Highlights of the Week - 12th December 2014

It has been a strange week.

It was the week we announced a change to the commissioning policy we had been suggesting in our urgent and necessary measures that would require smokers to quit 8 weeks before elective surgery and for those with a BMI of over 35 to lose weight before having their procedure. Or, as reported, "a U-turn", "backtrack" or "reverse".

Having worked on the measures for some time, we felt there was a good rationale that balanced the benefits to the individual to their own health both to do with general anaesthetic and recovery from surgery and in terms of their longer term health with the financial necessity of the position we are facing both this year and next.

But by Thursday, I was explaining on local BBC evening news that we had taken the decision to encourage, rather than require, people to change these behaviours before their operations.  I and been on the same programme only a week earlier explaining the rationale for the changes and why we thought they were the right idea, so understandably people wanted to know about the shift.

The reality is that we managed to attract a lot of media attention, more than we had been anticipating, especially at a national level and as a result of significant feedback, felt that progressing with the measures as outlined would not get the results we needed with the level of support from whole system.

It leaves us with the need to identify other savings to achieve our financial plan and as we move in to the last quarter of the financial year, this look incredibly challenging. It also means that we need to get staff working on a different approach. I hope our clinical leaders will be able to work to create another programme to deliver the outturn we need.

Highlights of the Week - 12th December 2014 (@jeclo)

Highlights of the Week 1: A new structure for Mondays: lots of meetings, but each with clear purpose
We now have a regular Monday meeting schedule that will carry us through to March which will ensure we attend to both the in-year financial position and planning for next year.  Last year we ran a series of bigger meetings that were successful, but did involve a large number of people.  This year we have tried to break the sessions down in to smaller groups with a clear purpose during the day.  As Chief Operating Officer, I get to attend all of them, so a very well structured day!

We start with Operational Delivery Group 9-11, which is our key Director forum for actions that deliver the in-year financial position and chase down the urgent and necessary measures action plan as well as the delivery of the schemes we set out the start of the year.

The Commissioning Managing Directors' meeting at 11 is a forum to ensure that the MDs are acting consistently and to share information from across the different System Resilience Groups (there are 3 in our CCG) and the two Better Care Funds.

We have a technical planning group at 1pm that will ensure that we hit all the deadlines required for planning - submission of finance information, activity returns, trajectories for key targets and the update of our annual plan - and to make sure that they are consistent.  This co-ordinating activity is vital and something we need to improve on from last year where, with external support both helping and confusing, we didn't manage to meet all expectations.

The Contract Negotiation Oversight Group at 2pm allows us to review the consistency of our approach across the negotiation of all our contracts.  It ensures that we treat providers in a similar way or understand the uniqueness of circumstances and apply ourselves to community, mental health, children's or acute contracts equally.

We finish the day with the Commissioning Intentions Group where we work on the transformation schemes that will deliver the financial plan.  This is critical, but important to maintain energy as we get to the end of a productive, but challenging Monday.

Highlights of the Week 2: Our press office has been really busy, but impressed with how they have responded to the seemingly impossible
We have been inundated with interest in the urgent and necessary measures we have proposed, which have attracted national and local political as well as media interest.  This has meant an incredibly busy time for the press office in the CCG dealing with the requests for statements, interviews and appearances.  

They have responded really well and it feels like we have been able to give a clear message about what we have been doing.

Towards the end of the week, the message shifted as we took the decision to change our advice on the requirement for people to seek support to lose weight or quit smoking prior to elective surgery, but again, they managed their part of this well and, however difficult, we responded to the further round of interest.

It isn't an easy task, but we have a duty to communicate as clearly as possible and they are a vital team to allow us to do that to the best of our ability.

Highlights of the Week 3: @NEWDevonCCG Western Locality GP Members' Forum-real willingness to work with us on the financial challenges
We spent Tuesday talking to our member practices in the Western Locality of the CCG about the urgent and necessary measures we were taking.  We need to be able to carry our members with us as we try to implement changes to the way elective care is offered, so this was an important moment.  Clearly all the actions we are proposing have been worked up by clinical leads in the CCG so there is good clinical evidence and advice that supports our proposals, but testing this with the wider group of GPs who need to implement on a daily basis in surgery is vital.

We run the forum twice on the same day to allow practices to attend either a morning or afternoon session and that way we usually get over 85% of our 52 practices attending at some point.

There were plenty of questions about the measures we have articulated - requiring people to quit smoking for 8 weeks or to lose weight if their BMI is above 35 prior to routine surgery are the most well reported, but there is a longer list - though a general sense of this being a necessary, if not welcomed move.  The practices understood the scale of our financial challenge and the need for us to take action that would lead to a real change in referral processes.

We described the Macro Marginal Analysis approach that we have adopted, building on work by Professor Cam Donaldson and Charlotte Williamson.  This looks at the treatments that add less value to people, based on best evidence and is how we identify areas like second hearing aids or shoulder surgery as issues we should review.

It felt like we achieved good understanding and left with an optimism that we would be able to implement the changes.

Highlights of the Week 4: The Planning and Programme Office Christmas Meal: first one I've been to in ages...
The small and perfectly formed Planning and Programme Office Team based in Exeter are a key part of supporting the work I lead as Chief Operating Officer.  They are the hub and co-ordinating force for a lot of our activity, including planning, assurance, financial recovery and project tracking.

It was the Christmas meal this week and, after several years working on my own, it was great to be back in the office christmas party swing. (I will miss the Locality's party this year for the second year running, due to a diary that places me in the wrong place at the wrong time).

A good way to end the week and to say thank-you to a team that are often unnoticed in the organisation, but bring a real professionalism and dedication to an often thankless task.  Clearly, it would breach protocol to divulge any more details, but safe to say that there was an appropriate moment to make my excuses and head home, leaving those with age on their side, to continue their celebrations.

Highlights of the Week 5: It only takes one meeting to remind me why I do this job; lots of exciting opportunities to offer better services more locally
When I use to battle a golf course each week, there was a saying that it isn't the 80+ average shots that would bring you back the next week - the combination of hooked drives, balls landing in bunkers, duffed chips or woeful putts - it was the one fantastic, glorious shot, that would see you loading up the car on a cold Sunday morning at 6.30 to have another go.  As the ball left the club and arrowed towards the green with the clean sound of a perfect strike, the feeling was addictive. 

So in a week when there were plenty of challenges, there was one meeting that allowed me to explore the opportunities that primary care has to take forward new initiatives and how we can work as a CCG to make that happen.  Sat with a GP and members of the CCG and practice team we were able to consider ideas, create new thinking and look at how patients could get better care more efficiently and effectively.

One great shot; I'll be back 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.

Highlights of the Week - 5th December 2014

We have a new cafe in the reception area of Windsor House in Plymouth where I work (at least it is my home  base, but I spend as much time elsewhere, particularly Exeter, as there).  It is a very  small little unit in  the corner of quite a large space, but it does make a much bigger impact than its size.  The reception area is quite an attractive space - relatively modern, bright and airy - but it could feel a bit souless (outside the Christmas carols or sporadic ceremonies).  Now there are the wafting smells of fresh latte, paninis and soup drifting across the atrium, it all feels a bit more inviting.  I haven't used it much - two or three lunch time soup stops - but I do feel better for it being there and there does seem to be a good trade.

It reminds me of the importance of an entrance.  When I was in York the public main entrance to York District Hospital was transformed by using money generated from selling concession space to a number of high street outlets to change the whole layout and feel of the first space that the public enter.  It was very grim before they began and utterly unrecognisable by the time they had finished, with a large light and open waiting area accessed via a number of patient access desks. I thought it was a great piece of design and a good way to generate the capital required to fund the development.

Even more noteworthy for me, though, was the impact that the shops themselves made on my sense of the environment (I used to walk through the reception area frequently for meetings and only on a couple of occasions as a patient).  The presence of a large Costa coffee shop and a modern and an inviting news outlet alongside a flower shop made me feel much more at ease and that the building was likely to house higher quality services than it previously had done.

And, of course, we all know that effect - the importance of the first few impressions, but if I expect my care to be better, the reality is that my rating of what then happens is likely to be higher; I live my life by my own perceptions of quality, more often than objective fact.

And that all means that, in some small way, I am a little bit more optimistic about work each day when I am greeted with the smell of roasting coffee in the morning and that has got to be good!

Highlights of the Week - 5th December 2014 (@jeclo)

Highlights of the Week 1: Every Monday morning, Operational Delivery Group, real signs of improvement and grip
The Operational Delivery Group is the two hour meeting that kicks off each week that focuses on the financial recovery plan and delivery of key pieces of our workplan across the CCG.  It will never go down as the most motivating and uplifting way to begin another 5 days at work, but it is starting to get a rhythm and moving beyond the moment of good intent to show real delivery.

It is one of several meetings that the Area Team of NHS England now attend to gain greater assurance about our work on our financial plan, both for this year and next, so it also has that external feel of monitoring: we need to get it right.

This week we had a reduced list of outstanding actions, fewer comments about things we are not able to report on and, for the first time, a complete report that allows us to see the impact of all the many initiatives that we are taking forward.

So, not the joyous, uplifting highlight, but a huge sense of progress and on reaching a level of professionalism that we are more proud of.

Highlights of the Week 2: @NEWDevonCCG Governing Body meeting ; less pages more focus on strategy and action
You can't measure quality by the number of pages... but if there are over 900 pages of papers for a Board meeting, you can assume that it will long and a bit of a test of concentration and endurance. This month we had reduced from last month's mammoth set to a more manageable size and there was better focus because of that.

It is a difficult compromise, a lot of the papers were about policies and procedures that we needed to have in place to ensure that our decisions followed due process, but I think that there is also a chance that something important doesn't receive the prominence it needs.

So the meeting this month had a good balance and we approved elements of key strategic direction, such as the next stage of integration work with Plymouth City Council; had a range of detailed discussions on aspects of our recovery plan and the urgent and necessary measures we are proposing; and we paid die attention to key quality, safety and performance issues.

All in all, a sign of us attending to the right issues.

Highlights of the Week 3: Area Team Assurance Meeting went as well as billed. Focus on achievements as well as challenges

Last week I trailed the quality of the preparation work for the Area Team quarter 2 assurance meeting between the CCG and NHS England, noting the excellent suite of documents that we had pulled together against the key lines of enquiry.

The meeting this week was a robust, but constructive session that allowed us to describe some of the many positive things we have achieved over the last 3 months in amongst the major issue of the struggle to hit our financial plan targets that rightly dominates the Area Team's requirement for assurance.

Our Urgent and Necessary Measures form a key part of the discussion and they have attracted a significant amount of media and therefore system interest and we are able to think carefully about the approach we have adopted.


Highlights of the Week 4: Plymouth Pride Awards: an evening celebrating some wonderful achievements with friends in Plymouth

I was delighted to be a guest of Plymouth City Council at the Pride of Plymouth awards this week. 

It was a wonderful evening that celebrated the commitment that many have made to their community within the city in a number of different categories.  There were stories that were inspirational, for example about fostering or fundraising as well as those that were incredibly touching, such as servicemen overcoming injury or those living with cancer.

Then, of course, there were the children. I am sure that being a parent has changed how I view stories about children who have done amazing things or face significant challenges in their lives, but fortunately we were saved from some of them not receiving the ultimate accolade as all the finalists were jointly awarded the winning prize!

Highlights of the Week 5: A first chat on a sofa in the Spotlight studio-it is hard to stay focussed on the core message for individuals

Anyone who has seen the footage of my outing on Spotlight to explain our urgent and necessary measures, especially those that focus on impact on people who smoke or have a body mass index of over 35, would not expect this to be a highlight; it ended with a relatively intense pursuit of a question about whether we intending to have any measures aimed at those who drink or abuse drugs.

We have been clear that we want to be open and transparent about the message and to focus on how they will affect individuals.  We haven't tried to hide behind a series of crafted overly positive messages and our duty is to explain precisely and clearly.

We had agreed with Spotlight that this piece will be a deeper analysis of the issues that have led to the implementation of the measures. It is important not to get drawn in to simple answers, but to ensure we give a very clear message about who will be impacted and how.  But with time short, answers get interrupted and I am cast as evasive.

It is a highlight, not because the moment itself is enjoyable or that I think I've done an overly good job, but the response to many who saw it has been positive about our intent and what I was trying to explain.

If nothing else, there are now a group of people who I live near who have an idea about what I do for a living, the weekend on the sideline at the kids' football was full of their feedback!

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.