The measures include providing a new elective pathway for people with a BMI of over 35 who would previously have had surgery as a usual treatment for their orthopaedic condition; we are now looking to ensure that they are offered weight management initially in order that they benefit more from the surgery or, as is already the case for some, opt to have no surgery as once they have lost weight, their pain reduces and mobility improves. Elective orthopaedic surgery for people with BMI of over 35 provides limited benefits for some, there are risks and our proposals are in line with NICE guidance, but that doesn't stop the idea raising concerns and comments. We are also looking for people to have given up smoking for 6 weeks prior to surgery in order to improve their outcomes.
Within the expected local debate we now know that our financial challenge is big enough to recieve national attention and so Simon Stevens was asked a question about our proposals at the Health Select Committee at the start of the week. He expressed some reservation and the media interest continued. And then, of course, it got a mention in Roy Lilley's blog.
Which all adds pressure to those who are trying to find the right solutions to a huge challenge for which there are no easy answers. It is not the most uplifting of tasks to be sorting through a list of ideas to determine which ones are acceptable and which aren't, but it is necessary that somebody does. Our Turnaround Director will start next week - a sign of the next phase in escalation and hope that gives us some further support, but we can expect more detailed scrutiny and challenge ahead.
Highlights of the Week - 31st October 2014 (@jeclo)
Highlights of the Week 1: Locality Board is focussed on understanding issues and making decisions on commissioning, finance and integration
We are working to ensure that whilst we are in financial recovery we are clear about how to be most efficient in our "business as usual" processes. This includes being clear about the role of the Locality Board and whether it needs to meet monthly or perhaps slightly less frequently.
This month, though, showed the importance of the clinical leadership that it provides within the Locality. There was a hugely engaged discussion on financial recovery and the measures we will need to take over the next few months. Members rightly questioned from a clinical and quality perspective, but were supportive of the proposals.
We were reviewing a key set of actions around a key commissioning decision and the Board were clear about the prinicples and management actions suggested as well as supporting the conclusions that they were presented with.
And they are clear about the imperatives of integration; we have an opportunity in Plymouth to create something that will have lasting impact and they are prepared to think through how things would need to change in terms of their own role in order to deliver those benefits.
All in all, it felt like clinical leadership in action with some key issues to address.
Highlights of the Week 2: Individuals at the Centre 2 launches: 16 teams with ambition to improve the way we work of key projects
It was great to be back at the start of our Indiviudals tat the Centre programme for the first module of the 2014/15 programme that will run through to June next year.
We have scaled up this year with 16 teams compared to 5 last year, so our ambition is huge. The teams are represented at each for the four modules by 2 change agents who then are responsbile for taking the ideas back in to their project teams and inspiring progress over the weeks between the modules.
So the programme takes 16 project outlines and looks to support their development and delivery by exposing them to some developmental thinking around the purpose of their work and their ambition.
Fantastic success last year, so looking for many more exciting stories to tell this year.
Highlights of the Week 3: Money is central to IATC2; but we can have the discussion and ensure focus without losing the impact of all that we are trying to achieve
And clearly this year the context for the programme is difference. At a time when we have targeted a further £750,000 of savings from our running costs (on top of our projected underspend of £2 million) we need to be clear about the value that any time away from the core financial recovery work gives.
So we spent a good proportion of the day thinking through how each project will impact on the financial position of the CCG. It was heartening that all our staff were very much energised by that discssion and, far from being the moment that killed all the optimism, it was the point at which the projects becaame real and their delivery even more important.
Highlights of the Week 4: Integration seminar looks at the impact on Devon of our proposals in Plymouth. One CCG with two local authorities
Integration makes yet another appearance in the blog and, as most will know, we are making fantastic progress with our work in partnership with Plymouth City Council with a dual ambition about integration of both delivery and commissioning by March 2015.
In an organisation like ours where under a third of our population is covered by the footprint of the City Council, this does beg the question, "What about everyone else?" and in our context, what about all those people who are covered by Devon County Council.
At one level, the decisions taken in one area are discrete and there is no real need for the Local Authorities to have an overly close working relationship, but, for us, the decsion in any part of our organisation has an impact elsewhere.
For example, we will struggle to have a governance and decision making structure in one part of our organisation that is different from the rest, so there is a constitutional issue if we alter how the Locality is governed to move towards a Joint Strategic Commissioniong Board. Equally, if we link a proportion of staff to a new commissioning unit in Plymouth, there is an impact on our internal business support services that impacts large parts of the CCG.
This workshop gave those learders from across the CCG a chance to look at the issues and think through the implications. Some of us have been exposed to this each and every day for the last year, but clearly people outside of Plymouth haven't. Getting everyone to the same level of understanding is important as we are nearing another key deicsion point and we need to ensure due dilliegnece. The session pointed to the challenges, but gave us the clear sense of the questions we need to answer over the next few weeks, so hoepfully we arrive at the next Governing Body meeting with a clear recommendation.
Highlights of the Week 5: Professor Clough on Woman's Hour http://bbc.in/1p9AOHk Dementia and cinema - fantastic!
Not often that my father's work and mine overlap, despite the fact that he has been a social work academic at Bristol and Lancaster Universities for most of his career. We share plenty of similar stories, but not many direct connections. His last piece of work with Age Concern in Lancaster before he finally retires (well, we will wait and see as he is still very much active in his early seventies) has been about dementia and isolation and one of the projects they have been experimenting with is about creating dementia friendly screenings at a local cinimea designed for couples and families to attend.
They have been very successful and have attracted the interest of Woman's Hour and so the 11 minutes of this episode explore the project. At a time when the press is full of stories about the issues of social isolation, this feels very uplifting and optimistic. I'm a dementia friend and so keen to explore these types of initiative and very pleased to listen to these wise words!
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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