Highlights of the Week - 17th October 2014

Another busy week.....

I used to coach for a large part of my job; perhaps 6 or 7 sessions a week with different managers, executives and clinicians.  A large part of those discussion would be the presentation of stress, the times when multiple factors hit our lives at the same time - problems at home, problems with a relationship, moving house, money, health and different situations at work.

It is not usually just one element as, often, we can cope with one part of our world being out of alignment with the balance of other bits that are working well.  People would invariably feel unable to cope when a myriad of different issues were hitting them at once.

At the moment work is really challenging: three and a half days last week were spent in meetings that were entirely about the financial position and for the others it was the context; family life is hectic (and it will feel more like that as I spend a bit more time both physically and mentally at work) and we are in the middle of some internal building work at home. That means that the house is in chaos with dust and material everywhere, but there is also a project plan and we need to maintain our part of the schedule to ensure we can move out of and in to the right rooms at the right time. Sleep is more fitful.

So the brain is full - when to sand the floorboards, when to fill the cracks, the best order to decorate and where things will be stored.  Physically tiring too - home from a long day and then spend three hours on hands and knees sanding.

The antidote is not easy, but running is important for me (not as easy with dark mornings, or certainly not as inviting) and interesting that Simon Stevens has highlihgted the issue of workforce fitness again this week, though I'm not sure joining gyms is the real answer.  The truth is that we all need to recognise the challenges we face across all aspects of our life and, as the pressure increases, be clear that we are taking steps to manage that impact.  It isn't ok for me to shout at the kids, kick the dog or find release in a bottle of wine each night; now is the time to be aware of self first of all and of others around me.

Highlights of the Week - 17th October 2014 (@jeclo)

Highlights of the Week 1: A week of true challenges but the team in @NHSNEWDevonWest has come through with flying colours
Given that I've spent three days in all-day financial recovery mode, I haven't been around much in the Locality to explain, motivate and encourage the level of effort that has been required to produce the recovery plans, action and evidence that give assurance about our forecasts.

But, as usual, the team in the Locality has responded to some fairly short and blunt requests with a collective response that has been really impressive and of great quality.  They work smoothly and efficiently under pressure; no panic, just a complex and time consuming task completed speedily and relying on each person to produce an element of the jigsaw.

There is a great balance in the team, but together they invariably produce when we need them to most.

Highlights of the Week 2: A late Friday meeting with @PlymLeader sharing perspectives on the importance of integration and our joint perspective
Mostly after a difficult week I could do without a 5pm meeting on a Friday.  But this week, meeting with Tudor Evans, Tracey Lee and Carole Burgoyne at Plymouth City Council to talk about our integration plans and joint work was a positive way to finish.

The financial challenge in the CCG causes ripples across our partners - they clearly want to know how our budget position will affect the plans we have to work more closely together and also how the CCG will protect resource allocation in the city at a time when recovery is the number one priority. 

We agree that we need to keep our integration momentum, especially when budgets are hugely pressured - we can both point to savings we have made this year as a result of our joint work. Even more importantly, we are clear about the benefits that a pooled commissioning fund will bring from next year.

Highlights of the Week 3: A meeting with Monitor about our community services commissioning strategy.  Interesting perspectives to explore!
There is a lot discussed about Monitor and their approach to competition and integration and this week we got to sit and discuss our plans for community services with a team from Monitor who came to visit.

We clearly have very different roles and therefore our perspectives are hugely different, but I didn't find them difficult, uncaring or obstructive, just with a very clear sense of their purpose and the job they have been given to do.

Our plans for community services describe approaches that would see an open competitive procurement for some services, such as urgent care, with a more restricted procurement process for services for complex adults, recognising the importance in this area of integrated pathways.

There was a lot for both of us to reflect on and there is still further clarity required on exactly how the final proposals will be received, but it felt like we had made real progress and we have a good sense of how we need to proceed.

Highlights of the Week 4: @NEWDevonWest Leadership Team day looking at integration and financial recovery: great focus on both
In the middle of the intense work on financial recovery, it was important this week to raise our heads from the immediate work to check that we are clear about what we as a team in the Western Locality are trying to achieve for the remainder of the year and that it fits with our slightly longer term ambitions.

Integration will have a big impact on the team and the staff within the CCG.  We don't have the final staffing model for an integrated commissioning organisation yet and we may have some time when we work in a virtual or seconded team administering a pooled fund, but we do have a clear intention and direction that will see big changes to structure and ways of working.

We were very clear that the work was critical to our future success and we can only see the increasing importance as life looks tougher.  The Leadership Team got a good grip on both the integration issues and on the financial challenges, where we worked in some detail on the next steps and actions.

Highlights of the Week 5: End the week at the Great West Run - there are different types of tiredness, but this is one that sustains
Very little training (enough running on the moors, but nothing that could be classed as sufficient or relevant to running a road half marathon), but I knew I'd be ok to get round and enjoy the feeling of running with a large group of people.

And, however slow, however hilly and however painful at times, it was a beautiful sunny autumn morning and I did spend the rest of the day with the wonderful buzz that a long-run can bring.

(even if I was back to sanding by the evening!)

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 - 10th October 2014

With the ongoing announcements at party conferences, I've been reflecting on the extent to which we manage to get parity of esteem in mental health.  Before criticising anyone else or the system we operate in, I have been working in and around the health service for over 20 years with various roles of influence in resource allocation and the commissioning and provision of mental health services, so the reflection is personal too. But we just haven't got anywhere near parity between general health and mental health services and that doesn't seem to be getting any better, despite political promises of future investment or the release of monies of psychiatric liaison or crisis services.  Ultimately, I do think a large proportion of that blame is political, rather than in the delivery.

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.

Highlights of the Week - 3rd October 2014

You can't will things to happen and I did promise only one paragraph; but by a combination of exceptional planning and luck, the Ryder Cup was won in front of me last Sunday.  The selfie has a distant glimpse of Jamie Donaldson preparing to take his final shot to the 15th green and then the pandemonium and celebration ensued following his match winning swing.  What had been a relatively deserted fairway half an hour previously was suddenly flanked by thousands of spectators and hundreds of cameramen, golfers and entourage.  It was a fantastic day - amazing atmosphere on the 1st tee over 4 hours before the start, through to the final shot and then a great night of celebrating in Edinburgh.  More memories for the Ryder Cup locker.

 

And the week then continued with the NHS promises made through the run of party conferences; some talk of more money and new initiatives and ideas.  David Cameron described the need for 7-day a week, 8-8 access to primary care.  I know that society continues to move towards an "always open" culture and that younger generations want things instantly, here and now, but I remain to be convinced that this is the most important issue that needs to be resolved over the course of the next parliament.

Investment in primary care and more professionals working in practices is definitely important - I am relentless in describing the need for us to drive change through innovative primary care providers - but I am not sure that, universally, it is about opening hours and access.  Maybe it is in London where a commuter city needs services that fit around those who need to see a GP when they are busy and away from home, but does that mean it is a policy that is fit for everywhere?  Encouraging, though, that a debate framed around primary care is central to the political discussion.  That must be right.

Highlights of the Week - 3rd October 2014 (@jeclo)

Highlights of the Week 1: GP Provider Forum-discussing how general practice could develop in the cash strapped world we live in
I think the CCG has a role to play in ensuring there is a developing primary care provider market; it is critical to the future map of services we need to see. We are not the contract holders and NHS England does also have a role in this regard, but we are a membership organisation with practices as our constituents and we are also the most significant commissioner in the health system.

The Locality held a GP provider workshop to describe to assembled practices what is happening from our perspective and to give them space to discuss together what that might mean.  There is a spectrum of practices from those who are at the forefront of thinking about how they may need to change and adapt to face new challenges to those who provide high quality services, but are overrun by the day job.

I had a comment in this blog last week about whether primary care was up to the taking advantage of the opportunities on offer; as a CCG this week we didn't respond with a "yes" to a thoughtful proposal made to us by a GP practice, prompting a tweet back "yes, but is the CCG?". It is a fair point-we have to be better at finding the intersection between what we are seeking and what primary care can offer.  We'll do better.

Highlights of the Week 2: Governing Body thinking carefully about the financial challenges and the actions we need to take to resolve
Relentless focus on recovery plans and money saving ideas is wearing and requires an ability to reenergise from time to time, lest it feels like the only purpose we have is to bear down on cost.  Money is critical and one of the biggest accountabilities we have, but it is not uplifting to the spirit and is not what drives me to work in the NHS to have a uni dimensional focus.

This week the Governing Body was reviewing our recovery actions and considering those issues that would be matters of commissioning policy or a change in protocol or procedure. It is not easy in a large group to look unified and with a single mind-that's because we are not.  Rightly, we have a range of perspectives on the set of actions we are considering and a healthy debate will get us to the best outcome.  We are under pressure though as NHS England are placing greater scrutiny both on our financial outcome, but also how we do our business and what it says about our commitment.

There are difficult choices, undoubtedly, but is was encouraging that the Governing Body was united in considering the necessity for us to take a renewed set of emergency actions and were able to debate exactly which measures would get the biggest impact, without having undesired collateral consequences.

Highlights of the Week 3: Discussions about what integration and better care funds mean for the CCG-are we ready for the changes needed?
We have been moving towards integrated commissioning and integrated provision with Plymouth City Council at some pace with an ambition about major changes by April next year; we are broadly on target for that timeline. We are also progressing discussions with Devon County Council, albeit at a different pace.

We are getting to the point now, as we consider the detail of governance and staffing, where there is an awakening to the fact that integration does fundamentally change how our CCG will work - the existence of two pooled Better Care Fund budgets totalling almost £80 million with the two local authorities does that, if nothing else.

But integration may take us further; what will it mean for the way we have designed the CCG? Does our Locality Board still do the same job?  Is it the holder of the pooled fund?  What about staffing - how is our internal business services model affected?  How is our membership role affected?  And what of the Governing Body - is there a fundamental shift to the cornerstone of our governance?

I spent some time ahead of both a Locality Board seminar next week and a Governing Body development day the week after discussing the presentation and material that we should be using to help them consider the issues and options.

In all of them, there is a "do minimum" option - the question is, "Does that help us to make the most progress, whilst balancing the risks?"

Highlights of the Week 4: Final planning for our outcomes based commissioning workshops-our strategic way forward
We are running the first of a couple of outcomes based commissioning workshops as part of our Local NHS Futures programme.  These are designed to give Executive Directors, Non-Executives, key Board members and those charged with delivering the projects within the programme an understanding of the underpinning methodologies that we have committed to as a group of senior leaders across all health and social care organisations.

There are several elements:

• Outcomes based commissioning-moving towards a set of contracts where we focus on specifying the outcomes we are after, rather than the throughputs, and leave more space for providers to innovate on pathway design
• Capitation based commissioning-moving towards contracts that acknowledge that all services are cash limited and the provider and commissioner share risk and benefit against a fixed budget also considering what fair shares of that budget would be
• Integration-we want integration to be seen as an enabling strategy too.  It is an opportunity to move towards both outcomes and capitation based contracts that bring together different elements of the care pathway in to one contract or potentially one provider.

We discussed this week the final parts of the presentation and the outcomes we are seeking.  Given our finances, we need to be hugely ambitious.  Not only is this a long term change in underpinning methodology and philosophy of contracting and collaborating, but it also needs to deliver savings in our system from next April; a massive challenge.

Highlights of the Week 5: The annual staff survey is launched and we are a lot further forward than last year
Our staff survey results last year were not the most uplifting when compared to other CCGs.  There are simple explanations - we were one of only 14 CCGs nationally who volunteered to take part in the survey, so the sample size is both small and self selecting. With over 400 staff (we have internal business services), when the smallest CCGs have less than 20, the comparison is probably less than helpful and we determined simply that we needed to do better the second time around.

It feels like we have made real progress. In areas such as the number of people receiving appraisals in the previous 12 months, we will do much better this time around; in my view, there is no reason why this number shouldn't be almost 100% and I am expecting that in the Locality where I have the most direct input.  In addition, we have introduced new strengths based appraisal paperwork so, hopefully, people will also have found appraisal a more useful experience too.

There are some interesting questions in the survey where there is a perceived wisdom about whether a low score or a high score is better.  What do you want the answer to the question "Have you ever felt under pressure to come to work when you weren't feeling well?" to be?  I completely understand that you would want the answer to be low, but I do want people to have enough sense of duty and service that they get to work whenever they can, rather than having minor excuses not to.

I wonder how many CCGs will be taking part in the survey this year. Whatever our results, I'm proud that we are one of the ones who will be and for the second year running.

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 an NHS Week - 26th September 2014

Before I start... I've talked a lot about Individuals at the Centre, you can now see the five projects here..

Being heard http://youtu.be/Noq5R1Fn2KQ

Being the difference http://youtu.be/1I7ibVQnwzQ

Equality and diversity http://youtu.be/zSgrCfSNxuw

What about me http://youtu.be/-XjrjOlTM1w

Wheelchair users http://youtu.be/N_bXeMWjIl8

This weekend I'm off to watch the Ryder Cup (an opening remark that will have some people navigating away from this blog as fast as they can!).  I've been to the last three home Ryder Cups and they have all been fantastic; this one completes a tour of England, Ireland, Wales and Scotland.  The Ryder Cup is the only professional golf event I've every been to and it has fascinated me from being very young.

I have only seen Europe win - the first time was the most glorious week at the Belfry, bathed in sunshine watching Paul McGinley sinking the winning put on the 18th. Then things got progressively wetter at the K Club in Ireland before an onslaught of torrential rain at Celtic Manor in Wales meant a delay of the final round (this meant I was back in work on the Monday when the tense final day played out, which definitely wasn't a highlight).

So the perfect weekend this weekend will involve hearing only happy stories from the family at home, finding that the Travelodge in Edinburgh is ok, a hot day on Sunday, a good view and a win, but a close win with the winning putt happening right in front of us.  It is just as likely to be raining and that we are watching a meaningless shot as the crucial action is happening elsewhere, but I am going to back the thought that I'll be able to write next week that I was there when Garcia sunk that amazing bunker shot to win the cup again.

Next week's highlights might happen on holes 1,7,11, 14 and 18, but for those not excited by golf, I'll promise only one paragraph next week....

Highlights of the Week - 26th September 2014 (@jeclo)

Highlights of the Week 1: Discussing Right Care - is this the method to underpin our work major programmes of work?
Matthew Cripps from NHS Right Care came to run a workshop with us this week.  It is important that we have a sound methodology to underpin the major programmes of work that we are involved in and Right Care may be the thing we are looking for.  We looked at the commissioning for value pack last year - essentially Right Care points to the top areas where we could improve cost, quality or both by comparing us to other parts of the country and particularly the performance achieved by the top 20% and these aren't necessarily the same as the areas we are currently working on.

The analysis shows to gains we could make if we performed at the top quintile in diseases of circulation, cancer and orthopaedics.  It is vital that we verify that the data is pointing in the right direction and not just an anomaly compensated for somewhere else, but we know we are spending many millions more than our budget so there are definitely several areas where we need to improve.

The advice was not to look to take on too many areas at any one time, which is good advice and one we need to contemplate on as we embark on 9 simultaneous workstreams.  We do need to find the real issues that have significant enough potential for saving, but the level of overspend in our systems does mean that we can't afford to limit the number of issues too much.

Highlights of the Week 2: Locality Board in Tavistock - there are some very different places within our Locality, but many similar issues
I don't think many people, even those who don't know the south west very well, would be surprised to find out that Tavistock in West Devon is significantly different from Plymouth.  The leafy market town in Dartmoor is truly beautiful and the view from the moor on the way home down across Plymouth harbour is fabulous.  Not that Tavistock is more than 10 miles from the outskirts of the city and, as I have said several times before, Plymouth has some fantastic parts, most notably the view from the Hoe, but Tavistock is very different.

The Locality Board this week included the usual set of public questions and, despite there being different people there, the issues are the same.  People are concerned at the moment about what the future holds for the NHS and the sense that they need to be watchful to ward off any potential local service reductions.  They are grateful too and we get stories of what the NHS has done for them.

The things we discussed in Tavistock - future of community services, the safety of different elements of service and our financial position - were the same and ultimately we are working to ensure that the NHS in Tavistock or in Plymouth is delivering what people need.

Highlights of the Week 3: Communities of Practice meeting-an invited guest at someone else's gathering: hugely interesting
A day in London to finish the week as I had been invited to a Communities of Practice meeting with a group of integration pioneer organisations who have started getting together two or three times a year to talk through the challenges they are facing and to share the real successes they have had.

So I got to hear from Greenwich about their integrated teams, Eastern Cheshire about their Better Together programme and North West London about their work on primary care co-commissioning, as well as brief updates from a number of other areas.  They are doing some fantastic things and I have come away with some great new ideas of what we might be able to add to our thinking locally.

But I had a lot to say too (I guess many will not be surprised to hear); once you get past our financial challenges, the progress we are making on community services, on integration of both commissioning and provision in Plymouth and on our Local NHS Futures programme is good to share and people are very interested.  It is easy to describe where we are: everyone in the NHS knows Torbay, we are the bit of Devon and Plymouth that isn't that!

Highlights of the Week 4: @markmarriottydh has brought the capacity and skill we need to drive forward our programmes of change, but not singlehanded
I got a chance to spend a couple of days this week with Mark Marriott our new Programme Director for Local NHS Futures.  He is exactly what the programme needs and we are already starting to see the benefit of his first couple of weeks with us.  He brings great experience in running complex programmes and a focus on delivery that has been well honed within the navy.

We discussed the immense challenge that we have set ourselves with nine programmes of work to make significant progress with over the next couple of months.  Ultimately, everything needs to be able to feed in to next year's contract intentions - a different way of doing business between commissioners and providers in our system.

What is clear, though, with a programme of the size and scale that we are embarking on, is that Mark can't do this alone and we collectively need to make sure that we are putting enough resource in to the supporting programme office and to each project to ensure that we get the benefit of Mark's leadership.  It isn't easy with the number of competing challenges we have, but it is critical.

Highlights of the Week 5: Huge opportunities for Primary Care as we look towards next year's commissioning intentions
I get to do the introduction and context setting type of presentation at different events in the CCG and this week at our opening planning session for next year's planning round.  As I'm setting out how our Local NHS Futures programme working collaboratively with all our providers will guide how we work, it is important to try and give some examples of how things might be different next year.

So I start to describe, or speculate about, what outcomes based commissioning or capitation based funding systems might mean to how we commission or contract.  The examples include how we might do things differently around orthopaedics with secondary care providers, but the most exciting to me seem to be around how it might stimulate primary care to become more proactive in shaping the future care system.

We have a significant deficit, we don't have any money to invest without guarantees about value and return on the investment.  But we can invite primary care to think about the areas where we could share risk and as a result increase services provided around general practice.  I can describe real potential around different ways of looking at pharmacists or dermatology or diabetes - in fact the list is really long.  Let's hope we have some practices ready to take up the challenge!

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 an NHS Week - 19th Sepember 2014

This week has been dominated by the vote on Scottish independence.  I was in Edinburgh last weekend where a relaxing weekend break with beautiful views of castles and history were accompanied by the sounds of marching and campaigning.  Whichever way you look at the issue, it has been really encouraging to see so many people turning out in an election and the involvement in politics of 16 and 17 years olds.

There have been many issues throughout the campaign, including discussion around the changes that might be seen in the NHS in Scotland if the vote had been for independence.  There are already differences in healthcare between England, Wales and particularly Scotland, reflecting local variation in response to local needs or preferences - prescription charges, for example.

The NHS holds on to the notion of being a universal, equal offering across England, so that wherever you are in the country, you can expect an ambulance to reach you in the same amount of time, for your local A&E to treat you within the same 4 hour window and for your access to potentially life saving stroke treatment to be equally expedited.  But, to what extent is that the reality of how things are now or, indeed, that this is truly the expectation of the public.

Many people will know, or be able to deduce, that the ambulance response time figures quoted for different services are averages that are typically made up of very fast responses in city centres, offset by much slower response times to outlying rural areas.  The volume of the city centre calls will offset the occasional longer trip to the coast or moor in Devon.  It would be economically impractical to station ambulances at every point to guarantee the same response everywhere - a remote community may only phone for one ambualance a year - and to some extent people do understand that.

We are in the middle of the community hospital debate in Devon as a result of publishing our community services strategy.  In looking to develop more services that help people to stay in their own home and deal with the projected increase in the over 75 population - set to rise by 22,000 in our CCG over the next 7 years - we think we need to consolidate beds from smaller cottage hospitals to larger community units.  We have a lot of community hospitals in Devon - you would expect that with the rural nature of the county and the type of population who are able to support their local units.  It is not an easy discussion, communities rightly care passionately about local facilities and it is not a "one size fits all" debate - we aren't basing the discussion on what happens in London or Dorset or anywhere else, but it is about what this population needs and expects from its local NHS.

Highlights of an NHS Week - 19th Spetember 2014 (@jeclo)

Highlights of the Week 1: Senior Leadership Team welcomes a new member; a calm, reflective, thinking environment space
The entry of a new member to the Leadership Team to ensure we continue to have good representation from the Partnerships Commissioning Team - the part of the CCG that oversees joint commissioning - gave us the opportunity to revisit the 10 components of Nancy Kline's Thinking Environment.  We have used her approach consistently as a Leadership Team over the last 18 months, but it is always useful to remind ourselves of the principles from time to time - the components are listed on the inside cover of our agenda pack.

It has been a busy week; there is a lot on, but I've made that comment in previous blogs so there is nothing new in that and it will be a permanent state.  As I keep saying, there is nothing clever about being busy. But you can approach things in different ways and this process for carrying out meetings really does create a calm 3 hour space, rather than a pressured, hurried and dispiriting morning.

There was good feedback from our new member on its impact and the feel of the room. More of that then!

Highlights of the Week 2: Governing Body development session- to what extent are we like any other Board; how does our membership change that?
Take an approach that is designed for NHS Trust and Foundation Trust Boards and apply it to our Governing Body and it won't take long before someone raises the obvious truth that we are different, we are a GP Practice membership organisation and that changes the way we need to work.

I agree we are different, but I don't think that fundamentally changes our role as a Governing Board (Body). It is still about assurance, formulating strategy and engaging stakeholders and at a Board level, that feels pretty consistent.  There will, of course, be some change to who the stakeholders are or how we engage with them and our assurance processes are different as we hold responsibility for budgets where we have no direct control over the people that are spending the money.

It was a good session exploring that area though and every time the Governing Body does manage to find time to think about purpose and role I think we move forward.  It is so easy to get sucked in to the business of the operational role that these moments of reflection are crucial.

Highlights of the Week 3: @NEWDevonCCG AGM gives us time to reflect. you can watch http://youtu.be/qSSRETEHbmw
It was our AGM this week and we attracted an audience of around 100 to listen to the review of our last year (though I suspect numbers were swelled by the launch of the community services strategy that followed in the second half of the meeting, as described below).

We went through the usual formal process with an overview of performance for the year and the presentation of the annual accounts - we tried to explain these figures, rather than just present the accounts in the required format which can be hard to interpret.

We have used new media over the last 18 months and our youtube channel (you should subscribe!) shows the various different clips we have created to try and make our messages more accessible to reach a wider audience.

This video summarises our annual report in a great film - all produced in house.  I think it sums it up really well!

Highlights of the Week 4: Launch of our engagement around Community Services @NEWDevonCCG #NEWDevonTCS 12 weeks for us to listen
The second half of the AGM saw us launch the next phase of engagement around community services.  This was a strategy revised following a round of public discussion, together with 3 locality strategies that explain the detail of how this strategy will impact on our different communities.

Our focus is clear with an emphasis on keeping people at home and creating integrated care organisations that can respond to needs more holistically.  The detail does include discussions about the right number of community hospital beds and the right size for different units.  Small units are more expensive and harder to staff and we are consulting on changing the use of some of the community hospitals in Eastern and Northern Devon with a greater ambulatory focus and the closure of inpatient beds that will be reprovided in neighbouring units.

This is of course where there will be a lot of focus.  The community hospital debate, both locally and nationally, is extremely vociferous.  We have been through a lot of clinical debate and discussion to get to this point and we think we have the right balance.  12 weeks now to listen to the public and hear their views.

Highlights of the Week 5: One Plymouth - it's about how we collectively lead on fairness and the Plymouth offer and ask

A smaller meeting of One Plymouth this week, with various leave and absences, but important discussions about fairness and about Plymouth's position.

In response to the Fairness Commission report, led by Dame Suzi Leather, what will be the One Plymouth collective response?  What would we as leaders within the city want to say jointly?  Do we share common positions?  We think we do and we do want to construct a reply, so we talked about what that would be and, more importantly, what that would mean we would each individually have to do a result - there is no point in signing a piece of paper if it doesn't change our behaviours.

Plymouth doesn't get the rub of the green in many areas (though you need to be careful as most areas would be able to point to the areas they lose out in).  Whether it is the speed and reliability of the rail network or the level of funding for public health in the city, it doesn't feel as though things are fair.  But it is no use just asking for more money and the discussion was around how a case is made for what more Plymouth could offer with a bit more national support.  And if we all made that case consistently, what different impact might that bring?

Things are slightly different in Plymouth, compared to the surrounding areas of Devon, you would expect that, but we do need to make sure it is fair.

You can read other blogs related to the work of the Western Locality of NEW Devon CCG

About our workplan: Western Locality Workplan

About our Locality business: Western Locality Business

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

Previously Jerry has been a Chief Executive and Finance Director in the NHS before spending several years running his own business driving programmes of change and delivering executive coaching and team and Board development.

Highlights of the Week – 12th September 2014

It is obviously a great week.  I mean, there are just some things that happen in some weeks that will, almost despite all other news, mean it is a good week.  And this week it is of course the launch of new Apple products and most intriguingly of all the iWatch.

I’m a bit of a sucker for Apple these days.  I was a firm PC man up until I left the NHS in 2007 and decided that one of the things that was going to mark out my new found freedom was running my company based on slightly less establishment IT.  I had an iPod mini as a leaving present too, so I set off in to the new world.

And then the iPhone arrived.  By that stage I had loved my iMac and Macbook; they were just great – so easy to use and worked each and every time you needed them to without fail.  But the iPhone changed everything, not just for me, but for the way we use technology and what we can do.

Whether I need all that functionality on a watch, I’m not so sure (but I do remember a conversation in which I confidently predicted that people who were moving towards buying 50 and 60 inch televisions simply wouldn’t watch films and TV on a four inch screen).  That isn’t the real excitement.  The news that Apple are working with key partners in the States to attack the healthcare market is.

What would happen to healthcare if the world’s largest company decided to use its wearable technology to change the landscape in the same way that they did with the iPhone.  I have no idea what they would do, but I can dream about something monitoring heartbeat or ECGs automatically on my wrist and predicting risk in a way that I can only dream about or automatically booking me an appointment when I’m free in my diary when the watch notices a particular reading.

I don’t know what will happen, but I do know something will and somehow it will just work intuitively for me. Exciting times.

Highlights of the Week – 12^th September 2014 (@jeclo)

Highlights of the Week 1: Organisational Resilience and Capacity Plan Face-to-Face Challenge- surely not a highlight!

The Organisational Resilience and Capacity  Plan (winter plan plus how we will hit elective targets for those not up to speed with latest terminology) for our locality (the area in the catchment of Derriford Hospital) has been designated as high risk.

We got this rating because of the level of challenge we have to deliver referral to treatment targets and it is a fair assessment, given our start point.  We also have had a few months of missing the A&E target too, following a year of really strong performance – Plymouth Hospitals had been one of the best performers on the A&E 4 hour wait last winter. So, to be blunt, you can expect the face-to-face challenge meeting to be challenging on both fronts.

The highlight was the feeling that as a community we are aware of the scale of the challenge, we know our numbers and trajectories really well and we are working collectively to resolve the issues we face.  There is not perfect harmony – compared to a winter allocation last year of £5.5 million, this year we are getting £2.3 million (and release of this is subject to our delivery), so we can’t meet everyone’s expectations and that does cause tension.  But on the day, we spoke consistently and showed the reward of the joint work we have done in planning to date.

Highlights of the Week 2: Local NHS Futures Programme moves forward and our Programme Director has (almost) started

A group of Chief Executives who will be leading projects within our “Local NHS Futures Programme –Transforming Care in Devon and Plymouth” met this week to finalise the details of the projects and arrangements in advance of the first Programme Board in a couple of week’s time.

We made real progress and we are now very much moving in to the delivery phase.  Something new is going to happen in the Devon and Plymouth health and care system with a systematic approach to large-scale transformational change.  It has happened in many other areas, but it hasn’t happened here on this scale.

We shouldn’t celebrate until there are tangible results from the programme, but it does feel like a major step forward.  We had discussions about the right way to cut the matrix – urgent care and planned care or frailty – but in the end we got passed the planning phase and it feels like there is real appetite for moving to delivery.

Mark Marriott has also joined us as Programme Director (he starts on Monday) and he will bring a real co-ordinating force that helps us to stay out of enjoyable, but purposeless and circular discussions, by staying sharp to project purpose.  It is a big challenge – lots of organisations with their own positions, but optimism is rising.

Highlights of the Week 3: Sunshine and a chance to think about creating possibilities with @annjamesnhs

There just isn’t enough time to think; rushing from one meeting to the next, stuck in air conditioned (or sweaty) boxes all day, staying out of the sunlight. 

This week Ann James and I managed to find an hour or so away from the office to reflect on how things are for each of us personally, our organisations and the NHS more widely.  The relationship between our two organisations – the CCG and Plymouth Hospitals – is a challenge; it is bound to be we are both in deficit so we never have any room to negotiate or compromise.

This week though, we did get to think of what could be different, what options their might be for different ways of working and how we could work differently to get different outcomes.  We are both interested in how the behaviours of our organisations impact on others and this was a good chance to reflect on that too.

No big agreements, no new announcements, but a sense of a few more seeds scattered on fertile ground and we may both get to harvest the result.

Highlights of the Week 4: CCG Executive meeting finishes on time- do we want to explore the relationship between numbers and speed?

I’m an advocate of small meetings; less people, stay focussed, make progress.  But of course, as an introvert that is bound to be my preference and it doesn’t mean that that is the most effective way.  As you place clinical leadership front and central to the way we run NHS organisations, there is a acceptance that there will be more people in the room, whether in CCGs or in NHS providers.

And that does mean that we are able to make more rounded decisions that take account more directly of the clinical dimensions, are better informed and hopefully place patient safety and quality to the fore.

But they are bigger and if you are not very careful, they are longer. Time can drag.

So we finished on time this week at the CCG Executive which has had a habit of running very late with a gallop over the second half of the agenda in half the time given to the first.  We all had a say, we got the information we needed and got to go home.

Now was that effective?

Highlights of the Week 5: Collaborative Services Board Development-We like what we have in house-how to make it even better

NEW Devon CCG is one of only a few CCGs that has the vast majority of its services provided by in-house staff rather than through a contract with a Commissioning Services Unit.  It works really well for us and was one of the key reasons for creating an organisation of our scale.

It isn’t the national flavour and there is an underlying concern that we will get sucked it to some arrangements that we don’t think will work as well. The development session allowed us some time out to really think about our approach and how we want it to develop.

We do buy some services in: procurement advice is one example where not only do we want specialist advice, but we also want people who have experience in other areas.

The most exciting development is our joint ownership with Plymouth City Council of a new company – Delt – that will provide IT services to both our organisations and the GP community across Devon and Plymouth. From that base we hope it will grow in terms of public sector organisations and in terms of other services.  It helps to retain high skill jobs within Plymouth and that does impact on the economy and therefore health and prosperity.

So, we are not a protective island, but we are clear on the benefits of the approach we have adopted and more to come.

Now, how will Apple change that?

ou 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 September 2014

I have spent a couple of days this week at the HSJ Commissioning Summit - a frank and open discussion between NHS commissioners and senior people within NHS England about how the new commissioning architecture is bedding in and to consider what may or needs to happen next.

It started with a reminder about Chatham House Rules.The definition is pretty simple:

When a meeting, or part thereof, is held under the Chatham House Rule, participants are free to use the information received, but neither the identity nor the affiliation of the speaker(s), nor that of any other participant, may be revealed.

I am therefore unclear whether I am even able to confirm that the Editor of the Health Service Journal, in introducing the event, announced that it would be carried out under this system. He went on to say, or perhaps I should say that I was left with the impression that, this clearly also applied to social media interactions.

Which is all a bit of a shame as there were some interesting and stark reflections on the current challenges and likely changes for the future that would have figured here. They still do, but do remember that the only thoughts recorded will be my own!

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

Highlights of the Week 1: Appointed a Programme Director to lead our "Local NHS Futures" work - starts in a fortnight

You may recall that a few weeks ago, in fact in the mad rush to complete a set of tasks before heading off on leave, we had thought we had appointed to our Programme Director role, before this fell through just as I was heading off to the airport (it didn't ruin the holiday, but was a huge disappointment).

This week we interviewed three more candidates and were delighted with the quality we were able to choose from.  Our new Programme Director (name will follow when there is dry ink on some paperwork!) will suit the programme's needs really well and am looking forward to the drive he will bring when he starts on 15th September.  

There is real optimism too about recent progress across all organisations with project briefs and clarifying roles, so hopefully momentum that has ebbed and flowed over the work of the Financially Challenged Health Economy programme is now firmly moving us towards concerted collective effort.

Highlights of the Week 2: Working supper with @plymouthcc to look at integration "wicked issues". We collectively resolve to solve.

As we look at our ambitious timeline for the integration of commissioning between NEW Devon CCG and Plymouth City Council, we can see just how much we are setting out to achieve by March 2015.  And that is before we look at the project to integrate the delivery of out of hospital health and care services over the same time period.

The evening workshop we held between key councillors, our Board and key Clinical Lead GPs was a really useful checkpoint on progress and to ensure we all understand the scope of the work we are engaged in.

This was the second in the series of events during the integration programme and this time we wanted to start a discussion on some of the "wicked issues". These included, for example, how we would create budgets and share underspends or overspends, how we would vote on issues and jointly create strategic plans and the differing role of politicians and GPs in their own respective organisations.

Nothing with this amount of detail and importance gets solved in one night, but it really did feel like we made significant progress.  Mostly this was because there is a clear sense that there will be lots and lots of policies, systems and procedures to work through, but that there was a bigger and more important prize that we will and should keep focussed on.

Highlights of the Week 3: Live with zero workshop 2 - how will this change the stress of emails in the Northern Locality? 

Following on from good evaluation of the first of the workshops about choosing the type of inbox you want, rather than just accepting the one you have, this week saw the second workshop at South Molton in Northern Devon.

There are no magic bullets, but I do firmly believe that you can choose to see your email traffic in a different way, accept the ways in which you make the management of your inbox easier or harder and set a realisable ambition for the future.

And that is what we explored with almost 20 of our staff.  Some came away with a bit of a disappointment that the workshop wasn't more of a "how to use outlook" session - there are a few tips on using technology, but that isn't the point of the workshop.  But there was a lot of really positive feedback and evidence both that plenty of people had found it food for thought and that they would be looking to change some things in their work.

Highlights of the Week 4: We've made the HSJ Top 100 Best Places to Work in the NHS - who knew?A good piece of news to celebrate

The benefits of being at the HSJ Commissioning summit is that you get a copy of the magazine hot off the press.  This week there was a supplement that used an independent company to research the best places to working the NHS, based on a set of measures and feedback.  I was casually flicking through in the break and realised there was a section on CCGs. Suddenly, there we were in black and white on the list.  The surprise was both because I hadn't known this was coming (I don't think anyone did) and because when you live in a challenged health economy you do get used to a different set of expectations about recognition or success.

So in all honesty, I don't really know what it means or what we have done right to end up here, but it is really encouraging, just for once, to be looking at that question when we are in the list, rather than pondering how others have ended up there with our name absent.  Let's celebrate a little!

Highlights of the Week 5: An evening at the HSJ Commissioning Summit with like-minded souls to reflect on where we really are in the NHS

The sessions I really enjoyed at the HSJ Commissioning Summit included a full and frank debate about the Better Care Fund - where I reflected on both the importance of positive ambition and also the danger of over stating plans, based on a national requirement that then turn sour on delivery; a discussion session on choice and competition - where within the strict confidentiality rules, we were able to discuss with Monitor their role in co-operation and competition; and a session with Stephen Dorrell, who is just an immensely impressive and experienced politician, engaging, intellectual and witty.

And then, like we now discuss with long-term conditions, it is not looking at each one in turn that matters, it is how you consider them all together; it is the totality of how all issues impact that I am really most interested in discussing.  And fortunately, that is what most other people are interested in too; enjoyable company in a convivial atmosphere.

And their view....? Well I am clearly not able to comment; what I can say though, is that I feel like there is such a significant challenge for the NHS and public services ahead, that it would be amazing if there weren't major policy battles in the lead up to the next election and that we might start to glimpse these at the party conferences this autumn.  If we don't see that, there aren't many who can see how we maintain the whole system sustainably, carrying on doing more of what we are currently doing.

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.