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.
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