Highlights of the Week - 23rd May 2014

I spent some enjoyable time with Ann James, Chief Executive of Plymouth Hospitals NHS Trust, this week.  We meet up relatively frequently and often have a range of difficult or thorny issues to resolve.  Always, though, there is time to informally and irreverently reflect on how things are for both of us and the leadership roles we play.

This week we were ruminating on the attention required to consistently have a diary that reflects the values that we hold to be important and that we tell others are the key ways that we expect them to act in the organisation.  It turns out that we don't have any tricks for this - it is really difficult when the are so many competing demands on our time - but there are some things that we both prioritise and some diary rules that we hold to.

Nothing surprising within that list, but I do make sure I get to staff briefings each month, that appraisals don't move from the day they were planned and that if I make a personal commitment of time to someone, that again has a higher level of status.  It felt for both of us like the relational aspects of leadership of our teams was high up on the list.

Plenty of interesting stories over a cup of tea!

Highlights of the Week - 23rd May 2014 (@jeclo)

Highlights of the Week 1: People do read the blog! A connection to an old friend and people booking to come to our Patient Experience Event
I ended up talking this week to a childhood friend.  We lived about 50 yards apart, went to school together, played hockey together and went on holidays today - I almost remember a fantastic 21st birthday celebration in Bude with a group of friends. I have seen Dave once in the last 20 years and that was over 10 years ago and that was the only time we talked in those years too.

But through the wonder of social media we are tenuously connected.

And it turns out Dave had started to read this blog and follow me on Twitter.  The contact was about interest in the work we have done on Strengths Based Leadership and, once we had caught up on family news, it felt great to be sharing across  two very different organisations - Dave works in System Architecture within finance.

Also this week I had a Twitter exchange with a couple of people who must have read last week's blog and were interested in our Patient Experience Summit next week.

I know that the NHS, our organisation and my generation are nowhere near exploiting the full potential of social media, but it is encouraging that there is some reach and purpose to these words!

Highlights of the Week 2: Another purposeful Locality Leadership Team meeting well trained in the Thinking Environment @NancyKline 
We have spent time in development days working on embedding Nancy Kline's 10 components of the Thinking Environment in to the way we run meetings and work as a team.  The components are not complicated and neither is the overall concept - that the quality of the things we do is built on the quality of the thinking we do first, so that the job of the team is to create a space for the best thinking possible.

In practice this is about things like attention (really paying undivided attention to the person who is talking/thinking), equality (that everyone's views are equally important) and ease (urgency destroys, ease creates).  It is not as simple as it seems!  But the results are profound.  The room has a sense of calm and purpose, people take collective ownership for the time of the meeting and it does truly allow everyone to be heard.

We are 18 months down the track from the first time we introduced the concepts (I had spent a day on a workshop led by Nancy) and this week was another reminder that with a hugely packed agenda, with 14 people in the room and with interruptions we can still discuss our business tension free.

Highlights of the Week 3: Meeting Local Chief Executives to create the joint work plan for the Challenge Local Health Economy
I have been shuttling around this week to touch base with the 5 Chief Executives who form the core scope of the work on the Challenged Local Health Economy in Devon and Plymouth.  I meet them all fairly regularly at different meetings, but having a week meeting individually with each of them and hearing their more personal views of the challenges we are facing was really interesting.

We are all working to put the needs of the 900,000 people we serve at the heart of our planning and constructing a commissioning recovery plan that is not based around organisations' needs.  I think people do really commit to that, but, of course, we each also have our own statutory requirements to deliver, held to account by Boards and regional bodies, so inevitably there is always a point where there is a degree of conflict or where the clear vision for the future comes from a certain perspective of the whole picture.

The challenge from PWC, who are working with us for the 11 week programme as our critical friend, is not that the individual leaders are not of the right quality and certainly we have huge talent and experience amongst the group, but is about whether the CCG can assume the system leadership role and whether the group will come together around a single plan.

Highlights of the Week 4: A discussion with our Communications Lead-not more content, just get better channels!
Each week I watch the email exchange in the Locality about the need to provide content for the weekly news update, the monthly newsletter of a range of other communication.  It seems to be something that we haven't managed to completely resolve.  As I sat down with our Locality Communications Lead, I knew we would once again return to this issue.

I am really clear though that we are not lacking in content; what we seem to be really poor at and very old fashioned or traditional, is our ability to turn information created for one purpose in to communications messages.  It seems to me that in the new media world we need to be expert at trapping and collating information produced across the CCG and repackaging it for a variety of different uses.

This means that the annual report should write itself from the year's worth of content and that the week would easily create from email exchanges, minutes or notes.  So we set ourselves that task this week.  How much mileage can we make from the words that I write here each week? Or the reports I write for the Board? Or by videoing the staff briefing that we give?

Hopefully that will avoid the collective moan that I feel in the Locality as the email request arrives (or the reminder ... or the urgent reminder!)

Highlights of the Week 5: The Collaborative Business Services Board is a real statement of our organisation's values
Unlike most CCGs, the vast majority of our office functions - finance, business intelligence, contracting, safeguarding, quality, referral management and HR - are managed in house, rather than via a contract to a separate Commissioning Services Unit.  This means we have over 400 staff, many CCGs have around 30 or less.

Given that we have taken a different path to many and that clearly we have some real challenges to resolve, we have to be able to show that the approach we have taken is working.  The overall numbers look right - we underspent our £25 per head management cost allowance by over £2 million last year and again this year we will use this level of efficiency to support our spend on patient care services.  In addition, over £1.5 million of the allowance is spent on our referral management services that many CCGs don't have so our like for like comparison is strong on the overall spend.

But the real question is about value and we are working with Warwick Business School on a long-term study of commissioning support.  The first report from them, one year in, gives us a very good sense of moving in the right direction and compares favourably to other models.

The Collaborative Business Services Board this week was interested in the value and metrics, most importantly though the conversation focused on how we ensure that the services and utterly aligned to support our recovery plan and financial position.


So another busy week, but I did make the coaching session, staff briefing and the three 1:1s with members of my team (albeit one on the phone).  Probably an 8 or 9 out of 10 for focusing on those key relationships.


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 - 16th May 2014

If popular culture were to be believed, this week would have seen most Liverpool Football Club supporters crying in to their drinks after a prolonged challenged for the Premier League title ended in ultimate failure last Sunday as Manchester City scooped the title on the last weekend of the Season.

I am one of those supporters, albeit from a distance and with little claim (other than they were the best club when I was forming allegiances in the mid to late 70s) to a connection with the city.  The truth for me and, as far as I can make out, for many others, is that this week has actually been about reflecting on the most amazing, enjoyable and uplifting season since their heyday and I've enjoyed it immensely.

It does serve as a reminder to me that it is much more about enjoying the journey, than focussing on the end or goal all of the time, especially if that becomes obsessive.  Am I really only going to enjoy football if we win titles?  Of course success is important and there is no doubt that I would have loved Liverpool to be crowned champions this year, but that can't become the sole focus.

In the same way, I want to enjoy Monday to Friday not just as days that get me to the weekend and I want to enjoy work now as well as thinking about what I might be doing in the future.  If I'm not getting satisfaction from this week, this month, this year, what does that say about the choices I'm making about the way I live my life?

So here are some of the things that have been great this week....

Highlights of the Week - 16th May 2014 (@jeclo)

Highlights of the Week 1 : A review of contract management in the Western Locality gives great feedback and optimism 
We are currently undergoing a detailed and externally supported review of our financial position in light of the need for us to find a deliverable plan that gets us to the £14.7 million deficit that we have agreed with NHS England.  It isn't easy and we are not yet confident of our ability to deliver that financial target.

This week there was a focus on the contracts we manage in the Western Locality and our plans for transformation and savings.  The outcome was very positive; the team has worked really hard on our plan, ensuring we align levers such as headroom, the potential for penalties and payments for quality through CQUINs, to deliver our goals.  This means we are able to give more confidence and assurance about the chances of achieving key NHS Constitution targets.

We need to go further and we will be looking for ways to generate greater savings whilst protecting the services that are important, but good to get feedback that others are impressed with what the team has been able to do.

Highlights of the Week 2 : Chief Officer Leadership Group for Challenged Health Economy work is starting to align around a joint plan
This week's was the fourth meeting of the group of Health and Social Care Chief Executives across our patch in the context of the joint work as a Challenged Local Health Economy.

The first few weeks have seen us establish the structure and process and get an agreed view of the size of the financial challenge.  Thought is now turning to how we address that challenge, with a couple of clinical Care Design Groups over the last couple of weeks, and the way we will work together over a longer period when the intensive support we receive for 11 weeks disappears.   

It isn't easy to work on a collective plan when each and every organisation is under huge pressure individually to deliver their targets, held to account by Boards, regional bodies and local councillors.  But neither is it a sustainable position to cite that complexity as a reason not to do what is obvious to all and work together on a strategic plan that gets the very best out of the increasingly stretched resources we have.

This week's meeting was positive, albeit that there are issues, such as our Transforming Community Services procurement process or Foundation Trust applications that can seem to cut across a desire to create a clear and compelling direction.  We have agreed in principle to a joint programme approach and office and we will have the first draft of the commissioning strategy that will give the overarching programmes of work next week.  It feels like better progress.

Highlights of the Week 3 : Integration Board discussion in Plymouth - driving progress whilst navigating elections and CCG Governance
The ambition is clear and we are working on delivering integrated provision of care and integration of commissioning between health and social care in Plymouth by March 2015.  We recognise the sheer scale of that challenge, but we are working to drive as rapidly as we can to a model that will allow us to make the scale of changes we need to in order that we can have a sustainable health and social care system.

This week we looked in detail at the key milestones in the programme.  We have to navigate short term issues like the local elections and that impact on getting early agreements signed off; if we don't the plans begin to slip.  But we also need to ensure that decisions dates and processes are aligned between the CCG and the Council and that we understand how progress in Plymouth will affect the CCG's discussions with Devon County Council and our Transforming Community Services programme.  It is one of those situations where it soon becomes obvious that managing the timeline is absolutely critical.

In the longer term we are plotting the impact of the general election next year, both on the politics of the programme we are working on and, again, on our ability to take key decisions in early 2015.

We have a way forward and we are making good progress.

Highlights of the Week 4 : The buzz of the Individuals at the Centre programme has been present all week and I'm on to the next steps
There has been so much wonderful feedback in the organisation and beyond following the successful showcase event that was the conclusion of the Individuals at the Centre Programme last Friday.  Many a bit sad that it is all over, but the reality is that living by the values we set as an organisation isn't something that can start or finish, it is something that needs to exist constantly.

The outline plan for the second year of the programme is getting a bit more detail around it and I am keen that we inject enough ambition to build on this year's programme, rather than simply repeating the same format.  We don't want to throw out all the wonderful elements, though, so we will end with some blend of old and new.

In the immediate future, the CCG is hosting a patient experience summit on 29th May at Exeter Racecourse.  The purpose of the day is to bring our community - commissioners and providers - together with a focus on patient experience driving improvements in care and quality.  It is being led by Jenny Winslade, Chief Nursing Officer in the CCG and is born out of the Individuals at the Centre Programme, so we will be spending some time on the day looking at the process we have been through and the stimulus that has led to the success of the programme.

We think this is the kind of event we need to be doing more of as a CCG.  It isn't easy, it is much easier for leaders in provision environments to more directly connect with patients and we don't want the event to feel at all like we are taking action because our providers aren't.  What we are looking to do though is host something that delivers on our values to put individuals at the Centre and gives key leaders in our system time to reflect together on how we might improve.

So I need to capture the excitement of what we have done, but knowing that many in the audience will have done far more and the story is only important in the way it creates a positive discussion on the day.

Highlights of the Week 5:@jenniferwinslad leaving do from CCG to join SWASFT.  Enjoy a new challenge & thanks for the time working with you
Just to be clear, it is not the Jenny Winslade, our Chief Nursing Officer, leaving is a highlight, but we did have a really enjoyable leaving do and it was a good opportunity to reflect on the work we have done together.

Jenny is leaving to join South West Ambulance NHS Foundation Trust as their Director of Nursing and I have no doubt she will be excellent at that.  Jenny has patient care at her heart and was never going to be able to stay in commissioning for the rest of her career and resist the urge to be back in more direct contact with patient care services.

We will miss her.  She has a team that will ably manage the issues and we have advertised for our new Chief Nursing Officer, but she has provided really good Board level leadership and dealt with some complex and difficult issues.  The role requires someone who can maintain excellent relationships with Director colleagues in provider organisations and upwards through NHS England and the NTDA, but also someone who is able to robustly challenge when issues aren't being dealt with appropriately.

Jenny has been good at getting the balance right.  We haven't got it perfect every time, but we have learnt as we have gone through the year and I do think it is an area where we have added value.

Together we have done a lot around integrated reporting and Integrated Provider Assurance Meetings, working to ensure that we look at all aspects of an organisation's performance in one place.


So I hope you enjoy this part of your journey; this isn't a stepping stone to something else, it is a choice about the most enjoyable thing to do at this stage in your life.

Highlights of the Week - 9th May 2014

This week is all about the CCG's Individuals at the Centre Programme.  Friday was the showcase and graduation for a seven month learning set programme and a year long piece of development work focused on how we walk the talk of putting Individuals at the Centre of all our work.

I have been leading this work in the CCG with support from Tim Robson who runs the website www.nowshowup.com. Tim has been bringing his thinking and inspiration on brand to our CCG, running a set of half day development workshops, Leadership Team and Governing Body sessions and the four modules of our learning set programme.  Brand in this context isn't about logos, mission statements or strap lines, it is about whether organisations deliver on the promises they make to customers or not.  Apple do, Ryanair do (they don't promise a quality experience and you get what you know to expect), so how about the NHS? And how about NEW Devon CCG?

I have invested a lot in to making this programme happen and the learning sets, working with 5 teams who volunteered to apply to be participants, have been hugely enjoyable and rewarding.  The proposition was simply enough: we were going to give staff time to think about our values and to create 5 areas of excellence where we could show that we had put people at the heart of our processes.  We simply took the restrictions (real or imagined) off and let them get on with it.  There were mentors for each group (huge thanks to Chris, Laila and Helen who worked alongside Tim and I), but our job was to support the teams, not to guide or direct.

We kept saying "Trust the process" throughout the 7 months.  This applied as much to us (don't intervene, don't try and drive success) as to the teams who we encouraged to use Simon Sinek's Golden Circle Model (www.startwithwhy.com) where more time is spent thinking about why and how you are doing something than what you are doing - organisations get focused on the delivery plans and projects, so it was a huge challenge with only a few months to create a pocket of excellence for people to believe they had the time to deliberate their "why" at length.

So Tim and I arrive at the graduation ceremony and spend the morning helping the teams to be ready to present to their invited audience and 5 "Dragons" - John, Anne, Caroline, Annette and Lorna, members of the CCG's Governing Body.  We still had no idea what was in the presentations ("Trust the process".....) so energy and stakes were high.  What have they made of the time they have had?  The five highlights are brief snapshots of their projects.

Alongside their achievements was an amazingly rich set of stories about what they have gained personally from the programmes - from someone reinvigorated who was about to leave the NHS to two people who have got new jobs in other organisations.  Very moving descriptions of personal growth.

Highlights of the Week - 9th May 2014 (@jeclo)

Highlights of the Week 1:IATC Wheelchair Users Project-Young wheelchair users in Plymouth present to receive their graduation certificates!
In some senses this was the most straightforward of projects in terms of the basic proposition.  We had heard some poor stories from the parents and carers of young wheelchair users in Plymouth about their experience of the wheelchair service and the team wanted to do something to improve that.  The remarkable story, though, is about their relationship and involvement with students from Woodlands School in Plymouth and the joint process of design.  And it was the students, not just the parents/carers who we worked with and listened to.

They truly placed 6 students at the heart of the project and based all their work on their input.  Their have been many spinoff benefits as they have gone on - money for a new wheelchair test track, including a place to practice getting in and out of transport with large and complex electric wheelchairs and working out how to solve the problem that if your wheelchair breaks down, you can't go to school because only one chair is approved for use on the school transport.

The students have been inspirational and have loved the experience too.  They have been to our offices (they wanted to meet in our work, rather than always at their school) and the team have shared plenty of food.  The lasting benefit? The team are determined to run the tender for wheelchair services based on the evaluation of the young students; a huge challenge, but the rewards will be equally huge.

The students were with us for the presentation and were very excited to receive their graduation certificates; a real highlight of the day!

Highlights of the Week 2: IATC Equality & Diversity Project.  This is their work youtu.be/MRbKt7KxpfI stunning (and Sam the videographer!)
Sam our videographer had been involved in several of the projects.  His work with this team is fantastic and you can see the result in the link above.  The team wanted to ensure that staff throughout the CCG really understood the protected characteristics and made these central to their work.  They wanted to go beyond this too and provide inspiration and leadership across a wider set of organisations.

The team struggled with changes to membership and were thinking about abandoning, but they reconfirmed their "why" and the importance of the work they had set out to achieve.  The real power of the story that sits behind the video is the work they did to create a huge range of relationships that led to finding volunteers representing all the protected characteristics to be part of their film.

People are interested (why wouldn't they be? A simple, but powerful few minutes) and this will reach far beyond the CCG.  Our job is to make sure all our staff see this video and reflect on what it means for them - great to have such a tool to enable the Governing Body to apply some leadership to that task.

Highlights of the Week 3: IATC Being Heard Project. Quietly revolutionising how we work with complainants central to the process in the CCG
Are patients central to the complaints process?  You would hope so; we have a team that spends a lot of time listening to and working to resolve patient queries and complaints.  But when first asked the question in one of the early workshops, the answer focused more on "it must do, our policy follows national best practice..." than on what we had done to really shine a light on that issue.

Halfway through this presentation, knowing that Penelope was the sole presenter on behalf of her team, I was wondering whether she was going to be able to keep the audience's attention (there had been plenty of emotion and tears earlier with the wheelchair users project, so momentum needed to be maintained!), but of course they had a wonderful trick up their sleeve with some acting of our of complaints process that grabbed the moment.

What does a complaint form look like if you invite someone to very clearly lay out what they think the key issues are and what they want done about them, rather than just sending us a story and inviting us to miss the key points as they see them?  How do we ensure that they get feedback not just about what we are going to do, but when it has been done too?  They have worked hard with complainants and Healthwatch to redesign what we do.

They have got national recognition and are off the present at a key national conference following an invitation.  They will go from strength to strength.

Highlights of the Week 4: IATC Being the Difference Project. Mobilised such enthusiasm and commitment from our "back office" Inspired!
This was the team I mentored, or more accurately this was the team I was meant to be mentoring.  We never quite managed to align diaries in between workshops so, apart from a number of individual conversations, they were on their own.

A team from across the CCG - 8 of them in all - who work in what would be described as the back office - Finance, administration, Governance, Programme Office and the Corporate Office.  They focused on one of the pieces of learning that Tim brought - that a brand is the product of a thousand small gestures, not a few big moments.

So they worked on a number of small changes that people could make to bring them more in touch with the importance of what we do, ultimately for patients.  They have surveyed staff views on how connected they are each week to direct patient care and how often they feel they make a difference; they have championed the CCG's Connect Programme where we offer 2 days for staff to work with local charities or voluntary sector groups linked to our work; they led the CCG's encouragement to make pledges for NHS Change Day and have taken it on themselves to present at team away days and events.

They want change agents in our organisation - people who will take their ideas and spread them wider.  They have 20 staff interested in that, so we are hugely excited to see where this takes us next-does feel like they have started a movement.

Highlights of the Week 5:IATC What About Me? project. The team have inspired each other and amazing stories from their patient support event
This team were a bit different to the others (they would say so too); they were very clear on why they wanted to work together as a four, but less clear on the area they would make a difference.  This really tested the "Trust the process" mantra as we were in module 3 before they started to solidify around some tangible work.

But it was a great example of how starting with Why and spending more time on that will make the 'how' and 'what' happen much more quickly.  In the end they pulled off a support event for people with psoriasis and eczema that had 60 attendees and some of the most compelling stories we heard all day; people who had lived with their condition for 20 years and never met other people to talk to; someone who found they were applying their cream in the wrong way and therefore getting very little benefit.  They had been for many years.

Their personal journeys were intense and lovely to see them revelling in every second of what they had achieved.  But the Dragons could really see the potential of commissioning a different type of service where people had the option of a group, community based treatment and approach that supported their emotional as well as medical needs as they recognised that sufferers can feel incredibly isolated. 

They definitely ended the day with a bang!

Highlights of the Week 6:(extra for one week only). Humbling and emotional feedback for me at the end of the IATC programme.  I was "all in"
I tend to be pretty confident about what I do at work and part of my job is to play that role.  But there was quite a lot at stake for me in the delivery of the programme and the organisation had given me plenty of freedom to design and run the development process and it would need to show results.  So I was definitely working with a bit more adrenalin than usual on Friday, speculating on the level of success that others would see.

The teams were all fantastic and had justified every ounce of investment made in them and every minute of time they had been given (the programme also generated over 500 hours of personal time within the projects).

And there was some lovely feedback from participants, the audience and the Dragons about what we had achieved and my part in that.  Very emotional, humbling and moving, but a really wonderful way to end the day, the week and the programme.

And now on to #IATC2, the plans for rollout within the CCG and for a patient safety and quality event on 29th May are already well advanced; can't wait!

Highlights of the Week - 2nd May 2014

This is what happens now when I (occasionally) get on the bathroom scales to check how far from my perceived ideal running weight I am.  They are wi-fi enabled scales that link to an online and iPhone app (all very modern).  They recognise which member of the family I am (we all have suitably different weights), tells me my weight, displays my BMI and where this lies on a healthy range and then records that information to a cloud where I can retrieve it later - I automatically have a record of every time I weigh myself.  All very neat and fits in with my app enabled life.  

But there has been an automatic software update and now there is an added extra when it has finished telling me all the information I wanted......

It now also gives me a weather forecast; today's was rain, which, when I went out, it wasn't.

Like most slightly geeky bits of technology, half of me loves this, because it just can do it; the other half is perplexed by the value of a single icon of weather to reflect a whole day and whether telling me things I didn't want is actually a bit of an imposition (perhaps in the settings I could turn this off, I haven't checked).

Anyway it is similar to a concept that @timrobson07 has been using as part of our Individuals at the Centre programme in the CCG - all of us, everyday, have the opportunity to install updates to the way that we work, rather than just sticking with a version of ourselves that will increasingly look out of date (compare these scales to the ones I used to get forced to confess my cake addiction on at school...).  Sometimes, though, the update may not give you what you had hoped or wanted!

Highlights of the Week - 2nd May 2014 (@jeclo)

Highlights of the Week 1: Collaborative Business Services Board-A space to focus on the quality of what we provide to ourselves and others
We are one of the few CCGs to have (almost) all of our commissioning support services provided in-house.  We are part of a study on the effectiveness of approaches to business intelligence, contracting and other back office functions with Warwick Business School, so we will be able to reflect on comparisons over the next couple of years; early data is encouraging.

The Collaborative Business Services Board is our formal process both to ensure that the functions are running effectively and to give us a mechanism for checking that we are providing the level of support that our commissioning teams need.

We are in a process of financial recovery and how our referral management service works with some of the elements already described is critical to our ability to deliver the level of transformation that will help us move towards a balanced financial position.

We had a positive meeting this week and we are clear about what we are trying to achieve, the governance that sits behind that and the need to continually adjust our offering to meet new requirements.  We will never have the finished article, we can't have as things will keep changing; so we will make improvements that give us a service to be proud of.

Highlights of the Week 2: Interviews for new Public Health consultants in Plymouth a real sign of the new energy for joint working 
Delighted to be sitting on an interview panel in Plymouth today helping to recruit two new consultants in Public Health.  The team has had vacancies for a while, so it was great to be part of the process to try and give them the capacity to drive health improvement in the City.  In any case, I do like to be involved in other people's interview process- no worries about the process and not quite the same tension about the outcome, so a chance to try and add real value to the observations and deliberations.

I had nothing to do with the question setting, all the work of the Director of Public Health, but questions about the Better Care Fund and how Public Health could support a CCG that was in financial recovery were a real sign that Kelechi has a good understanding on the areas where we need to work together with his new department.

We already share one member of staff, a consultant who is also our Locality Clinical Lead for Children, Young People and Maternity, and hopefully we will be able to build on this start.  The Director of Public Health will be joining our Locality Board, which will be a really significant addition alongside the Director of People and we look forward to the contribution he will make there.

Highlights of the Week 3: Health and Wellbeing Programme Board confirms our ambition to create integrated futures and refocuses for delivery
The Integrated Health and Wellbeing Board is the title of the Board in Plymouth that, working to the Health and Wellbeing Board, is the Programme Board for the delivery of our joint plan for integrated commissioning, integrated provision and Children's services.

We have the start of our joint programme office in place and it feels like there is a building momentum now for the delivery part of the programme and I am optimistic that we will turn our intention in to reality.

This isn't without its challenges.  True integration of commissioning raises big questions for a CCG- fundamentally, what is left in the CCG if we move commissioning in to a joint vehicle?  And in our situation, what does integration in one part of our patch (Plymouth) mean for the other part (Devon) and in particular for my locality for the areas in the South Hams and West Devon.  There are also clear questions about what happens when democratic decision making meets GP membership decision making-what will our process be?

There are also plenty of small scale issues to resolve that eat away at our "jointness".  The transformation programme is not a freestanding programme as it also serves as one of Plymouth City Council's 5 transformation schemes to deliver their savings and service change.  That means that we have to tick some boxes in terms of the Council's need for consistency, so sometimes I look at the highlight report - in fairness, we all do - and struggle to see where the CCG figures.

But in our conversations we are all equally determined to get this to look and feel right and we know we will need to tolerate, on both sides, the idiosyncrasies of the other's ways of working.

Highlights of the Week 4:Leadership Team Development Day-what do we need to enhance to deliver in 14/15:everything is open for discussion
We are facing a huge financial challenge over the next few years and our first target is to determine an approach that gives us a realistic chance of hitting our control total in 14/15.  Throughout the organisation everyone is really focussed on this work and we are making progress, though there is plenty of 2 steps forward, one step back (and also times when these numbers are the wrong way round).

We have set ourselves a task as a Leadership Team to review how we have things organised and to ensure that, despite any history or justification of why we have the structures we do, we will put in place the arrangements for this year that focus our best resource on the biggest challenge and ensure we have alignment.

Whether we find a way to get to the numbers we need or not, we are clear that we must leave no stone unturned and we all need to be doing the things that add the most value based on our strengths, experience and ability.  We will know next week how radical this means we will need to be; mostly this is about which way you look at a matrix, rather than carving up what we have spent a year putting in place.  We need to put financial risks above locality structure or boundaries between our different departments.

We have come a long way and we spent the day discussing that without it feeling like we were defining our kingdoms.

Highlights of the Week 5: The team do a fantastic job on our Locality Integrated Governance Process-it works perfectly when I'm not there
Of course it does... the team are very able and we have created a real jointly held belief in the importance of having a foundation in the Locality and the organisation about the risk and assurance process that ensures we are appropriately working on the right issues.

But there must be a law that says that the time when someone is coming to look at what you do will be the one of the few times that I won't be there-it has happened many times in my life, at some very important times, so is something to be sanguine about.  In this case, one of our non-executives was visiting to see how our Locality undertakes the local process that feeds through to the Integrated Governance Committee that he chairs.

I think we do this stuff really well and the feedback was excellent.  The team, at their own direction, also decided to extend the remit of the meeting to pick up the crucial links between finance, contracting and the commissioning team to review the ways that we get that interaction right to give us the best chance of delivering our locality work plan-our part of the CCG's financial recovery.

More time to spend on that over the next couple of weeks, but great progress and everyone stepping forward to deliver their part of the overall approach.


So a week of challenge and real progress on delivery, but how exciting to be told the weather without having to look out the window.....!

Highlights of the Week - 25th April 2014

No blog last week... holiday time and a wonderful week skiing with the family.  This is the perfect holiday for the 5 of us as everyone looks forward to it equally and shares the enjoyment (less of "do we have to go to the beach again" kind of moments)

The highlights of last week would have been Family, Space & Emptiness, Mountains, Sun and Fun & Chilling, which in 5 pictures looks something like....

We have been skiing at Easter for a few years, so have gone back to Tignes, where the height almost guarantees snow, even in the middle of April and didn't disappoint this year.  I still can't quite get to grips with the heat (t-shirt high in the mountains at lunch time) with the activity of skiing, but it suits us more than the better snow you might get in February that often comes with cloud, cold and twice as many people on the slopes. 

So suitably refreshed and ready to be back at work this week!

Highlights of the Week - 25th April 2014 (@jeclo)

Highlights of the Week 1: Plymouth Health and Wellbeing Board Solution Shop: Systems Leadership & Alcohol - how have we done?

The Plymouth Health and Wellbeing Board does meet formally to carry out its important business, but has placed emphasis, from the outset, on having a wide membership, not acting like a "traditional council committee" and injecting development space in to its work.

This week we were hearing how the external support to experiment in using a Systems Leadership approach to a particular project - the delivery of the Plymouth Alcohol strategy - was working.

The facilitation was excellent and expertly delivered some hard hitting and key messages from the those charged with the delivery of the strategy.  It seems like we aren't connecting well enough between the senior leaders at the Health and Wellbeing Board and our teams trying to implement; It felt to me like we aren't quite "walking the talk" and the messages for us were profound.

We spent an afternoon thinking carefully about that and what it meant for the more general work of the Board.  We have a way forward that will ensure we listen really carefully to what the team has to say and respond with action.  What was hugely encouraging was the sense that we are going to keep working on this together as a leadership community and get to the right outcome for the city.

Highlights of the Week 2: Another member of staff reflecting on the joys of living with an empty inbox - a coaching success

It is hugely annoying to post a highlight of the week as "finishing the week with an empty inbox" - I know the antibodies it can create!  But having coached many people over the last few years on how to get to a daily state of empty inbox and lived in that mode, it is now the way things routinely are for me (and is definitely a positive kick that allows me to focus each day).

I had spent some time with a member of staff a few weeks ago who was really struggling to see the right way forward and progress anything meaningfully, because of the sheer amount of work that she had on, characterised by the number of emails in her inbox (hundreds).  We talked about how this could be different and the benefits of being able to prioritise each day without the fear of what might be lurking, either opened or unopened, in the electronic post.

She went away sceptical, but determined.  And today she came back in a different frame of mind, feeling much more in control and recounting how she has been able to really get to grips with things as a result of believing that it would be possible and then making it happen.

It reminds me that I have promised to run a workshop for staff on "Why I choose the inbox I have" and I have committed with my PA to get some dates in to do that a few times over the next couple of months.

Highlights of the Week 3: The Chief Officer Leadership Group of the Challenged Local Health Economy Programme - an emerging sense of joint action

We are three weeks in to the intensive support for the programme of work as a Challenged Local Health Economy, having been identified as one of eleven such communities nationally.

That means that on Monday the first checkpoint report went off to the national team which detailed the joint local understanding of the extent of the challenge.  It feels like we have progressed well with that, with the Directors of Finance group working hard on determining the financial challenge we face over the next 5 years and support from PWC synthesising information from interviews, public health reports and performance metrics to present a rounded view. 

The geography of NEW Devon CCG does not constitute a natural health and social care community as it spans three acute trust footprints and two local authorities.  The boundary was chosen because GPs felt that this was the size of area that would be needed to address the issues we were facing and so we are starting the journey of creating a programme of work across the area for the first time.  

It feels slower than I suspect it does in other areas where there are already natural communities that have been working together for many years, but it does feel like the chance of finding a strategic solution are better than they have been previously and the Chief Officer Leadership Group - covering 12 health and social care organisations - has met three times in a month; a sign of some real commitment to a health community wide solution to the challenges we are collectively facing.

Highlights of the Week 4: A clear Locality Workplan will be the cornerstone of our effort this year - and there is real sense of progress

The Locality workplan - the distillation of our QIPP transformation work and other workstreams - will be at the heart of our work in Western Devon for the next 12 months and beyond.  It will be critical to the success of the Financial recovery plan too - we are facing huge financial challenges and we have to ensure all our commissioner QIPP plans come to fruition.

We had a broadly block contract with our main acute provider last year so the imperative around the Locality plan wasn't as pressing.  We have to up our game this year and part of the rationale for reorganising our commissioning team was to ensure we are fit for that challenge.

We have a new lead for the workplan and cleared some space for her to get focussed over the next few weeks.  There feels a really good energy around the work and I am more optimistic that we will deliver on our ambitions in the Locality - the contract under performed in volume and value terms last year and we need to make sure we manage that again.  So on returning from leave I am impressed with the energy and looking forward to seeing the results and turing plans in to reality.

Highlights of the Week 5: A hour spent helping someone to prepare for an interview feels like some of the best use of time

I really enjoy being asked for input, coaching and advice from members of staff who aren't put off by the introverted exterior and demanding encouragements to action they often hear me utter.  The question is often framed as "you won't have time, but....", but I hardly ever turn down those who ask; my ego is easily stroked!

This week it was to spend an hour doing a mock interview with someone who is desperate to further their commitment to the NHS by taking on a new role, staying within our CCG.  It is clearly not about me, but I had a great time - there is something in the energy and intensity about the ambition to serve that I love hearing about from anyone who is driven in that way.  

Not a perfect performance, but as I was once told, the purpose of rehearsal is to be perfect on show night, not in the warm up and the feedback will hopefully help them to be at their very best next time out.  

And I guess it is a reminder to choose to put things in the diary that will end up as a highlight of my week....!

Highlights of the Week - 11th April 2014

I would avoid next week's blog if I were you, unless you want to read about the joys of skiing in the sunshine with the family.  This week was therefore about ensuring that progress continues with all the major work within the CCG and left in a neat state before heading off.

We are still concluding contracts (negotiating on some, agreeing heads of terms on others and moving towards signing final contracts on others, though less of these); working hard on the financial plan that doesn't yet square up in terms of the risk we will be carrying as an organisation to meet our agreed control total; completing a programme structure for how we will deliver all the schemes that add together to form the basis of the financial plan; and are in week 2 of the 11 week intensive support around the Challenged Health Economy work.

We struggle to meet all those demands when they arrive together at this time of year and, of course, underspending on running costs is one element of our financial recovery plan, so additional resources to address the issues impacts directly on the chances of success; but I know this story will be familiar to many.

One of the elements of a governance review of the CCG a couple of months ago was a commentary about the wisdom of entering last financial year without any reserves or contingencies.  The report noted that this wasn't robust or good governance.  As we look to make sense of this year's plan, it is hard to see how we won't be in that position again - is that bad governance, bad leadership or an artefact of the position we find ourselves in?

Anyway, nearly time to ski, so....

Highlights of the Week - 11th April 2014 (@jeclo)

Highlights of the Week 1: Strengths based leadership day with the Western Locality Senior Leadership Team

As trailed last week, our strengths based leadership day, facilitated by Mike Roarty from Clearly Inspired, was a hugely enjoyable and positive experience.  The photo shows how the 7 strengths from each of the 16 members of the team (half clinical) are distributed across the different quadrants and facets.

So our team has more strengths in the relational quadrant (4 of my 7 are in the execution section), but the really interesting perspective was to compare this to our previous version of the diagnostic in December 2012.  We had clearer areas of similarity then - the picture was more "spiky" (about a third of the team has changed in that time and individual's profiles may also have altered) and overall the picture now looks more balanced.

We spent the afternoon looking at how this applied to the critical work plan delivery we have ahead of us (workstreams such as integration, elective care, urgent care, primary care and system configuration) and how we would best work to deliver that using this new information.  

The team felt in good order and ready for the challenge ahead!

Highlights of the Week 2: Meeting with Kelichi Nnoaham, new Director of Public Health in Plymouth.  Discussing how we move forward in partnership

We haven't had a substantive Director of Public Health in Plymouth for a while and it was great to meet up with Kelichi as he came to the end of his second week in post.  We have spoken a few times and each time it felt like we had good alignment on our views of the joint purpose, but this was a time to test that out.

There are many challenges.  Public Health outcomes in Plymouth are poor; in comparison to other areas of the CCG in Devon, they are really poor.  Public Health funding in Plymouth is way below other comparable authorities and the City Council is working hard with Public Health England to try and address the anomaly.  And the Public Health team (based in the same building as we are) have seen a number of people leave to join Public Health England as that infrastructure is established.

It was a good first discussion with a commitment to further action and to ensure that Kelichi gets a prominent role in some of the local architecture to make sure that the issues for the population in the City are well represented.  We talked about how the CCG needs to be accountable for delivery for some parts of the DPH's portfolio and how Public Health will be vital in helping us to determine how we scale our services to be affordable and sustainable.  It was a positive first meeting and look forward to more ahead.

Highlights of the Week 3: It is lovely to get a thank-you and to hear about the difference that you've made to someone

This lovely card arrived in the post.  It is a thank-you for some coaching that helped the individual move forward and reconnect with what they felt to be important.

It does remind me that saying thank-you is important. I don't need much feedback to keep me upright, but I do sill love it and it is great to know that the energy I try and devote still to coaching and development is appreciated.

I have gone from a world of many coaching clients and sessions each week, to occasional sessions with a few individuals.  It is the thing I miss most about my years creating and running my business, so I do enjoy even more the time I still mark out and reserve to spending time on development activities



Highlights of the Week 4: Our Urgent Care Partnership 1 year on.  A story of success, improved relationships and realism about the challenge ahead
I Chair the Urgent Care Partnership in the Western Locality - the urgent care system that surrounds and encompasses Plymouth Hospitals. The team put a lot of effort in to ensuring this works successfully and a little over a year after we formed we spent a bit of time at the meeting this week reflecting on the progress we have made.

We are under no illusions- we know we have had an easy winter; we know that the mild weather and lack of infections combined to do all they could to offer us the best chance of success and even then we have had several moments of really significant pressure. But against that backdrop Plymouth Hospitals are the third best performing A&E against the 4 hour target this winter.

I'm not sure that single measure captures enough of the complexity of the system, but what is relevant is that after some time struggling to hit the target and being seen as poorly performing in comparison to other Trusts, they have managed to improve their performance at a time when others were really struggling.  The hospital deserves real praise for that - an awful lot of hard work from staff with determined clinical and managerial leadership.  

It is though also testament to the workings of the wider system and the way partners have discussed the right solutions and then delivered against the agreed direction.  Additional money has helped, but I do think the element of determination is the most critical.

The feedback was good - our urgent care dashboard is a stunning way to capture what is going on in the system and to predict as well as reflect on the demand pressures we face - and all members felt we had made really good progress.  We recognised that next winter will almost certainly present greater climate and infection issues and we need to spend the next few months ramping up our responses to be ready that, but some thanks to the team for the work that has brought us here.

Highlights of the Week 5: Finally I'm in print...well almost, my words in a book, but they are not the important ones to read! Well done @timrobson7

At the front of Showing Up by Tim Robson you will find these profound words.  Nice to be asked and delighted to read a proof of the book and link that to the work Tim has been doing with us on the Individuals at the Centre programme.

It has made a real difference to many people in the organisation and we have used some of the concepts consistently over the last 12 months.

In this book, I particularly have reflected on the School with Pay paradigms pondered on how similar work is to school (just with added pay).  The metaphor works well and has helped to reframe a couple of the ways that we work.

So almost a shameless plug for someone else's book, but trying to grab some of the limelight at the same time!

Highlights of the Week - 4th April 2014

I do my best to avoid being bombarded by news each week, which isn't easy if you spend a lot of time in the car.  I did get in to a habit of downloading and listening to a lot of audio books whilst I was doing consultancy miles - up and down the motorway from York to Lincoln or Nottingham or Plymouth.  That felt like such a benefit; there are lots of books that scare me with their size, but on audio with hours to spare, they become a real joy and I would never have tackled 1Q84, The Children's Book, Wolf Hall or Bring up the Bodies any other way.

But now, with an hour here and an hour there, I've settled on a range of podcasts.  And that means, at the moment that I'm living the dream as a Liverpool fan in the company of The Anfield Wrap, contemplating films with Kermode and Mayo and deciding which Desert Island Discs are worthy of a listen (some great, some don't help a tired driver!)

And so my Farage vs Clegg debate has been limited to what I choose to digest on the BBC News app and I can flick past the daily stories of gloom or doom.  So whilst it won't appear as a Highlight of the Week, not listening to the news is definitely part of what helps to keep positive each week!

Highlights of the Week (@jeclo)

Highlights of the Week 1: Time spent with the 22ours development group always gives a wealth of mental stimulation, new ideas and reflection
When I was working in coaching and development, I needed a space to meet with like minded people, share ideas and develop new approaches.  I contacted some friends and through them some further colleagues and we ended up creating 22ours - a development group (wittily titled because we meet 3 or 4 times a year for 22 hours and the space is created by us, for us).

We met in Newbury this week.  When we first met we learnt about each other, talked about what we did and what might be a better way.  Now we can reflect on three authors - the publication of one book, the next one due in the Autumn and a third about half written - new companies and, for me, a career change to apply lots of the learning.  I got space to reflect on what life is like for me and, specifically, how I manage stress at difficult times.  Came back exhausted after 22 hours of stimulation, but ready for the rest of the week.

Highlights of the Week 2:Agreeing new ways to work with my senior team-positive discussions focussed on maximising impact, not keeping roles
"Let's focus on strengths, let's focus on impact and let's make sure we are thinking about the future, not the past".  All sounds simple, but a year in, I'm asking the senior team in the Locality to think about changing reporting lines, their portfolios or who they directly manage.

They have risen to the challenge, noting when they recognise that they have a reaction that isn't helping the discussion and ensuring we get to a great outcome.  There are times when they don't get what they need from me - one of them told me this week that they were worried that appraisal would be another time when I expected them to reflect on their own work and resolve problems, when what they wanted was direct feedback on their work (which they did get, fortunately) - but this time I did give them lots of reflection, my views on the issues and then invited them to think about how we could do better in the year ahead.

I was reflecting on "if it ain't broke, don't fix it", but thinking every year about how we flex and change to improve what we do feels important and ultimately more fulfilling.  As I carry out new roles in the CCG and have a wider focus, it is really important that we know we are fully aligned in the right direction.

Highlights of the Week 3: Working with PwC to ensure that our Programme Office has right capability & capacity for the work ahead (it does!)
Spring is outside, the sun on the moor, the Facebook picture of my wife and youngest son on the beach drinking beer and enjoying the first day of the holiday (not the most helpful as I'm in the second conference call of the day and eighth meeting), but in the CCG it doesn't quite feel the same.

We put everything we had in to the most professional commissioning framework possible, publishing 23 modules of information to all of our providers from the end of November through to March.  We then intensified the effort in order to turn the 28 commissioning intentions in the framework in to contractable schemes - a lot of energy from finance, business intelligence and commissioning.  We have produced several drafts of a 5 year strategy and 2 year operating plan and worked with two local authorities and providers on the production of two Better Care Fund submissions.

Then we got on to contracting and have worked with 6 major providers to agree contracts, resulting in mediation, arbitration, external support and some still outstanding.  We have also faced up to our financial difficulties with financial recovery failing to stop us reporting a deficit last year and working to agree a deficit plan for the year ahead with all the incredible amount of work and scrutiny involved across the whole CCG.

So it is not surprising that people are looking forward to emerging spring-like in to April.

And then PwC have arrived for a 10-week, intensive support programme as we are one of the 11 "Challenged Local Health Economies".  We are grateful for the support, but it is not an easy task to encourage staff that this is really the big push now, with implementation of the joint plan to follow.

But that is what we have been doing and our Programme Office has responded really well.  It is a tough job in the organisation that gets little praise, but we have worked with PwC to ensure that they are happy that we have the capacity and capability in place to deliver.  We will need support to complete the plan and implement, but we are set for the programme ahead.  One week in and things are on track.  Let's hope there is a highlight every week!

Highlights of the Week 4: A brief look at my StrengthScope report gives great feedback about how the team see the best bits of me at work
This feels a bit like stealing a highlight from next week as I looked at my strengths report for our Leadership Team Development Day next Tuesday (it will most probably be in next Friday).  We have used the individual and team assessment before, but are revisiting as the team has changed and things move over time.

I said last week that strengths based appraisal was really valuable and the whole personal and team strengths approach lands well for me.  Everyone will have 7 strengths using this particular diagnostic, but what is interesting is how I think I use them and how that compares to the experience of the team around me.

It clearly isn't a process aimed to bring you down, but it was great as I prepared for the session to get feedback from others and to see which bits of me land well.  You can guarantee that the day next week will have some more challenging feedback as we encourage all the team members to fully explore themselves and their colleagues, but setting the positive frame will hopefully mean we do that from the right viewpoint.

Highlights of the Week 5:"Board to Board" with @PlymouthHealth and @plymouthcc focussing on progress over last year & opportunities ahead
The CCG has had a couple of Board to Boards with Plymouth Community Healthcare over the past year or so; a period which has seen us move from focussing on really significant quality issues to noting the progress that is being made on delivering the services we want to see to keep people "safe, well and at home".

Given the journey we are now on, it felt really important to have Plymouth City Council in the room with us.  They have just approved the outline business case for our joint work on  the integration journey as part of their overall transformation programme, so this was a great moment to consider what impact this would have over the next couple of years and the long-term vision.

We have a really high expectation of what the community interest company will need to deliver this year if we are going to achieve our goals around the urgent care system and we were able to jointly reflect on the difficult, but mature discussions we have had that have left both parties feeling upbeat about the challenge.

The Board process - the presence of those from outside the direct management relationships - definitely adds a different dimension and we left even more committed than we had been previously.  The vision is strong and the joint intent evident.


Jerry Clough is Chief Operating Officer of Northern, Eastern and Western Devon CCG and Locality Managing Director for the Western Locality covering Plymouth and the surrounding areas of South Hams and West Devon.