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.

Highlights of the Week - 29th August 2014

I'm based in Plymouth, but with a role across the whole of the CCG, seem to spend as much time now in Exeter as I do back in the Western Locality.  It means that both keeping in touch through phone calls and emails is critical and that the team in the Locality are running things really effectively.

The Locality Team goes from strength to strength with new additions that have really added to the skills and abilities and a sense of maturing of arrangements that have been in place for around 18 months.

The joining up with local authorities offers an even better opportunity; we do need to ensure though that we don't destabilise some of the effective systems and processes that are just bedding in.  It feels like we need to avoid the pitfall of those Premier League managers who have just bought in wonderful new talent, but are struggling to make the new, better team gel effectively.  Build on what works.  

Highlights of the Week - 29th August 2014 (@jeclo)

Highlights of the Week 1: Delighted to be asked to join the Plymouth Fairness Commission @plymfairness
Plymouth established a Fairness Commission led by Dame Suzi Leather and after an extensive period of evidence gathering, consultation and consideration, produced a final report.

The premise is simple: what does fairness mean in our society and in the City and how could we all be acting to make life fairer for all?  It clearly raises a whole series of issues, not least for the work of the public sector and the role of NHS within that.  Does making better access to mental health services easier because their is a particular need make society fairer or should we be trying to aim for people in Plymouth to only have the same need for services as elsewhere?

I am really looking forward to joining the Commission and spending time answering those questions and looking for actions.  The report is well worth a read and you can find it here: www.plymouthfairnesscommission.co.uk

Highlights of the Week 2: Strategic Risk Committee-embedding our risk and assurance processes to focus on strategic risk
We have worked really hard to created our Integrated Governance Reporting system within the CCG and I think we have a really good system emerging that reviews risk, highlights the emerging high risk issues and reports on those to the Boards that are responsible for ensuring actions are in place and we are acting to reduce risk, rather than just noting its presence.

With an organisation of the size of NEW Devon CCG, covering multiple providers and urgent care systems, it is important that we don't just deal effectively with individual risks, but that we also manage to pull the perspective back enough to take a strategic and high level view of the overall organisational issues.

The Strategic Risk Committee has this as its purpose: to ensure that our system of risk is well enough developed to be overseen by the Audit Committee and then to spend most time on the whole organisation view.  We made good progress this week and there is a real sense of the final few steps we need to take to have that fully embedded.

Highlights of the Week 3: New style staff briefing is well received. It is still commitment that really matters
We brief in five sites across the CCG.  We have struggled to make this happen each month, consistently - there are, after all, many pressures on our time.  The new process leads us through around 8-10 key issues, each with a short video presentation from the Chair or Chief Officer, followed by a discussion led by the presenting Director.

This format was well received, though we still need to make sure the language we use is understandable by all staff attending - for some the issues of system resilience are their daily vocabulary, for others, there is little contact with what that means.

Overall, though, I still think that it comes down to priority and commitment: what would have to compete in my diary to lead to me not being able to lead staff briefing?  I don't think it works if it is always handed over to deputies.  I am delighted that those who simply can't attend can now watch the video elements later, but ultimately I want all staff to really value staff briefing because of its content and the way we make it work.

Highlights of the Week 4: Board requested a deep dive in diagnostics-impressed by the presentation of our actions
In amongst all the targets that are routinely achieved within our health system - I think Devon is well served by the NHS and provides care in line or exceeding national expectation in most areas - there are some targets that are challenges and a few that have been a struggle for some time.

The diagnostic waiting times in our Locality are one of those targets and, after several months of being updated on the issue, the Locality Board requested a deep dive to fully understand the problem and to assure themselves that our actions are sound.

The presentation this week was really impressive.  Our Head of Commissioning clearly had a grip of all the issues at the level of individual types of diagnostic and impressed the Board with the level of understanding and the detail of the actions in place.

It feels like Plymouth Hospitals have worked really hard to make progress and that we are on the verge of a step change in achievement.  The next few weeks will enable us to see whether that is the case.

Highlights of the Week 5: Another productive discussion with @kcnnoaham-great to have real public health leadership in Plymouth
Kelechi Nnoaham has been in post in Plymouth as Director of Public Health for less than six months, but the impact of having a substantive DPH in post after an extended period of temporary arrangements has been significant.

At a personal level, I really enjoy spending time with Kelechi discussing the range of issues that impact on us both.  There are things we have a different perspective on - we spent some time this week talking about the role of the Health and Wellbeing Board around our alcohol strategy and investment - but it feels very positive to have a consistent force around the core role of Public Health within our community. 

There are some exciting pieces of work that Public Health are working on and no doubt I'll soon be commenting here and explaining the 4-4-54 plan.

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 - 22nd August 2014

Back from a wonderful two weeks in Cyprus - a heat that forces relaxation and a slowing down of life; a perfect break and a great time with the four fifths of the family who were there

For regular readers of the blog, I can report that our dog is safe and despite some photos posted on Facebook by "friends" who implied menace, Jasper enjoyed his 2 weeks in a house full of other four legged playmates.

And my daughter had an amazing trip to Tanzania and managed, with the help of neighbours, to return without us being here to meet her.  In fact, better than that, she set up our new broadband service, desperate as she was to be back on line with her friends, did some washing and, most impressively, fixed the boiler when there was no hot water (It was one of the more comedy moments of our holiday as I was trying to explain to her how to lie on your back under the boiler, turn two taps to top up the water, whilst I was eating dinner in a beautiful taverna).

But surely, first week back blues? It has certainly been a busy week, but beautiful Devon welcomed us back and, as ever, there are always highlights amongst the workload

Highlights of the Week - 22nd August 2014 (@jeclo)

Highlights of the Week 1: The babysitters were brilliant; last week's blog was the most read ever-is that good?

Thanks to everyone who got involved in keeping the blog running over the last 2 weeks; I really enjoyed reading it in the sun and, from feedback, the team got a feel for how positive the experience can be.  I especially found last week's piece on the tragic death of Robin Williams and the issues linked to mental health really interesting.

And it seems lots of other people did too - last week's blog received more page views than any other one I have written.  The good part of my brain is delighted and it is exactly the outcome I would have wanted. The ego part, may have preferred that one of my thoughtful pieces previously would have achieved such acclaim!

But it has led to a number of discussions in the Locality and CCG about communication and the role that a blog can play in that.  It also has a role  in the life of the writer - the act of writing and remembering highlights definitely changes how I view a week and how to bring closure at the end of 5 days of turmoil.  We'll see how many page views there are this week!

Highlights of the Week 2: BCF-Lots and lots of issues and work, but the focus is helpful

We have two BCFs to complete, one for Plymouth and one for Devon (where we work alongside South Devon and Torbay CCG). The latest guidance and change of emphasis only ramps up the level of complexity and the scale of the work effort both in this completion phase and, of course, for the delivery of a nationally set target of a 3.5% reduction in emergency activity.

We have redoubled our efforts this week with some additional support helping us to refresh our strategic narrative and the schemes that will underpin delivery.  We assessed ourselves as having low confidence in achieving all the targets in the BCF - we believe this is a realistic assessment at this moment - and this means that our two BCFs figure within 7 in the south of England receiving additional external support and scrutiny.

All the different programmes we are working on interlink - so the BCF aspirations clearly fit within our work on integration and form part of the working with our "Local NHS Futures - transforming care in Devon and Plymouth" programme.  This makes things slower initially, but the week on BCF does point to am emerging clarity of vision, ambition and detail.

Highlights of the Week 3: We need a Programme Director for "Local NHS Futures". Conversations are encouraging

In the last couple of hours before I went on leave the Programme Director that we thought we had secured didn't materialise.  We desperately need this post to steer the programme over the next 6 months and to provide clear leadership across the community, so it was a real disappointment.

This week was therefore 5 further conversations with potential candidates and it feels like  we will quickly be able to find a key leader to take on the role.  The blend of skills are important; we need someone who has the expertise to run a complex programme office, where the complexity is heightened by the reliance on capacity within each organisation as well as a central office function.

We also need someone who has the presence to command respect from the range of senior leaders across the health and social care system and broker solutions to wicked problems.  More positive and hopeful again this week

Highlights of the Week 4: Another meeting to agree a process to ramp up our work on financial recovery

We need to ramp up our efforts on financial recovery - as discussed here previously, we are carrying too much financial risk and the actions we have in place will fall short of achieving the level of change and savings we need.

It is hard to think of new ways to save money, but we have no choice.  In previous incarnations of commissioning, such as District Health Authorities or PCTs, we would have looked across all of the budgets - such as direct provision, public health, primary care, capital and joint spend with local authorities - and found offsetting savings.  These approaches just aren't available to CCGs.

The meeting this week did describe a new emphasis for our work and an approach that will both encourage and demand more input from across all parts of the organisation - it felt like a useful and purposeful way forward.  We need to balance that with maintaining staff commitment and engagement.

Highlights of the Week 5: Joint Health and Social Care development group in Devon shows areas with potential

And the bit that keeps making more sense that most other things I get involved in, is the work we are doing with two local authorities on joining up commissioning and provision.  

This week we were discussing our approaches to community services, Strategic Resilience groups and we spent a good amount of time  looking at the current state of the personal care market, where the Council struggles in some parts of Devon to source enough capacity to meet demand, within the tight cost envelopes that they work to.

It was another area where it feels like we could do something together that would get better outcomes. Most importantly, the quality of the relationships between us that allow those discussions to happen go from strength to strength.

Busy then and managed to get involved in pouring ice cold water over my head - welcome home!

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 - 15th August 2014

Highlights of an NHS Week  -  15^th August 2014

I can't imagine that anyone has not heard of the death of Robin Williams this week; either from the news itself of his suicide or the controversy surrounding the media coverage of the story.  Ask anyone in their mid-40s and they are very likely to have at least one film or programme featuring or starring Williams they love; whether it be in the early days in Mork and Mindy which I used to love watching on a Saturday evening as a child or in the really moving Awakenings.  My step-daughter, who is in her mid-20s, loved Jumanji and Mrs Doubtfire and my teenage girls have grown up recognising and loving him in Night at the Museum and as the voice of the genie in Aladdin.  My personal favourite is Good Morning Vietnam - fantastic soundtrack!

Driving to work this week I listened to a moving discussion on the Today programme featuring Adrian Strain, whose 34-year-old son had recently taken his own life. He reflected on the fact that most people knew very little about mental illness and as a parent he always worried about whether he could have done more.

The facts about mental health problems speak for themselves:

·           1 in 4 people will experience some kind of mental health problem in the course of a year

·           Mixed anxiety and depression is the most common mental disorder in Britain

·           Women are more likely to have been treated for a mental health problem than men

·           About 10% of children have a mental health problem at any one time

·           Depression affects 1 in 5 older people

·           Suicides rates show that British men are three times as likely to die by suicide than British women

·           Self-harm statistics for the UK show one of the highest rates in Europe: 400 per 100,000 population

·           Only 1 in 10 prisoners has no mental disorder

This statistics, alongside all of the media coverage this week prompted me to reflect on what we are doing as a service to support people with mental illness and the promotion of mental health within the CCG and this became the inspiration behind this week's first highlight.

Highlight of the Week 1 -  Inspiration for this week's blog

Parity of Esteem describes a five year strategy by supporting mental health patients through improved choice, better physical healthcare for people with serious mental illness and better crisis care.  

In the CCG we are working with our mental health providers to implement this strategy and key elements of service development and improvement are being driven forward.  In addition, we are working with our colleagues in the criminal justice system to provide to people in custody and we are one of ten national pilots to provide CPNs in police call centres at critical points in time.

We are joint funding additional psychiatric liaison posts in acute host’s sites and working hard with our providers to improve access to psychological therapies.

Highlight of the Week 2 – Western SLT away-day

So despite it being the middle of August, in the past a quieter time of year for the NHS, the pace of work hasn't really let up.  I love the Locality SLT away-days for some of the reasons I mentioned last week - time to think and reflect but I found myself, for the first time ever this week wondering if I could spare the time to attend with a significant number of deadlines looming and the promise of a day off on Friday!  However, I went and I'm glad I did.

We were fewer in number at this session, facilitated brilliantly by the lovely Kathy Toogood, and this meant we could get into some really detailed discussion about the Locality work plan.  We used our thinking rounds, focused on our strengths as a team and worked through the GROW model in order to determine how best to create the conditions for success for our teams.   

I met my deadlines, have spent a great day with my girls on my day off and also had the privilege of some space and time for me professionally.  Great result!

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Highlight of the Week 3 – Board development

We have a relatively new Board in Western and the Board will be even newer in September with the arrival of our newly elected Board member, Dr Tom Davies.  Every two months we have a Board development session to support their learning of the key issues in commissioning and how, as a Board, they hold our Locality to account.  

This week's session focused on urgent care and the CCG Strategy - what does the CCG's 5-year strategy mean to them as a Board?  How do our commissioning intentions flow from the strategy and into our locality workplan? And how will we know that we're delivering what we set out to achieve?  We had a really productive discussion and it was great to see the Board challenging our work plan and being clear about their involvement.

Highlight of the Week 4 –   Stepping up and giving something back to the service

We are lucky to have a significant number of young people working in our organisation, particularly in our referral support service, many of whom have joined us as apprentices.  This week two members of the service team approached me to see if there were any developmental opportunities in commissioning.  In a nutshell, they will be released for a few hours a week to begin to experience the world of commissioning and the Locality team will support their personal development and learning in the hope that we start to give back some of what the NHS has given us over the years in terms of developmental opportunities.

Highlight of the Week 5 – Who said August was quiet!

August, so often an opportunity to catch up, reflect on those manic days gone by and planning for those to come.   Not so it would seem this year!

As another hectic and challenging week passes by with everything other than “business as usual” commandeering time, the ability to observe, respond and reflect on the impact of those things seems a necessary skill of anyone working in the NHS today – commissioner, provider or volunteer!

“I can’t change the direction of the wind but I can adjust my sails to always reach my destination”    Jimmy (James) Dean  

Happy sailing!

DRSS Summer Blog número dos                                                                 

The work men are finally here!

Fourteen months after we moved into Bridge House, work has finally started on making the building more suitable for disabled access.  The car park’s fine, you can get in and out of the building ok and there’s a disabled loo, but it’s a two storey building, without a lift and the main meeting room is upstairs on the first floor.

Sadly installing a lift (inside, outside or stair lift) is either impractical due to infrastructure reasons or would require some serious financial investment.   So, we are moving all the meeting rooms downstairs and creating more office space on the first floor to ensure that everyone can attend every meeting they need to.

It’s taken a long time, and some serious frustration, to get to this point.  We’re not looking forward to the inevitable disruption of running a contact centre whilst the builders are in, but they are being incredibly accommodating and are working later shifts to avoid our busiest periods. Finger’s crossed things won’t be too bad!

Apologies and thanks to all our staff and visitors with disabilities – sorry it’s been such a long journey and a huge thank you for your patience and understanding.  We’re nearly there!!

DRSS Highlight of the week 1 – Staff surveys, the power of listening

Our staff survey results weren’t great last year and we’re really keen to understand and address the issues.  We also want to give everyone the opportunity to share their ideas and comments and see how we help deliver the 5 CCG pledges.

How do you engage with everyone in a way that makes them want to speak up? Feedback and gathering feedback is something that can be quite hard, it’s very individual.

After much deliberation the DRSS Project Delivery Team gate crashed several small team meetings.  We sat down with around 8 people at a time and we LISTENED to everything they had to say (using the 5 CCG pledges as a guide). It was a wonderful eye opener, listening is a very powerful tool and skill which felt quite liberating. We normally listen in order to respond, to provide answers, to give explanation, in DRSS we are trouble shooters by nature and we want to be able to help but this time we guided others to find the answers for themselves. Listening found a new power in DRSS but it doesn’t mean a lot unless we do something with the information we have learnt.

All this information is being collated and will be fed into the CCG Staff Survey Action Planning Group and their action plan.

DRSS Highlight of the week 2 – Anyone got that holiday feeling?

You may have noticed that holiday season has come to the NHS.  The out of offices seem to talk to each other more often than we do!

Rota-ing is turned into a fine art and clinicians are suddenly thin on the ground; no-one is around to pick up those all-important queries and yet we still seem to have deadlines looming. 

On the bright side, we’re catching up on our emails and are in the office more to do those jobs that have been propping up the ‘to do’ list for a while!!  Shame the stream of patients being referred doesn’t seem to be following the same dip in activity!

We can’t complain though, the constant supply of exotic holiday goodies, sweets and treats is keeping morale up for those of us left behind!

DRSS Highlight of the week 3 – Difficult conversations

Difficult conversations, something best avoided or tackled head on?  We get to have quite a few of them every day.  In our business they’re unavoidable, if not always terribly comfortable.

As providers struggle to meet ever increasing demand on their services there is an inevitable impact on waiting times.  ‘Six-year high for hospital waiting lists’ read the headlines this week.

On the ground, this results in fewer and fewer appointments being made available on Choose and Book as hospitals use every ‘spare’ slot to keep the ship afloat and avoid fines and bad press as a ‘failing hospital’.  Fewer new appointments mean more patients ringing DRSS for appointments that just don’t exist (why ring an appointments line when they have no appointments?).  So it’s onto a waiting list for them and choice of date and time usually go out the window as there is no choice available.

As gatekeeper of commissioned pathways and commissioning policies all referrals are screened, flagged with the on-site GP Referral Facilitator for clinical input, and returned to practices when they don’t meet the agreed criteria.  Whilst this might push up the quality of referrals and reduce unnecessary trips to hospital, for patients in pain (and worried about their health) it’s not usually the outcome they’re expecting, or wanting.  They don’t see what their GP has written in the referral letter; often it differs considerably to what the patient thinks. What is deemed ‘low priority’ or ‘cosmetic’ in the wider scheme of things is anything but to the person living with the condition.

The highlight for us is the commitment and energy that the team bring to these situations, which will surely get harder as the local NHS works towards financial recovery.

DRSS Highlight of the week 4 – Kernow CCG

Kernow CCG recently started a review of the local referral services - DRSS and the Kernow Referral Management Service (RMS) in Truro.  They want to ensure that patients and practices in East Cornwall receive a comparable service to the rest of Cornwall and that the service offers good value for money.

A team from Cornwall (including clinical, patient, practice and CCG representatives) spent an afternoon with us in Plymouth, learning more about our working practices and spending time with the team, before sending a report to the East Cornwall Locality Board. 

We are delighted that the CCG have confirmed their decision to continue their working relationship with us and look forward to greater collaboration, new ideas and ways of working with our colleagues across the Tamar.

DRSS Highlight of the week 5 – Time to reflect

Thank you Jerry for going on holiday.  Obviously we’re missing you a lot, but we’ve had great fun with your blog! 

We usually work at such a pace, on a myriad of different things (generally all at the same time), that we don’t often (or ever) pause to reflect on the highlights.  We’re just not very good at that sort of thing. It’s usually straight onto the next job, the next patient, the next issue. 

Being sandwiched between primary and secondary care, as part of a decidedly imperfect system, makes us a very good target when things go wrong with referrals.  It’s understandable, we know it’s not usually true, but it does rather tend to get us down. 

Taking the time out to chat with each team about what’s made a difference to them this week has been a bit of a revelation – heart-warming and re-affirming.  It has made us incredibly proud of our service and the work we do.  It’s not perfect, but it is full of hard working people who genuinely care about getting patients the right appointments or care.

We really should do more of this reflecting in the future as it has made things much more fun. 

We thought we’d sign off with the words of Peter Drucker:

“Follow effective action with quiet reflection.  From the quiet reflection will come even more effective action.”

We hope you've enjoyed the blog over the last 2 weeks - normal service resumes next week on Jerry's return!