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.