There have been many issues throughout the campaign, including discussion around the changes that might be seen in the NHS in Scotland if the vote had been for independence. There are already differences in healthcare between England, Wales and particularly Scotland, reflecting local variation in response to local needs or preferences - prescription charges, for example.
The NHS holds on to the notion of being a universal, equal offering across England, so that wherever you are in the country, you can expect an ambulance to reach you in the same amount of time, for your local A&E to treat you within the same 4 hour window and for your access to potentially life saving stroke treatment to be equally expedited. But, to what extent is that the reality of how things are now or, indeed, that this is truly the expectation of the public.
Many people will know, or be able to deduce, that the ambulance response time figures quoted for different services are averages that are typically made up of very fast responses in city centres, offset by much slower response times to outlying rural areas. The volume of the city centre calls will offset the occasional longer trip to the coast or moor in Devon. It would be economically impractical to station ambulances at every point to guarantee the same response everywhere - a remote community may only phone for one ambualance a year - and to some extent people do understand that.
We are in the middle of the community hospital debate in Devon as a result of publishing our community services strategy. In looking to develop more services that help people to stay in their own home and deal with the projected increase in the over 75 population - set to rise by 22,000 in our CCG over the next 7 years - we think we need to consolidate beds from smaller cottage hospitals to larger community units. We have a lot of community hospitals in Devon - you would expect that with the rural nature of the county and the type of population who are able to support their local units. It is not an easy discussion, communities rightly care passionately about local facilities and it is not a "one size fits all" debate - we aren't basing the discussion on what happens in London or Dorset or anywhere else, but it is about what this population needs and expects from its local NHS.
Highlights of an NHS Week - 19th Spetember 2014 (@jeclo)
Highlights of the Week 1: Senior Leadership Team welcomes a new member; a calm, reflective, thinking environment space
The entry of a new member to the Leadership Team to ensure we continue to have good representation from the Partnerships Commissioning Team - the part of the CCG that oversees joint commissioning - gave us the opportunity to revisit the 10 components of Nancy Kline's Thinking Environment. We have used her approach consistently as a Leadership Team over the last 18 months, but it is always useful to remind ourselves of the principles from time to time - the components are listed on the inside cover of our agenda pack.
It has been a busy week; there is a lot on, but I've made that comment in previous blogs so there is nothing new in that and it will be a permanent state. As I keep saying, there is nothing clever about being busy. But you can approach things in different ways and this process for carrying out meetings really does create a calm 3 hour space, rather than a pressured, hurried and dispiriting morning.
There was good feedback from our new member on its impact and the feel of the room. More of that then!
Highlights of the Week 2: Governing Body development session- to what extent are we like any other Board; how does our membership change that?
Take an approach that is designed for NHS Trust and Foundation Trust Boards and apply it to our Governing Body and it won't take long before someone raises the obvious truth that we are different, we are a GP Practice membership organisation and that changes the way we need to work.
I agree we are different, but I don't think that fundamentally changes our role as a Governing Board (Body). It is still about assurance, formulating strategy and engaging stakeholders and at a Board level, that feels pretty consistent. There will, of course, be some change to who the stakeholders are or how we engage with them and our assurance processes are different as we hold responsibility for budgets where we have no direct control over the people that are spending the money.
It was a good session exploring that area though and every time the Governing Body does manage to find time to think about purpose and role I think we move forward. It is so easy to get sucked in to the business of the operational role that these moments of reflection are crucial.
Highlights of the Week 3: @NEWDevonCCG AGM gives us time to reflect. you can watch http://youtu.be/qSSRETEHbmw
It was our AGM this week and we attracted an audience of around 100 to listen to the review of our last year (though I suspect numbers were swelled by the launch of the community services strategy that followed in the second half of the meeting, as described below).
We went through the usual formal process with an overview of performance for the year and the presentation of the annual accounts - we tried to explain these figures, rather than just present the accounts in the required format which can be hard to interpret.
We have used new media over the last 18 months and our youtube channel (you should subscribe!) shows the various different clips we have created to try and make our messages more accessible to reach a wider audience.
This video summarises our annual report in a great film - all produced in house. I think it sums it up really well!
Highlights of the Week 4: Launch of our engagement around Community Services @NEWDevonCCG #NEWDevonTCS 12 weeks for us to listen
The second half of the AGM saw us launch the next phase of engagement around community services. This was a strategy revised following a round of public discussion, together with 3 locality strategies that explain the detail of how this strategy will impact on our different communities.
Our focus is clear with an emphasis on keeping people at home and creating integrated care organisations that can respond to needs more holistically. The detail does include discussions about the right number of community hospital beds and the right size for different units. Small units are more expensive and harder to staff and we are consulting on changing the use of some of the community hospitals in Eastern and Northern Devon with a greater ambulatory focus and the closure of inpatient beds that will be reprovided in neighbouring units.
This is of course where there will be a lot of focus. The community hospital debate, both locally and nationally, is extremely vociferous. We have been through a lot of clinical debate and discussion to get to this point and we think we have the right balance. 12 weeks now to listen to the public and hear their views.
Highlights of the Week 5: One Plymouth - it's about how we collectively lead on fairness and the Plymouth offer and ask
A smaller meeting of One Plymouth this week, with various leave and absences, but important discussions about fairness and about Plymouth's position.
In response to the Fairness Commission report, led by Dame Suzi Leather, what will be the One Plymouth collective response? What would we as leaders within the city want to say jointly? Do we share common positions? We think we do and we do want to construct a reply, so we talked about what that would be and, more importantly, what that would mean we would each individually have to do a result - there is no point in signing a piece of paper if it doesn't change our behaviours.
Plymouth doesn't get the rub of the green in many areas (though you need to be careful as most areas would be able to point to the areas they lose out in). Whether it is the speed and reliability of the rail network or the level of funding for public health in the city, it doesn't feel as though things are fair. But it is no use just asking for more money and the discussion was around how a case is made for what more Plymouth could offer with a bit more national support. And if we all made that case consistently, what different impact might that bring?
Things are slightly different in Plymouth, compared to the surrounding areas of Devon, you would expect that, but we do need to make sure it is fair.
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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