Day 21: “Trying times are not the times to stop trying” – Ray Owen

Our local hospital provider has been reported as providing a poor service for patients presenting with fractured neck of femur in the National Hip Fracture Database; reported in local media.  Whilst this report was published recently, it was an issue that the hospital identified and took action on in 2012, including an independent review by the British Orthopaedic Association.  These actions were reported in the hospital’s Quality Accounts for 2012/13. Today we undertook a review of the hospitals actions and were pleased with progress being made.  Some actions are yet to have their full impact, so we expect further improvement.  The openness of the hospital to our support and challenge has been encouraging.

Day 20: Quality Surveillance Group

I attended my first Quality Surveillance Group Meeting today.  The purpose of this group is to bring together Chief Officers & Quality Directors from CCGs across the Hertfordshire & Midlands South Area with the Area Team, Local Authorities, Local HealthWatch, Care Quality Commission, Monitor, Trust Development Authority & Health Education England to look at and address quality issues.

At this meeting we reviewed a wide range of current actions under way to improve individual organisations’ quality and also focussed on further wider actions needed in the areas of mental health, healthcare associated infections and primary care quality.

I've really enjoyed this week, which sees me finishing my first month in the role.

Day 19: Paperless NHS

Today I had a series of meetings with a mountain of papers supporting them after other meetings earlier in the week with similar wasted forests.  This is all a cost to the NHS, i.e. public, for the paper, printing and staff time to co-ordinate.  So I floated the idea that we aspire to becoming paperless to our Executive Committee this morning.

I was inspired by @SteveKellGP's paperless Board meeting earlier this month and am convinced that we can do the same and better.  I am sure the path to paperless won't be easy, but we'll focus on the people and the changes needed and the technology should be easier (not easy, but easier!). As with all change, buy-in to a vision and good leadership will be crucial to our success.

Advice, comments, suggestions all welcome!

Day 18: Wow! Newham Community Engagement

Spent today in Newham with colleagues from many different local organisations hearing about, seeing and experiencing their patient/public engagement activities, Healthy Communities initiatives and Community Prescription Service. The CCG in Newham is contracting with a range of accredited voluntary sector organisations to provide healthy lifestyle and community project support to patients at risk of diabetes. Future work will include providing a pathway for patients with mental health needs.  You can read a bit more about this here: http://www.newhamccg.nhs.uk/Downloads/About%20Us/Papers%20from%20previous%20meetings/10%20July%202013/L3%2020130710%20Newham%20Community%20Prescription.pdf

The approach they are taking to building capacity and resilience in the voluntary sector for the benefit of patients & communities is truly inspirational. The clear leadership and identifying long term goals across organisations has contributed to their success. 

The highlight of the day was participating in a Smovey class run by Age UK Newham (Google it!).

Day 17: Three Boards

Really important day today with three significant Board meetings and a demo from Dr Foster Intelligence of their new Quality Investigator Tool.

First Board was monthly meeting of CCG Governing Body, followed secondly, by a Board workshop about culture, vision & values. CCG making good progress, but we agreed we need to do more to be a truly listening and responsive organisation. 

Third Was a Board to Board meeting with our main hospital provider. We discussed our respective visions for the future of clinical services and a significant amount of synergy between our respective ambitions for Luton.

Day 16: Nursing Numbers

In a couple of meetings I had today the subject of open publication of ward level nursing numbers arose.  How we can make this meaningful for patients & the public is a particular concern.  We need greater candour & transparency to help influence improvement, but also need to not unduly scare people.  I hope that guidance published to the NHS later this year is clear about what should be published & that the media is sensible in how this is reported.

(Two highlights of my day today also included One 2 Ones I had with team members and my Area Team Director of Nursing and also meeting @NRCUK in real life after tweeting with him for so long)

Day 15: Meaningful Reporting

I had a great discussion this morning with Director of Nursing colleagues from a provider and neighbouring CCG about safeguarding and public reporting to Board. We agreed that the information that is provided to Board meetings and therefore in the public domain needs to be more meaningful to inform better decision making about quality issues.  We also agreed that we would work together to improve safeguarding and quality escalation systems & processes to make it more meaningful, easier to focus on the issues that really matter for our patients and to get better information to our Boards about quality issues.

(finally, I'm just a little bit smug that I’ve managed to write exactly 100 words after such a packed & exciting week!)

Day 14: Learning from Errors

Weekly Executive Committee meeting this morning, where we discussed a range of current issues, including planning for Winter pressures, our collaborative commissioning agreement for IVF services and addressing some of the resource gaps we have to deliver some of our planned programmes of work.  Also a really helpful discussion reflecting on learning from errors made in a previous project.  The discussion was very positive about how we embed the learning in future organisational processes and there was no attempt to blame any individuals for past errors.  Made me glad I’m working for an organisation that takes such a mature approach to learning.

Day 13: Thinking Time on the M1

Today’s diary: catching up with my Deputy Director, Governance & Risk meeting, budget review & Contract Management Board with main hospital provider.  Getting more to grips with how the CCG does its business.

Spent drive home thinking about a vision for quality and how we should ensure that quality is at the heart of everything we do.  We’ve a Board workshop coming up next week looking at learning from Francis, Berwick & Keogh (highly significant NHS reports on quality for those not directly involved in the NHS) where I hope, with colleagues, to enthuse the whole Board in this.

Day 12: Whose Line is it Anyway?

Spent more time today getting to know Quality Team members from the CCG and NHS England Area Team.  A recurring topic that arose in a number of discussions was the boundaries between CCG and NHS England Area Team’s respective responsibilities for primary care quality (sorry if this is a bit of a dull subject, but it’s important to me that we each understand what bits we each do and what we can achieve more from by working together).  In particular I discussed issues such as GPs and practice staff received safeguarding training and the provision of infection control support to primary care.  Further consideration needed to ensure that our respective teams prioritise appropriately and get the best out of the little resource we have for the benefit of our patients and the public.

Day 11: Safeguarding Of Vulnerable Adults

I spent today at a Local Safeguarding Adults Board (LSAB) away day; members included: Police, Local Authority, NHS and independent Chair.  We looked at likely legislative impact of the Care Bill on LSABs and member organisations/services.

We reviewed successes and areas that need improvement.  Within the local area there is a good culture of reporting safeguarding adult issues.  There’s still more we can tailor our approach to safeguarding to the local population, including developing new policies, procedures, communications, undertaking audits & improving the effectiveness of the LSAB.

We talked about ‘what good looks like’ and systems leadership that we, LSAB, must show to get there.  The day was expertly facilitated by Research in Practice for Adults.

Day 10: Reflections

It’s the end of my second week; I’m still enjoying every day and haven’t yet questioned whether I made the right decision, so things are going well.

My impression of the role and the CCG is one of high aspirations to achieve some really beneficial outcomes for patients & the public, but resource constraints to do everything we want to.  Prioritisation will be key!

There’s still a lot to do to get the governance of quality right and to drive continuous improvement.  As we progress to improve patient’s experience and outcomes from services, the challenge ahead is inviting.

Day 9: Executive Committee, Discharge Team and Patient Safety & Quality Committee Development

Executive Committee Meeting first thing this morning; this is a weekly meeting of the CCG’s senior leadership team.  We covered a lot of issues in two hours, including some preparation for a Board to Board meeting with our main acute hospital provider later this month.

Attended a meeting with senior staff from our community services provider to discuss their review of the integrated patient discharge team.  Still much more work to do to get this right for patients so they’re where they need to be as quickly as they need to be.

Spent time this afternoon working on developing a Patient Safety & Quality Committee specifically for my CCG.

Read today about progress made in improving patient safety across England in last year; particular progress in reducing VTE (a kind of blood clot) but still lots more work needed http://www.hscic.gov.uk/catalogue/PUB11588

Day 8: Board Workshop Planning

Still meeting new and wonderful people with such passion for improving things for patients & the public through commissioning.

Spent some time today getting to know our mental health commissioning lead and current issues of how we connect quality & performance management.

Further planning today for a Board Workshop later this month about transparency & improving organisational focus on quality, putting the patient at the heart of everything we do.  Agreed this must be reflected in our vision & values.

Day 7: Community Services Q1 Quality Review & MH/LD Provider

Spent time this morning reviewing quality & safety issues for our community services provider in Q1 April – June) in preparation for formal quality review meeting later this week.  Some great work being done on safety & patient experience, but always room for improvement and a future challenge ahead with Health Visitor workforce.

This afternoon I met with the Director of Integrated Services & Director of Mental Health from our mental health & learning disabilities provider. They’re doing many good things around improving patient experience and to ensure a positive environment for therapy & recovery as well as well-developed community services.

Day 6: Team Starting To Form and Patient Safety & Quality Committee

Start of week 2 and the team is beginning to grow: my deputy returned from two weeks holiday; she has been doing an impressive job prior to me starting and is a real blessing to the Quality Team and CCG.  Also, a new face to the office; a temp PA to provide me and the Quality Team with much needed administrative support.

This afternoon: Patient Safety & Quality Committee, which we've been holding jointly with a neighbouring CCG. Today we agreed a plan to separate to have a committee specifically for our CCG, but with some continued joint working and greater clinical engagement, but still focussed on the huge quality and patient safety agenda ahead.

Day 5: Area Team Directors of Nursing & Family Photos

Impossible to keep to just 100 words today, so won't try (I knew this would happen, but thought it might be longer than 5 days before I had to break this rule, hope you still find it interesting!).

I spent the morning today with Directors of Nursing from both NHS commissioner and provider organisations in Hertfordshire & South Midlands led by Heather Moulder; this included acute hospitals, mental health & learning disability and community Trusts as well as CCG lead nurses.  The focus of the meeting was workforce and Regional Chief Nurse @RMayNurseDir joined us to talk about work she is doing leading National Nursing Vision Action Area 5. She presented an overview of guidance and national expectations for nursing workforce, likely to be launched at the Chief Nursing Officer conference this Autumn.

We also heard from Director of Nursing colleagues about nursing workforce challenges respectively in community, mental health and learning disability, along with impressive values-based recruitment to nursing and care assistant roles at Northampton General Hospital led by Suzie Loader.

We celebrated the success that has been achieved in reducing pressure ulcers within the region, but acknowledged that complacency must not be allowed as there is more to tackle on this, such as those originating from the community-based care settings.

There was also a very interesting conversation about compassion including the measurement of this.  Further research being done looking at measurement and how this can be used to best influence improvements in compassionate care.

My afternoon was spent catching up from being out of the office for the past day and a half and also, very importantly, finally got pictures of Mrs F & the kids out and put up in my office!

Thank you for reading my blog this week, do comment and feedback, as I want this to be helpful, interesting, useful to you and willing to improve this.  More to come next week.

Day 4: Area Team Commissioner Directors of Nursing & Quality

Where to start? Today, the job became properly real (in a good way). I spent the day with the other Directors of Nursing & Quality from commissioners within the Hertfordshire & South Midlands Area and from the Area Team. What an amazing group of people, inspiring leaders and incredibly welcoming of the 'new boy'.  We identified our shared purpose and values as clinical leaders and discussed the challenges that we currently face, both individually and collectively.  The day culminated in agreeing the priority areas we all need to address where working together will bring more value.  I feel privileged to be part of this group and look forward to meeting with the wider group of Nurse Directors from the area tomorrow. 

Day 1: It all starts here...

Today is the 2 September 2013 and my first day in a new job. This is the first of my 100 words a day for 100 days. It isn't intended to be Pulitzer Prize-winning material; but I aim to write around 100 words each day describing my experience of my new role and working in commissioning in the NHS. My first day as Director of Quality for a Clinical Commissioning Group was spent mainly meeting some fantastic people and getting acquainted with the building that will be my second home (it's a bit of a maze over 5 floors!). We talked about the challenges and opportunities ahead for improving health & outcomes for the local people and the need to increase a focus on quality whilst also moving to greater integration and efficiency.  Tomorrow I'm meeting with the Nursing Director of our major provider, so will write about this in tomorrow's blog (with her permission, of course). 

Day 3: Hospital Chief Nurse, Office Move, PA Interviews

Today started with the Chief Nurse & whistle-stop tour of the urgent/emergency care parts of the local hospital.  Great staff, all committed to great care, including identifying areas where 'the system' doesn't best serve patients, e.g. effective discharge.  Future visit(s) needed to get to grips with their more significant quality challenges.  Back at office had further time with colleagues in Medicines Optimisation & Human Resources to get to know them and their areas of the business.  Moved office to be nearer my team, supported by incredibly efficient IT & admin colleagues.  Final significant task of day was interviewing for a temp PA.  Spending tomorrow with Directors of Quality/Nursing from CCGs in local area.  

Day 2: Quality & Commissioning Teams

Last minute change of plan, my meeting with the hospital Director of Nursing was postponed, so I'll write about this tomorrow.  Today was spent meeting with further members of my team and catching up with wider members of the CCG family. As well as more generally getting to know people, we discussed issues, ranging from challenges of safeguarding for commissioners (newly published Government Policy on Safeguarding Vulnerable Adults available here https://www.gov.uk/government/publications/adult-safeguarding-statement-of-government-policy-10-may-2013) to the planned 111 service re-procurement. I continue to be impressed, but not surprised, by the dedication and passion of my new colleagues for the people we serve. There is a clear desire here to make things better and I am already proud to be part of this.