It has been going on for years; Mental Health wasn't the most heavily invested national service framework, we didn't create and drive the improvement of mental health services in the target driven culture of the NHS plan with anywhere near the ferocity and determination that we did with general services; we don't have the same measures for referral to treatment times nor the datasets that are recorded routinely elsewhere; we don't have the political attention when we fail to hit a mental health target as we do for A&E or finance or elective waiting times; the Better Care Fund had a prime opportunity to focus itself on mental health a real candidate for joint, integrated improvement, but is really interested in a 3.5% reduction in emergency, acute hospital activity; and not once in the whole of the discussions about the resilience of our system over the winter months has mental health been a central part of a discussion.
It would unearth a major issue of course (a financial bill that we simply couldn't afford locally) if we did apply the same targets and record the same information; there is a good reason not to. I don't think though that, at its heart, it is a particularly difficult challenge, to achieve parity; every time we set a target, aspiration or ambition, we could ensure that it applies equally to all settings. If we can't do it quickly (we don't have the money we had in the NHS Plan to make rapid progress) we could start and set a long term ambition and would feel like a more open and transparent discussion. The talk I hear about parity is critical, I welcome every statement that people in the NHS make, but the announcement of a bit of money by politicians that describes parity as its aim misses the target for me.
I remember being in the States for a learning tour at Harvard several years ago. I only had a working knowledge of the US health system before that and after it was still only limited, but I did get to understand one of the major issues over there is not the uninsured, but the underinsured - described to us as the Boston Taxi Driver issue. People who can't afford to fully insure themselves for everything prioritise and choose what they want health insurance for. Invariably they choose things that would keep them alive and that would allow them to carry on working and leave out less obvious issues, typically mental health treatment. So they, like us, end up, through an entirely different system, deprioritising mental health.
Ultimately, I guess, politics is about us; if mental health rather than A&E won elections we would see greater investment and promises. Until then will it always be fighting for parity?
Highlights of the Week - 10th October 2014 (@jeclo)
Highlights of the Week 1: What's a highlight? Fantastic reflections on what really is a week's highlight personally rather than a commentary
I set off doing this blog following weeks of just posting the 140 characters of my 5 highlights of the week on Twitter each week. It moved from being a 3 minute activity to something a bit more considered; I wanted to explain what those highlights meant and to provide a bit of context and reflection. I've noticed that as I have written a bit more, it has gone from being the 5 true moments that were happiest in the week, to a crafted exposition that balances the tasks that I need to carry out.
It is important - the blog is "out there" so people might conclude that whilst the financial challenge mounts, I'm just laughing and smiling throughout and that deduction may have an organisational impact as well as personal. But perhaps in that moment something of what I was and am trying to achieve gets a bit lost.
This week I was showing the blog to a few people and re-read some recent posts, so had a pause to reflect and I determined to try to get back to the original ambition, whilst still recognising the implication of putting things in to the public domain. There is a purpose to this and to bend it to be something else because of a concern that people won't be able to see different parts of what I strive to achieve doesn't feel like the leadership that I aspire to. So more smiles from here on...!
Highlights of the Week 2: 22ours - a development space with fantastic, stimulating people. The only input is ourselves @ChooseYou2 @timrobson07
I will have mentioned 22ours before; a group of development specialists that I meet with 3 or 4 times a year for an intense 22 hour learning set. The only resource we have is each other (we have crafted one workshop with Nancy Kline) and the agenda is emergent at each meeting, sometimes a bit more planned, but often totally spontaneous. Often supportive, it has been the setting of some hugely challenging and searching sessions of feedback too.
But it is a great space - a place I went to when considering moving to Devon and giving up my business and a space this week for me to think through the impact of the kind of role that I carry out and the extent to which I am really adding the most I can in the way that I'm currently working. Plenty of food for thought.
Alongside my move to the West Country the learning set has seen the writing of 3 books and this week was celebrating the sales of one reaching almost 10,000 (amazingly big for a first book in the development market), the imminent publication of the second and the nearing of a publishing deal on the third.
It felt like a an injection that will give the energy and resolve to make the biggest impact on the challenges and tasks ahead. A reminder that pausing for breath is important.
Highlights of the Week 3: Finding your voice on Twitter - what does that mean? Is it really that hard?
Some things that I find really hard, others seem to glide though without a second thought; but there are some things that I do fairly naturally that others seem to struggle with. Deciding on your voice on Twitter is one of those. I can't remember pausing for long to think about what I would want to tweet about or how I would want to express things.
I didn't contemplate tweeting lots of personal things - it simply isn't my style to broadcast that kind of information and I prefer the slightly more contained Facebook for that kind of interaction; I didn't think about following 2000 people so that I could get 1500 followers- it isn't the way I go about creating relationships; I don't favourite lots of celebrity tweets to try and get reflected fame; I did just decide to try and do what I would do anywhere else: be consistent, reliable and try to inspire (try to be occasionally funny, share a bit of vulnerability and then (work hard to) not worry about the reaction).
Of course it is an edited version of me-I'm not the same on Twitter as I am in work and am different again at home. Ultimately, those are just contexts, the "voice" is just to be comfortable with the presentation of me in this particular space.
Highlights of the Week 4: Raising a smile before another event looking at how we move the huge challenges we have ahead of us forward
I looked out at the team at our planning event and the there was an immediate sense of people who are tired and working really hard on our financial challenge who are concerned about the future, worried about our ability to deliver the scale of change and just running to stand still.
I was about to move in to a session that would describe the next steps in our NHS Futures programme to deliver financial sustainability, will give an exposition of our financial position and implications and then try to work out how we synthesise the need to work collectively with our providers with our need to produce a CCG financial plan that balances and is robust.
And so I decide to spend 10 minutes changing the energy a bit; introduce a bit of humour and get the room laughing and smiling. As we go round the room, people are asked to share increasingly funny stories as they introduce themselves, a very, very simple piece of facilitation.
When we finish I simply observe the importance of making sure as we work diligently on the stressful and all encompassing task of financial recovery that we have to look after our own state and the impact on us and our teams.
As I look back out at the team, it looks more like a group ready to start the workshop ahead.
Highlights of the Week 5: A meeting with the Exec Team at @PHNT_NHS. Huge challenges but an atmosphere of possibility and desire to explore
Both the CCG and Plymouth Hospitals NHS Trust are in planned deficit this year - planned in the sense of being agreed with our respective assurance organisations NHS England and the NHS Trust Development Authority. It means that when we get together, there isn't a lot of pausing on the successes before we look at the tasks we need to complete. And everything is harder as neither of us has the flexibility to make a compromise or a deal if it worsens our individual financial positions.
This week though we did manage to spend at least some of our time together looking at where we might make progress together using the NHS Futures programme as the structure for a new way of working. We also both acknowledged the basic philosophy we share in trying to improve services for those we serve, not always evident when we argue robustly about our different perspectives on a particular area of disagreement.
Small steps and progress - let's hope it counts for something as we head in to a new contracting round.
More smiles next week :-)
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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