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.

Highlights of the Week 28th March 2014

Spring is definitely here in Devon and the beautiful magnolia tree outside the front of the house is just about ready for its full glory.  It covers the view of Dartmoor just behind it, but the (mostly) glorious mornings have led to a concerted effort to get back in to a more regular routine of morning running.

It takes about 20 minutes of hard uphill grind with dog in tow to get to the top of Ugborough Beacon.  It's quicker without him with regular toilet stops (for Jasper!) slowing down the overall progress, but that does mean a less fanatical approach and more time to look over the rolling hills of the South Hams and out to sea.  The really enjoyable part is that the rest of the hour is all downhill and, on a crisp morning, is stunning.

Running is an important part of the management of a busy week for me, ensuring both head and body are in good shape to deal with the pressures and four early mornings this week mean I feel good at the end of the week and not in quite the same "thank Crunchie it's Friday" mood as last week.

Highlights of the Week (@jeclo)

Highlights of the Week 1: Integrated Governance reporting at our Locality Board
We have worked really hard on our integrated governance reporting with each locality in the CCG producing an Integrated Governance Report covering patient safety, finance, performance and other commissioning areas.  Our risk template process pulls the highest risk areas from the risk registers and ensures there is a clear, concise summary in front of the Board.

That sounds fairly dull, but the reality is that across the three Localities and Partnerships there is a real sense that integrated governance, with a strong focus on patient safety and patient experience, is front and centre. 

Stroke performance at Plymouth Hospitals has had a risk template for a while and as a result the Board wanted a "deep dive" this month.  It was good to note some improvements in performance and the work the team are doing to support the Trust in making those changes.  The Board wasn't totally assured, but they were pleased to see the depth of the work that sits behind the summary

Highlights of the Week 2: Plymouth H&WB sign off our BCF and 5-year strategic plan
I do enjoy the Plymouth Health and Wellbeing Board.  It has a wide membership so feels like a very positive discussion.  The Police and Crime Commissioner, sits alongside Plymouth Community Homes or Plymouth Community Healthcare Chief Executives and when discussing the impact of alcohol in the City with the Director of Public Health, this makes for a well informed debate.

Both the Better Care Fund and our strategic plan have been to the H&WB before - we have shared both at an early stage and had an informal 'solution shop' for members on the BCF to explore the potential in some depth.

We have huge ambition around integration and it is hard to capture that within the confines of a Fund that we are focussing at the services that wrap around hospital admission and discharge in the first instance.  What was great to report to the Board was the level of joint working between the CCG and the Council.  We are totally aligned on how we are taking integration and the BCF forward, despite the pressures on our different systems and it does mean that the Board was focussed on the impact for people, rather than on judging our different intent.


Highlights of the Week 3: My first use of our new strengths based appraisal system 
It is not revolutionary, but we have worked hard to back our development work using a strengths based leadership approach, with the ways we work in the CCG.  One aspect of this is to have an appraisal system that takes a strengths focus.

So I sat with Debbie this week and listened to the things that she has excelled at over the last year and that have energised her.  We explored what it was about those projects and achievements that she felt most drew on her strengths and then looked at how she could make more of those in the year to come.  Her objectives are therefore based on making more of her strengths and we managed the whole discussion without any focus on her weaknesses.

It might sound a bit fluffy, but the reality is that of course Debbie touched on the things that haven't gone well - strengths focus doesn't mean problem phobic - but it was much more enjoyable to assess how the things she does well could be used to address them.


Highlights of the Week 4: Individuals at the Centre has a life of its own
I keep tweeting about our Individuals at the Centre programme and the 5 teams who are coming towards the end of their 9 month learning journey.  The finish line is looming and there are working really hard to enjoy their work is getting to the outcomes they had hoped. 

And of course, most are blown away by how far they are exceeding them.

This week we had a member of the public at our Locality Board using a public questions' slot to feedback on an event she had been to earlier in the week - a patient involvement event for people with psoriasis and eczema.  The preceding challenging questions had me prepared for another difficult moment.

But she wanted the Board to know how amazing the event had been, how inspiring the team were who were running it and how impressed she was with their energy and enthusiasm.  As I explained to the Board, this is what can happen if you give people the freedom to come up with ideas for themselves - no senior oversight of direction, just support for their journey and a lot of faith in the process (and some crossing of fingers!)

I also talked to a member of another group who was preparing for her annual appraisal and commented that  she was really looking forward to the section on how she lives out the values of the organisation (a new part of the appraisal paperwork) as she feels like she has a little bird perched on her shoulder called IATC that constantly reminds her.

Priceless!

Highlights of the Week 5: The joys of the open plan office
The CCG office in Plymouth is co-located with Plymouth City Council in a large open plan building. I was no fan of open plan, but it has been amazing for how we work as a team and interact with other staff from the CCG and Council.  It is helped by having technology such as phones that work through headsets on the computer so there are no phones ringing everywhere and no loud conversations.  But it is large enough that the background noise becomes a hubbub rather than distracting.

Most of the time....

This week there have been moments when I have joined in the conversations about new dresses, haircuts, pregnancy, football etc along with up to 30 other people, but the shared laughter across the office as a result is really powerful in terms of what keeps us all together as a team.

We have 3 offices amongst the open plan - designated for me, the Chair and the Locality Chief Finance Officer, but we pretty much don't use them and are usually out in the open plan keeping in touch with how the place feels and the team conversations.

Today was birthday cakes - one of the downsides is there always seems to be cakes around.... perhaps not a downside unless you're running to keep fit.....!

Highlights of the Week 21st March 2014

It has been a tough week.  That is what happens when you are in the middle of the annual contracting process and you get caught between the proverbial rock and a hard place.  In our context, that means an NHS Trust and a CCG both with projected deficit plans for 2014/15 trying to close a gap in expectation on the size of our contract.  I think it is, at its simplest, because there isn't any overlap between our highest offer, all in without any safety net, and the Trust's lowest acceptable number.

We've worked really hard at maintaining the right senior behaviours within those negotiations and I think, broadly speaking, we have managed that - a credit to the values of people on both sides of the table, but it is immensely hard when you are in mediation, leading towards arbitration and trying to make your points, which both sides believe in.  

We need to focus together on delivering the scale of transformation that will bring our local system back in to balance, a place it hasn't been for many years.  We have edged towards that over the last year, but we do need to find a way to get through contract negotiations in tact in order to reset our ambition.

Nancy Kline's "Thinking Environment" is a key part of how we work in our Locality (the Western Locality of NEW Devon covers the city of Plymouth - Britain's 14th largest city and the 4th largest natural harbour in the world! - and the surrounding rural area of South Hams and West Devon) and increasingly across the CCG.  Her ten components provide the space to improve thinking on the basis of "the quality of anything we do relies on the quality of thinking we do first".  We practice hard at keeping to the components and running meetings in that style.  It creates a calm, reflective and purposeful atmosphere which is helpful in a week like this.

One element is to start and finish meetings on a positive (and the blog isn't living up to that!).  Another is to practice the 5:1 ratio of praise and affirmation to criticism - and so after a start that notes the challenging week, on to the 5 positive reflections....

Highlights of the Week (@jeclo)

Highlights of the Week 1: first CCG annual members' meeting. More GPs and practices than we expected and great engagement, plenty to discuss

You plan a members' annual meeting and then wait to see if there is any level of engagement of practices with that kind of event when we are describing a bit about our first year and more about our work ahead.  The sight of extra tables being set up is either a sign of success or a low level of expectation; in reality a bit of both I suspect. 

The world doesn't change as a result of the event, but it does give some reassurance about the general direction we have set with our Clinical Leads and Board members; it also provides some challenge and new perspective which we can use to refine our ideas. 

Our Members seemed happy with the five pillars of our 5-year strategy and were interested in what the support as a Challenged local Health Economy will bring.  We had a really interesting discussion about what co-commissioning primary care would mean for the CCG and Member practices - up for change was a strong view.

Highlights of the Week 2: staff brief-talking about the huge potential for improving care through integration & honestly about staff impact

The CCG is working hard on two streams of integration work, one with Devon County Council and one with Plymouth City Council.  They are both progressing well and this week we were briefing staff in the Western Locality on the work in Plymouth as papers were published for a Council Cabinet. 

The impact of the programme with stated goals of full integration of commissioning (and full integration of provision of community health and social care services) will be profound and completely changes the notion of what a CCG is and it's governance. The prize is worth the level of change and those who came to the staff briefing heard the honest description of the benefits and the potential uncertainty for staff.  The response was reflective and positive - I think most staff share the sense of importance of the task, above what it may mean individually.

Highlights of the Week 3: Individuals at the Centre mentors' catch-up. Seeing where the teams are for 9th May. Sounds fantastic, but scary!

We are just over a month away from the final module of our Individuals at the Centre learning set.  This means in about 5 weeks we will know whether the enthusiasm, tools, techniques and guidance we have offered to five teams in the CCG has resulted in 5 changed and remodelled processes or systems in the organisations together with 28 new change agents. 

The temptation is to forget all the intent we have shown throughout the programme and provide a firmer steer or greater opinion, rather than support for the teams' ideas and work. 

But the call gave us all the reminder about the greater purpose and we are excited about all the great snippets we shared about what the teams are planning. I feel a bit like a worried parent, but I'm sure that the 9th May will be a huge celebration of success. 

Highlights of the Week 4:booked leave to write book in May. Announcing to increase personal commitment! A break to spend every hour working?

I have toyed with writing this book for over a year. If I hadn't rejoined the NHS it was the natural next step in my coaching and development work, based on a process I had been working on with groups and individuals over an 18 month refinement.

It is a 10 part model for thinking about career, job match, CV and interview preparation in a way that allows people to powerfully focus on themselves at their best. It has had great results and featured heavily in the work I was doing around the transition from PCTs to CCGs. 

Having worked with a few people recently using the model again and realising that I need to keep working on the things that bring inspiration to me and those I work with, I have told a few key people that I'm going to take some leave in May to break the back of the writing - doing so will mean I will do it as I can't stand owning up to not achieving a goal I've set for myself!

It will fall in the middle of really intense work on the Challenged Local Health Economy, so I'll be exhausted beforehand and busy afterwards. It still feels like the break - though full of long days locked on to a keyboard - will re-energise, so am just agreeing with the family that I can hideaway for a short period.

Highlights of the Week 5: Friday! (never said it before) but tough week (for all) at work means very much looking forward to York weekend

I am definitely not someone who only works for the weekend - work being the way we earn the money to do the things we really enjoy. I am clear that I want to enjoy every aspect of my life, each day and the work I choose allows me to enjoy my contribution to the society I work in.

But I can't claim to get that balance every day or every week.  Some days at work are incredibly stimulating and enjoyable, better than the weekends laying paving slabs or erecting sheds; others are tough and sometimes even I have to admit that the weekend with the family is the thing that seems to make sense of the week. 

This weekend was spent travelling the 6 hours back up to see old friends in Elvington, near York.  The whole family has loved the move to Devon, but it is lovely to see them reunited with old friends and for me to have some relaxation that can't involve any DIY or running a taxi service.

A 6 hour journey home (hopefully!) will see me ready for the new week ahead....

A bit about me...

I have had some feedback that this blog doesn't contain any backstory ... and in an X-Factor world, the backstory is almost more important than the content.

I rejoined the NHS last April (2013) at the start of NEW Devon CCG, having undertaken some consultancy / development/ interim work with the shadow CCG for the 12 months beforehand.  I hadn't been too interested in the assignment at first - I lived in York and had mostly managed to get home from clients most days.  The prospect of working away for 3 or 4 nights a week wasn't appealing, but the proposition of bringing together Chief Executive expertise with coaching and development emphasis was too good to turn down and it did mean that I was working with a number of different size CCGs, which felt good for the future.

I used to drive down to Devon to work with the largest CCG in the country early in the week and then back home to work with North Lincolnshire, amongst others, with less than 10% of the employees of NEW Devon.

I have now moved to Devon, resettling the family on the edge of Dartmoor in the South Hams and am busy integrating learning from the last 6 years and a passion for coaching and development in to an NHS leadership role.

The world before rejoining the NHS can be found at Atlyric Limited (or at least it can be until that finally closes!)

Highlights of the Week 14th March 2014

I try not to celebrate Fridays; it makes me feel like I only exist for the weekend, when in reality I like to focus on the enjoyment of the whole of the way I choose to balance home and work as aspects that make up my life.  But I am tired this week, so it will be good to relax a bit (although there is a large shed that I need to erect that will test the relaxation piece!) 

I am also four weeks from a holiday and I have been invested in that thinking about how great that will be as a colleague was describing their journey to the airport tomorrow morning.  I do think that anticipation is one of the best parts of holidays.

The five highlights this week on Twitter (@jeclo)

Highlights of the Week 1: GP Members’ Forum-an engaged debate about referral management shows practices are interested in the CCG

It was an interesting day.  We run a forum for the 53 practices in the Western Locality of the CCG every quarter and we get a representative regularly now from over 80% of practices.  We probably had more of a challenge around engagement than the other Localities in the CCG: Northern has a tighter group of just over 20 practices that have worked well together and there are 4 clear sub localities in Eastern that promote really effective engagement.

So we’re always checking whether we get good enough engagement or not and the Members’ Forum is a barometer of that.

This week was a good day.  We run the same event twice – morning and afternoon so that we don’t shut practices, don’t use up all the locums available by trying to get everyone there at once and to give us a good group size to some of the breakout sessions and stalls and stands that we put on.

We did a presentation about our 5-year strategy and our commissioning intentions, but the real engagement, which could be a euphemism for a bit of angst, was around referral management.  The CCG has brought together two really good centres in Plymouth and Devon that have worked slightly differently under one management structure.  Clearly GPs locally are worried about losing what they see as the special character of our local centre.

I love the debate.  We could have done better on the engagement and communication, but the process is sound and involves the Locality Boards and Governing Body making decisions on behalf of their members and in the best interests of patients first and foremost.  But the discussion was exactly what we need to ensure that the Members are not passive about the CCG and our decisions.

Highlights of the Week 2: Working with the Clinical Leadership Group on the next version of the 5-year strategy. Increasing alignment and focus

We have processed the feedback on the first submission of our 5-year strategy and the job on Wednesday morning was to work with the Locality Chairs, Vice Chairs and CCG Chair to improve the description of the kind of system we are trying to create, the challenges we face, the impact on our provision landscape and the way it will feel for patients.

We have 5 key pillars in our strategy

Partnerships to improve health and wellbeing

Integration and Personalisation

General Practice as the organising unit of care

A regulated system of efficient and effective elective care

A safe and efficient urgent care system

It was really interesting to hear everyone’s take on what those pillars stand for and how the NHS would look different as a result.  There is no doubt that the work on integration is top of the pile for us – we are really commited to transforming how health and social care work together, but we also are looking at vertical integration in some parts of our system.

The Clinical Leads group brings together GPs from very different areas and we are addressing some of the real issues for our economy about health inequalities, demography and our ageing population and the need to support local access. It feels like a very positive and purposeful discussion, against a very challenging backdrop.

Highlights of the Week 3: An evening with the CCG Leadership Team to think about how we model our values for our staff.  All of us, all the time

There is a deep irony that we finished an evening of dinner and discussion at 10.30 when one of the main issues for discussion was how we model our values and one of the keenest areas of debate was whether it is ok to be emailing at 10pm – is that the example we want to set for staff?

However, giving up time in a social atmosphere to think about those issues didn’t feel like the kind of work we should be worrying about.

I am passionate about the issue “Leadership by example is not one form of leadership, it is the only form of leadership”.  I buy that.  So I don’t send emails after 6.30pm, before 7.30 or at weekends.  I try not to work in those spaces too, but that is less easy.  Is it ok that I work in the evening, but don’t let others know?  Or is that deception?

I think that managing the impact is important, so if I work because that is a choice I freely make (and for me it is unusual, I prefer to work at a fearsome pace during the day/ week to keep on top of emails and tasks than to work at weekends), but protect others from the impact of that or what may feel like a demand for them to do the same, I think the intent is positive.

I tell people at work and they know that in an emergency they can text or phone me, but I won’t respond to emails.  I hear it back from many people, so the example must be having an impact, positively, on our leadership style (one person said “I hear you delete all emails you get after 6pm – not true, but I quite like the idea that people might think that!)

Highlights of the Week 4: Spending time with one of our Locality Chairs to explore the many areas we align on, rather than the few differences

I sometimes clash with one of our Locality Chairs.  I love fluffy development, time to explore values, behaviours and patterns; he prefers for development to be business focussed and to be “real”.  The development of mission and vision and consideration of whether a vision needs to be a purpose you own or could be aspirational was one area where we sparred a bit recently.

However, we both truly value the other’s contribution and skills so we agreed to sit down this week and work through how to represent the organisation on one side of A4 in a way that we both likeed and felt that the Board and staff would be happy to align behind.  All brought about by the fact that I like this from Plymouth City Council which is up in all their buildings, including in every meeting room where I work. Not flash, just simple, clear and often repeated.

It was a great hour, full of aligning behind what we are trying to achieve and finding out – from resource allocation to referral rates, just how much we agree on.  Time to find more time to do this more often.

Highlights of the Week 5: The emerging strength of the Commissioning Managing Directors meeting. A large CCG needs four localities with one aim

We designed a CCG with over 900,000 population around four commissioning localities and a partnerships Directorate that commissions scale services CCG wide.  So our bottom up design looks like it builds from those four key components.

Increasingly those it is obvious that we need to and do operate as one CCG with local community focus, ownership and accountability.  Our commissioning intentions and strategy are based on all areas working collectively then working out what that means in each local area; last year our commissioning plan was made by pulling four largely separate plans together.  We have made great progress – not easily, but increasingly with the commitment and energy from all parts of the organisation.

One of the key components of that collective effort now is the Commissioning Managing Directors’ Meeting every fortnight where the four of us have space and time to think through the challenges and to work our collective or individual responses, projects and actions.  In a Leadership Team with many issues to focus on and, at its heart, the job of overseeing the effectiveness of the CCG, we didn’t seem to get enough time or in an informal enough way to develop, enhance and improve our thinking.

So, today I finished Friday with a couple of hours sat with the MDs talking about the Better Care Fund, our 5-year strategy, the work on Challenged Health Communites, community contracts, the development of the Planning and Programme Office and a number of other things that came up.  Felt energising on a day that had signing off of paperwork for arbitration in the middle of the day.