Highlights of an NHS Week - 15th August 2014
I can't imagine that anyone has not heard of the death of Robin Williams this week; either from the news itself of his suicide or the controversy surrounding the media coverage of the story. Ask anyone in their mid-40s and they are very likely to have at least one film or programme featuring or starring Williams they love; whether it be in the early days in Mork and Mindy which I used to love watching on a Saturday evening as a child or in the really moving Awakenings. My step-daughter, who is in her mid-20s, loved Jumanji and Mrs Doubtfire and my teenage girls have grown up recognising and loving him in Night at the Museum and as the voice of the genie in Aladdin. My personal favourite is Good Morning Vietnam - fantastic soundtrack!
Driving to work this week I listened to a moving discussion on the Today programme featuring Adrian Strain, whose 34-year-old son had recently taken his own life. He reflected on the fact that most people knew very little about mental illness and as a parent he always worried about whether he could have done more.
The facts about mental health problems speak for themselves:
· 1 in 4 people will experience some kind of mental health problem in the course of a year
· Mixed anxiety and depression is the most common mental disorder in Britain
· About 10% of children have a mental health problem at any one time
· Suicides rates show that British men are three times as likely to die by suicide than British women
· Self-harm statistics for the UK show one of the highest rates in Europe: 400 per 100,000 population
This statistics, alongside all of the media coverage this week prompted me to reflect on what we are doing as a service to support people with mental illness and the promotion of mental health within the CCG and this became the inspiration behind this week's first highlight.
Highlight of the Week 1 - Inspiration for this week's blog
Parity of Esteem describes a five year strategy by supporting mental health patients through improved choice, better physical healthcare for people with serious mental illness and better crisis care.
In the CCG we are working with our mental health providers to implement this strategy and key elements of service development and improvement are being driven forward. In addition, we are working with our colleagues in the criminal justice system to provide to people in custody and we are one of ten national pilots to provide CPNs in police call centres at critical points in time.
We are joint funding additional psychiatric liaison posts in acute host’s sites and working hard with our providers to improve access to psychological therapies.
Highlight of the Week 2 – Western SLT away-day
So despite it being the middle of August, in the past a quieter time of year for the NHS, the pace of work hasn't really let up. I love the Locality SLT away-days for some of the reasons I mentioned last week - time to think and reflect but I found myself, for the first time ever this week wondering if I could spare the time to attend with a significant number of deadlines looming and the promise of a day off on Friday! However, I went and I'm glad I did.
We were fewer in number at this session, facilitated brilliantly by the lovely Kathy Toogood, and this meant we could get into some really detailed discussion about the Locality work plan. We used our thinking rounds, focused on our strengths as a team and worked through the GROW model in order to determine how best to create the conditions for success for our teams.
I met my deadlines, have spent a great day with my girls on my day off and also had the privilege of some space and time for me professionally. Great result!
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Highlight of the Week 3 – Board development
We have a relatively new Board in Western and the Board will be even newer in September with the arrival of our newly elected Board member, Dr Tom Davies. Every two months we have a Board development session to support their learning of the key issues in commissioning and how, as a Board, they hold our Locality to account.
This week's session focused on urgent care and the CCG Strategy - what does the CCG's 5-year strategy mean to them as a Board? How do our commissioning intentions flow from the strategy and into our locality workplan? And how will we know that we're delivering what we set out to achieve? We had a really productive discussion and it was great to see the Board challenging our work plan and being clear about their involvement.
Highlight of the Week 4 – Stepping up and giving something back to the service
We are lucky to have a significant number of young people working in our organisation, particularly in our referral support service, many of whom have joined us as apprentices. This week two members of the service team approached me to see if there were any developmental opportunities in commissioning. In a nutshell, they will be released for a few hours a week to begin to experience the world of commissioning and the Locality team will support their personal development and learning in the hope that we start to give back some of what the NHS has given us over the years in terms of developmental opportunities.
Highlight of the Week 5 – Who said August was quiet!
August, so often an opportunity to catch up, reflect on those manic days gone by and planning for those to come. Not so it would seem this year!
As another hectic and challenging week passes by with everything other than “business as usual” commandeering time, the ability to observe, respond and reflect on the impact of those things seems a necessary skill of anyone working in the NHS today – commissioner, provider or volunteer!
“I can’t change the direction of the wind but I can adjust my sails to always reach my destination” Jimmy (James) Dean
Happy sailing!
DRSS Summer Blog número dos
The work men are finally here!
Fourteen months after we moved into Bridge House, work has finally started on making the building more suitable for disabled access. The car park’s fine, you can get in and out of the building ok and there’s a disabled loo, but it’s a two storey building, without a lift and the main meeting room is upstairs on the first floor.
Sadly installing a lift (inside, outside or stair lift) is either impractical due to infrastructure reasons or would require some serious financial investment. So, we are moving all the meeting rooms downstairs and creating more office space on the first floor to ensure that everyone can attend every meeting they need to.
It’s taken a long time, and some serious frustration, to get to this point. We’re not looking forward to the inevitable disruption of running a contact centre whilst the builders are in, but they are being incredibly accommodating and are working later shifts to avoid our busiest periods. Finger’s crossed things won’t be too bad!
Apologies and thanks to all our staff and visitors with disabilities – sorry it’s been such a long journey and a huge thank you for your patience and understanding. We’re nearly there!!
DRSS Highlight of the week 1 – Staff surveys, the power of listening
Our staff survey results weren’t great last year and we’re really keen to understand and address the issues. We also want to give everyone the opportunity to share their ideas and comments and see how we help deliver the 5 CCG pledges.
How do you engage with everyone in a way that makes them want to speak up? Feedback and gathering feedback is something that can be quite hard, it’s very individual.
After much deliberation the DRSS Project Delivery Team gate crashed several small team meetings. We sat down with around 8 people at a time and we LISTENED to everything they had to say (using the 5 CCG pledges as a guide). It was a wonderful eye opener, listening is a very powerful tool and skill which felt quite liberating. We normally listen in order to respond, to provide answers, to give explanation, in DRSS we are trouble shooters by nature and we want to be able to help but this time we guided others to find the answers for themselves. Listening found a new power in DRSS but it doesn’t mean a lot unless we do something with the information we have learnt.
All this information is being collated and will be fed into the CCG Staff Survey Action Planning Group and their action plan.
DRSS Highlight of the week 2 – Anyone got that holiday feeling?
You may have noticed that holiday season has come to the NHS. The out of offices seem to talk to each other more often than we do!
Rota-ing is turned into a fine art and clinicians are suddenly thin on the ground; no-one is around to pick up those all-important queries and yet we still seem to have deadlines looming.
On the bright side, we’re catching up on our emails and are in the office more to do those jobs that have been propping up the ‘to do’ list for a while!! Shame the stream of patients being referred doesn’t seem to be following the same dip in activity!
We can’t complain though, the constant supply of exotic holiday goodies, sweets and treats is keeping morale up for those of us left behind!
DRSS Highlight of the week 3 – Difficult conversations
Difficult conversations, something best avoided or tackled head on? We get to have quite a few of them every day. In our business they’re unavoidable, if not always terribly comfortable.
As providers struggle to meet ever increasing demand on their services there is an inevitable impact on waiting times. ‘Six-year high for hospital waiting lists’ read the headlines this week.
On the ground, this results in fewer and fewer appointments being made available on Choose and Book as hospitals use every ‘spare’ slot to keep the ship afloat and avoid fines and bad press as a ‘failing hospital’. Fewer new appointments mean more patients ringing DRSS for appointments that just don’t exist (why ring an appointments line when they have no appointments?). So it’s onto a waiting list for them and choice of date and time usually go out the window as there is no choice available.
As gatekeeper of commissioned pathways and commissioning policies all referrals are screened, flagged with the on-site GP Referral Facilitator for clinical input, and returned to practices when they don’t meet the agreed criteria. Whilst this might push up the quality of referrals and reduce unnecessary trips to hospital, for patients in pain (and worried about their health) it’s not usually the outcome they’re expecting, or wanting. They don’t see what their GP has written in the referral letter; often it differs considerably to what the patient thinks. What is deemed ‘low priority’ or ‘cosmetic’ in the wider scheme of things is anything but to the person living with the condition.
The highlight for us is the commitment and energy that the team bring to these situations, which will surely get harder as the local NHS works towards financial recovery.
DRSS Highlight of the week 4 – Kernow CCG
Kernow CCG recently started a review of the local referral services - DRSS and the Kernow Referral Management Service (RMS) in Truro. They want to ensure that patients and practices in East Cornwall receive a comparable service to the rest of Cornwall and that the service offers good value for money.
A team from Cornwall (including clinical, patient, practice and CCG representatives) spent an afternoon with us in Plymouth, learning more about our working practices and spending time with the team, before sending a report to the East Cornwall Locality Board.
We are delighted that the CCG have confirmed their decision to continue their working relationship with us and look forward to greater collaboration, new ideas and ways of working with our colleagues across the Tamar.
DRSS Highlight of the week 5 – Time to reflect
Thank you Jerry for going on holiday. Obviously we’re missing you a lot, but we’ve had great fun with your blog!
We usually work at such a pace, on a myriad of different things (generally all at the same time), that we don’t often (or ever) pause to reflect on the highlights. We’re just not very good at that sort of thing. It’s usually straight onto the next job, the next patient, the next issue.
Being sandwiched between primary and secondary care, as part of a decidedly imperfect system, makes us a very good target when things go wrong with referrals. It’s understandable, we know it’s not usually true, but it does rather tend to get us down.
Taking the time out to chat with each team about what’s made a difference to them this week has been a bit of a revelation – heart-warming and re-affirming. It has made us incredibly proud of our service and the work we do. It’s not perfect, but it is full of hard working people who genuinely care about getting patients the right appointments or care.
We really should do more of this reflecting in the future as it has made things much more fun.
We thought we’d sign off with the words of Peter Drucker:
“Follow effective action with quiet reflection. From the quiet reflection will come even more effective action.”
We hope you've enjoyed the blog over the last 2 weeks - normal service resumes next week on Jerry's return!
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