of our plans and the provider plans and improve them.

We don't want to get in to crisis response mode too often; it is useful to know that when we do, though, the response will be the right one.

Highlights of the Week 5: If we keep talking, we'll find a consensus way forward: conversations about community services 
There is a theme this week about conversations and communication.  We are aiming to move forward with large parts of the reprocurement of community services in Plymouth and Devon without the need for competitive procurement due to a focus on integration. The responses to our consultation on this were mixed from our local provider community where we had hoped for greater consensus.  

However, this week we have had a number of conversations with a range of organisations involved and everyone still seems to want to get to a solution that will work for all. From a position that felt really challenging for our ambition, our sense is now that, whilst we have had a wide number of stakeholder and provider engagement events throughout the last 12 months, what may help to move forward is a range of discussions with groups of providers in each community. 

And the plea has been to allow people to work through the next level of detail.  Nobody has argued with the key direction of our community strategy, in fact almost all responses have started with their organisations agreement with our vision, but there are some things that will only make sense when we work through how it will actually work in practice.


So ... you live and learn.  Perhaps there is more attention to detail that would help not only my daughter to feel welcomed back home after being away for 4 times longer than ever before, but also help translate strategy in to concrete reality for colleagues at work!

Anyway, anyone want to look after our dog whilst we are away......


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 - 11th July 2014

This week we have started the planning process for 2015/16 in earnest.  It will be a complex year as the process around our commissioning intentions will need to seamlessly fit together with the joint programme of work that will follow from the Financially Challenged Local Health Economy work;  this is moving in to the second phase where we need to turn our global intentions in to substantive plans.  In order to get that right, we need to start earlier and really clearly map out for all our stakeholders how the different elements support each other.

The irony of starting looking at next year is that we are both still finalising the fine points of some of the contracts for this year and are in the middle of significant operational pressures that require complete focus on the quality and financial aspects of the current year's performance.

It all feels increasingly like, whether in the hospital where emergency activity growth is making the environment feel like winter pressures in the summer or in the commissioning organisation, there is not going to be the usual slightly quieter period that exists after completing one contracting round and before the winter pressures kick in.

And what happens when there is no space in a system to recover and regroup? I think it is a real concern for the NHS in all aspects of the current work burden.  Whilst we can see the impact of financial overspends or treatment pressures, I'm not so sure we are sighted on what the long-term impact will be of the level of pressure that staff are now being expected to work under.

Time then for some....

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

Highlights of the Week 1: Drawing up the outline of our Primary Care Programme points to the huge opportunities for improving care
We've been finalising the key strategic programmes of work for the next couple of years, one of which is the co-commissioning of primary care, so this week I spent some time discussing the different elements and projects that constitute this programme; essentially mapping the process by which we move from an outline strategy to having a detailed workplan for the development of primary care.

One of the five pillars that make up our 5-year strategy is about general practice, working at scale being the organising unit of care.  This is a really exciting proposition - federated groups or merged general practices being large enough for community health and social care services to map on to the practice population and create a 1:1 relationship.  The opportunities that would create across a whole range of urgent and planned care are huge and something that I really believe we should be paying more attention to nationally.

The programme looks at benefits beyond that too for both general practices as commissioners and as providers.  The wider primary care market creates even more options, though we are not looking to commission these in the first instance, taking an incremental approach.  We will make sure that we join things up though and so the possibilities around pharmacy, for example, will be a key part of the programme of work.

Highlights of the Week 2: The Big Listen-Feedback from our staff is really encouraging about how the Locality and CCG is starting to mature
We had the third of our "Big" events this week, where we get together with a group of staff who either work in the Western Locality or support our work to explore how well things are working.  We have now run these on a six monthly basis over the last 18 months and this time had around 50 members of staff.  Interestingly, showing how our direction of travel is moving, this time there were 6 members of local authority staff who had taken up the opportunity to attend .

We talked about integration and our key workplan for the year to make sure everyone understands the key focus for the locality and CCG.  Most importantly, though, we gave people time to reflect on things and provide feedback on those key areas.

The core of the event is the "Big Listen" a space where the Leadership Team in the Locality are invited to listen to feedback (without interruption, comment or justification) from the members of staff present.  It has taken some practice to get to a point where the listening environment is created and staff feel able to openly share, but we are definitely moving in the right direction and the benefits are clear.

We got feedback this week that staff feel things are generally improving and some of the systems and processes in the CCG are starting to mature and feel more secure. Clearly some of that is about the issues themselves; some, I am sure, is because our determination to listen and to feedback ("You said, we did") demonstrates it is worthwhile.

Highlights of the Week 3: The presence of Local Authorities at our away day looks right and the presentation is really joined up
The second of three highlights from the development day is the joint presentation that was given about integration with Devon County and Plymouth City Councils by a joint team from the CCG and Local Authority.  We are working hard with both Councils on the integration agenda - both of service delivery and of commissioning - so there is a lot to say, especially at this moment with Plymouth City Council as we have reached the point of agreeing a joint business case setting objectives for March 2015 and 2016.

The feedback from staff noted how impressed they were about the seamless join between the organisations presenting and the obvious work that has gone on over the last weeks and months to get to a point where the messages are the same from either party.

There are huge challenges ahead with lots of discussions about governance, accountability and money to resolve before we get to move towards the level and scale of integration that we envisage, but this week was another sign that we have got many things right.

Highlights of the Week 4: We've asked a lot of staff through changes over the last 2 years, but they are still up for integrating commissioning
And the final away-day highlight was the reaction of our staff to the presentation on integration.  The vast majority of the Locality and CCG are made up of staff who went through the transition from PCTs, Clusters, networks and Strategic Health Authorities to end up working in NEW Devon.  This means that it is only about 18 months since they were last applying for jobs, being interviewed and coping with all the anxieties that this involved.

That change process was long and protracted, so there was an extended period of worrying about futures, salaries and being employed that they had to cope with.  This week, we discussed moving towards integrated commissioning and the kind of options we are considering.  Everyone understands what this means - eventually some and potentially all health and social care staff within the scope of the programme of integrated commissioning may move to a new organisation through some, as yet undetermined change process.  We can't yet say 'who' and we don't yet know 'to where', but we did discuss the sense of change.

Clearly staff were concerned, but given a couple of hours to think, discuss and reflect, the overriding response was that integrating makes clear sense and that we should be pursuing that line if we are to deliver on our vision to make the biggest impact for patients most efficiently.  Lots of feedback and pleas to ensure we manage our HR processes with a greater sense of understanding of the impact on individuals, but an acknowledgement of the need to progress; hugely encouraging.

Highlights of the Week 5: The Governing Body is carefully considered the responses to our community services consultation; the purpose is clear
We have finished an 8 week consultation on our community services strategy and our preferred option for procurement.  We have attracted significant attention as we are looking at a non-competitive award of contract for some significant elements of service in order to maximise the benefits of service integration.

The feedback this week was, as expected, mixed with a range of different opinions on the proposed way forward.  Faced with this broad range, the Governing Body has an important decision to take about the next steps leading up to key meeting in October when final options need to be determined to achieve the required timeline.

The discussion this week and listening carefully to the detailed views that have been expressed was very positive for the Governing Body balancing the different perspectives with a reminder of the purpose of the reprocurement.  There are no easy solutions and no risk free options; it is all about balance and judgement.  It does, however, feel like we are listening hard, considering carefully and do understand the importance of the next steps. This is another intense process with few gaps with staff who have been working flat out for many months; we also are thinking about how we support them.

And in terms of the long-haul, on the upside, after a very long, sometimes exciting, but too often painful, period of heightened watchfulness has been brought to an end.  Whilst I'll miss the fantastic talent, overall my total fatigue with the situation means that I'm relieved that we can now move forward.  On this issue at least, I can now rest.  Goodbye Luis Suarez, good luck in Barcelona, thanks for the memories.  Now relax.....


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 - 4th July 2014

It was the youngest's birthday this week. Lots of sports equipment requested: obligatory new pair of football boots, (which have featured on every list over the last 5 years of birthdays and Christmases) and, as a new entry, cricket kit - bat, gloves, pads, bag, ball etc.

As usual a wonderful reaction to the various presents that did arrive, some identical to the list, others similar to what was asked for (he is very specific on brand and model) and some that he simply didn't get, which was all fine.

He contemplated his new bat for a while, making all the right noises, but something was not right.  Eventually, in tears, he declared that he didn't like Kookaburra bats, but he felt terrible for being so selfish for saying so. ("Its fine, we can change it...")

This reminded me of a great piece of learning about presents.  We tend to give presents from our perspective (we give what we'd like to receive) and receive from the other person's perspective (we say what we think they would want to hear). How much better would be the world if we were truly able to give what the other person really wanted and valued and receive gifts in a way that was true to what we feel (with respect for the gift and the giver, but truth about our reaction)?

So we discussed "selfish" and "ungrateful" and the need to respect the effort, generosity and thought that goes in to the buying of presents, but the benefit of being true to self and carefully explaining what we like and don't like. He does often wish, I suspect, that his dad would just let him be!


Highlights of the Week 4th July 2014 (@jeclo)

Highlights of the Week 1: NEW Devon CCG has a new Chief Nursing Officer.  I'd congratulate Lorna Collingwood-Burke if she was on Twitter!
Really delighted that Lorna has come through a tough recruitment process with a significant field to be appointed as the new Chief Nursing Officer for the CCG.  I have worked with Lorna over the last couple of years and she undoubtedly has the values, experience, leadership and relationships to take forward the role.

Of course, with a new role comes new responsibilities and I'm looking forward to Lorna joining the small number of the Senior Leadership Team in the CCG who regularly use social media to share some of our key messages.  So, I'm not sure, without use of Twitter, whether Lorna will ever get to this blog (there are links in my email signature block and in our weekly staff bulletin, so perhaps), but if she does.....  make one of your first actions getting a presence on Twitter and then make a commitment to a regular tweet or two to highlight the great work that you and your team do!


Highlights of the Week 2: There are now three blogs in the Western Locality: you can find out about our workplan and Locality business too
I have been trying to enthuse the team for some time that we need to get a different approach to our communication and test out a new way for the CCG to engage with both our own staff, partners and anyone else who might be interested.

This week we have launched two new blogs, one on our Locality Workplan that Nicola Jones is in the hot seat for and the other on detailing the Locality business, including the parish notices, that Debbie Whiting will co-ordinate.  

Some of this content won't be particularly relevant or perhaps even interesting to people outside of the organisation, but much of it will and I think writing the communication in a blog form and in a way that we are happy to share publicly will change our approach. 

So here they are

Western Locality Business Blog

Western Locality Workplan Blog

Highlights of the Week 3 : Launch of Individuals at the Centre Year 2.  How will it support the delivery of our financial transformation?

Really delighted to be working with Tim Robson from nowshopup.com (@timrobson07) again this week to launch the second year of our Individuals at the Centre Programme.

Our key aims are:

• to get the half day workshop to over 90% of our staff
• to have 15 project teams working through a modular programme with as much energy and passion as the 5 teams in year 1
• to deliver at the same cost and fractional cost per participant by moving to a lot of online, nudge and self directed content, supported by a social media platform
• to go further beyond the CCG to work with partners, regionally and nationally

So we have set challenging goals.

The Leadership Team will all mentor projects this year and this will ensure a greater sense of organisation wide effort.

Of course, everything in the CCG needs to be firmly aligned to our financial recovery and transformation programmes.  So how do you reconcile this kind of bottom up change with the absolutely relentless focus on a CCG wide requirement?

We are expecting the teams when they volunteer to apply for the programme to have worked that out.  We want to get lots of applications that address the financial issue head on; if they don't, they probably won't get supported (improving quality in an austerity climate is clearly part of this).  What we want to test though, is that the finance message is so well understood and owned that our staff will make that link for themselves, without having to add it as an application criteria.

We'll wait and see!  But lots of energy from the whole leadership team to address the challenges and support staff to do that from themselves as well as follow our clear direction. And wonderful reflections on year one from participants, mentors and those who watched the showcase.

Highlights of the Week 4 : Integration discussions with both Plymouth City and Devon County Councils making great progress

The CCG straddles two local authorities: the unitary authority in Plymouth and Devon County Council.  These Councils move at different speeds, given their size and unitary versus two tier structure.

In to the mix of integration and the Better Care Fund we also have our plans for the reprocurement of community services that we need to complete before contracts expire in 2015 and 2016.  All in all, this makes the life of integration and our CCG complicated.

That we are making great progress with both local authorities is, therefore, a real testament to the quality of relationships we are building with key councillors and officers and for their and our resolve that the path we are set is incredibly important and is worth the energy.

This week we were at Caring Plymouth Scrutiny Committee for a review of the business cases we have with the City Council for integrated commissioning and integrated delivery of services.  There were plenty of questions and we pointed to a huge range of issues that we have yet to resolve, but we are making really significant progress and the Committee noted the alignment we are demonstrating.

The discussion with Devon County Council allowed us to step back and review the ambition of our joint vision and then how this would play out through our community services decisions.  It was heartening that we both acknowledged the importance of continuing to find time to ask "why" - to be clear on the core purpose of integrating services and commissioning - rather than keeping pressing on with lots of urgent tasks. We reconfirmed our joint intent and the next actions that would move us forward.

Highlights of the Week 5 : The workshop "How to live with zero:Why I choose to have so many emails in my inbox" finally happened this week

It has been trailed here and throughout the organisation and finally I managed to deliver the first of the two hour workshops that I'll be running with staff from across the CCG that invites them to pause and think about how they manage their inboxes.

The reason is that most people find this a source of real stress and anxiety; a sense that the world is bombarding them and they are not in control.  I've coached a lot of people on that stress over the last few years and the workshop is a combination of that work and my personal journey to get to a point where I live with zero emails in my inbox and have done for quite a few years.

So as more electronic letters were trickling in to our systems, about 20 people attended the workshop and listened, participated, discussed and reviewed the key messages.  The feedback has been great (someone today told me that they already have 300 fewer emails in their inbox) and I'll be doing it again in other locations across the CCG.

The biggest message of all is that your inbox is a result of your choices... it doesn't land easily for people, but after a while people do reflect on how they prioritise different tasks at work and how that impacts on the number of items left to process.

And of course, within 24 hours, our youngest had decided he loved his new bat and was telling me all about the great things about it.  Given time to reflect and little pressure, he formed his own conclusion, which was a great result.  It has scored its first runs and that makes him very happy! Let's hope he has as much fun with it as I had with my Duncan Fearnley, Ian Botham Attack (you never forget your first bat) when I was his age....

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.