Day 100: The End Of The Beginning

‘The End Of The Beginning’ is a little-known short movie from 2013. Even though it’s awards season (and that movie won’t be getting many!) I don’t want this to read like an Oscar acceptance speech and I promise I won’t do a Gwyneth Paltrow!

Whilst this post represents the end of my 100 day challenge, it is only the end of the beginning in terms of my time in this new role and I think I can safely say I am no longer in my ‘induction’ period!

I want to say a special thank you to Mrs F for her support in helping make me who I am today and particularly for sacrificing 100 half-hours of me so I could write this blog.

Thank you to my colleagues in Luton and the wider world of the NHS, Quality & Nursing who have given me much of the inspiration and material for the last 100 days’ posts.  With 10,000+ page views, that’s an average of over 100 per post, which is many more than I expected at the outset.

Thanks to everyone I’ve met for the first time in the last 100 days who’s said “we haven’t met before, but I’ve read your blog”.  This has given me a particular buzz, but been a little bewildering at times.

The experience of writing every day for 100 days has been really rewarding.  Taking time to reflect on the day and what I’ve learned is a discipline that I will certainly be continuing.  Some days have been harder than others to write about, but in the main my biggest problem has been writing only 100 words!

There have been low points during the past 100 days, as well as many high points.  There’s been dancing, I’ve got angry and I’ve certainly come across some ‘wicked problems’.  The image below is a word cloud made up of all the content from the last 100 days, which is 10,000+ words.

My plan for day 101 and beyond is to continue to blog, but in a bit more depth and less often than every day (Mrs F will be pleased!).  500 words a week for the next 50 weeks would be a good challenge to set myself to keep me writing; so if there are any particular topics you want me to explore in my blog, contact me, let me know and we’ll see how this evolves.

Thanks again and stay in touch!

(PS I knew I’d never keep this final post to 100 words, so I wasn’t even going to try!)

Day 99: To Fund Or Not To Fund?

We’ve policies about treatments funded by the NHS in Luton in line with priorities for local people.  We’ve a process that allows GPs to apply on behalf of patients, where there are exceptional circumstances, for them to receive treatment not normally funded.  As you can imagine, this can be a legal minefield.

Today I attended an annual training session for the clinicians and managers from the CCG who sit on the panel, which makes decisions on these individual treatment funding requests.  Always difficult decisions, as they affect individuals, but this training will help ensure we make them fairly and legally.

Day 98: The Magic Number?

De La Soul’s 1990 hit, says the magic number is ‘Three’.  At the Commissioning Nurse Leaders meeting today, our first task was, in groups, to identify three important issues that we’re challenged by to inform the day’s agenda.  Once conversation started flowing we found it hard to keep it down to just three!

All groups then shared their priorities, which essentially fell into or represented three elements: Leadership, Relationships & Accountability.  So my ‘take-home message’ from the day was to continue to develop relationships, the importance of real leadership and have to clear lines of accountability.  There’s no ‘magic’ solution.

Day 97: Equity, Equality & Quality

I met today with colleagues from the Local Authority who are helping us improve our approach to measuring and monitoring the impact of what and how we do things.  In particular they’re advising on improving how we assess the impact on patients, public and communities in terms of equality of services.  We are using something called Integrated Impact Assessments, which will allow us to identify where we need to do things differently to ensure that what we do has a positive impact.  We’ll be using this approach to help us in our current procurement of mental health & community services.

Day 96: Social Media Impact

We’re thinking more about how we want to use social media as an organisation and how we better engage with local people, including using social media.  To do this well, we need to ensure that what we do is based on best available evidence.

This blog is more a request than reflection: If you know of any tried and tested use of social media to engage with patients and/or public leading to improved knowledge, services or outcomes; please let me know.  We have limited resources, so want to use them wisely to get the best for our local people.

Day 95: #TimeToTalk

Today is supposed to be ‘Blue Monday', the most unhappy day of the year, but this hasn't got a great scientific basis.  Did you celebrate ‘Blooming Monday’ today? If not, put it in your diary for next year!

Whether it’s the depths of winter or mid-summer there are still many millions in the UK alone affected by mental illness.  The Time to Change campaign, run by Mind and Rethink aims to challenge stigma and stereotypes about mental illness through #TimeToTalk.  Join 50,000 others and make your Time to Change pledge here.

It's no coincidence that the Department of Health launched its Action Plan for Mental Health today.  The aim of this plan is to “…make a difference, in the next two or three years, to the lives of people with mental health problems”.  This will only happen if all of us more openly talk about mental health and recognise it as being important as physical health.

I was also alerted today, by Dr Alys Cole-King, to the Royal College of Psychiatrists and Royal College of GPs’ guidance on suicide mitigation from the Primary Care Mental Health Forum. Aimed at GPs, it’s helpful for other health professionals too.

I’ve rambled a bit and gone over my 100 word limit today, but it’s such an important subject and we must do all we can to end the stigma of mental health and ensure parity of esteem with physical health.

So go on, start the conversation, it’s #TimeToTalk…

Day 94: Quality Collaborative - Practice Nursing

Update about the Quality Collaborative at today’s CCG Nurse Directors’ meeting.  This is a series of projects we’re doing across local CCGs on areas of quality to use localised expertise more widely and prevent duplication.  Areas we’re addressing include pressure ulcers, infection control, care homes and practice nursing.

Each area’s sponsored by a CCG Director of Nursing, which means we’re accountable for delivery, act as a sounding board and ensure focus maintained and outcomes achieved.  I’m overseeing the practice nursing work, which I’m really excited about and keen to progress to support & develop what can be an isolated workforce.

Day 93: “I am the one and only” Chesney Hawkes

Today’s blog isn’t about my Chesney Hawkes incident, but now I’ve got your attention…

This afternoon I met with the Director of Nursing of our main acute hospital provider.  At the start of our meeting I joined her daily, afternoon bed management meeting where operational and nursing staff review the current situation in the hospital and look at staffing for evening, over-night and into the next day.

This is one of many ways in which the hospital manages the pressures at this busiest period of the year.  Throughout this process privacy, dignity and quality of service to patients is paramount.

Day 92: “Fab 4 Questions for Nurses” from @PDarbyshire

Patient Safety & Quality Committee, Community Service Chief Nurse One-2-One and 111 Clinical Governance Group meetings today, but I thought you’d prefer to read about @PDarbyshire’s tweet and my answers to his “Fab 4 questions for Nurses”:

1. What do you do all day? – Work with others to improve the health and outcomes for people of Luton.
2. Why do you do it? – It’s a calling and I love it!
3. How can you do it better? – More active listening.
4. What positive differences do you make? – Supporting my team in achieving individually and collectively, especially on the ‘difficult’ days.

Day 91: Development Day

Today we held a planning development day where we brought together colleagues from across the CCG to further develop some of our plans for 2014/15.  One aim of the day was to progress our preparation for discussions with providers about contracts for the next financial year.  We wanted to better develop our commissioning intentions into more tangible plans before entering the annual process of negotiating contracts with providers.  The result of the day was that progress was made in developing plans.  There’s still more work to do internally and with providers to make them a success for patients next year.

Day 90: A Great Opportunity

It’s not easy to attract people come to work in the NHS in Luton, particularly new GPs and practice nurses.  We are developing innovative approaches to attract people to work here, some of which include some diversity to the roles.  In addition to working in practice there are opportunities to work in education and/or clinical leadership within the CCG itself.  Our intention is that, if we secure the funding for these roles, they will be for a fixed period, e.g. three years, then we will recruit to them again for new people to keep bringing more new talent into Luton.

Day 89: Saying Sorry Is The Right Thing To Do

I got angry today.

It doesn't happen often.

People who know me well are aware I’m a calm person and rarely get wound up or angry.  Today was different.  Sorry I can’t disclose more details, but it was about the way in which a patient had been treated.  I waited until I was calm then took action.

Not unrelated, today I saw a brilliant new leaflet from the NHS Litigation Authority about saying sorry.  In spite of what people might think about an organisation responsible for managing NHS negligence claims, they recommend saying sorry as the right thing to do.

Day 88: New for Old

Spent most of today in Bicester at the call centre for our new 111 service that’s due to launch in about a month.  The national 111 team came to visit to review progress in getting things set up for the new service before it launches.  Luton was one of the first pilot services, which started in 2010.  Then I was involved in pre-launch reviews representing the ‘provider’, but today as the ‘commissioner’ of the service.  Some interesting questions posed to us about how different call scenarios might be managed, particularly how serious incidents would be handled between provider and commissioner.

Day 87: Mentoring

I had an initial session with my new mentor today.  I am fortunate and grateful to be working with such supportive people who are keen to help me develop and learn.  I’ve been given time and an excellent mentor to help me work through how I need to change to achieve my aspirations.  This will include what I need to experience, learn and do to develop and grow.  It will make me better at what I am doing now as well as in any future roles.  It will allow time for reflection and focus to putting these changes into practise.

Day 86: “The Most Important Group in the CCG”

I attended our Patient Reference Group tonight.  This group is made up of representatives from each of the patient participation groups from each of the GP practices in Luton.  I attended to talk about quality and safeguarding.  The thing that sticks in my mind from the meeting is something that was said by one of the attendees; “this is the most important group in the CCG”.  Patients and the public are at the centre of our plans and decision-making, but a conclusion from the meeting was we need to work harder to engage more and more effectively when we do.

Day 85: Planning the Plan

Shortly before Christmas guidance was published by NHS England on developing five year plans for 2014/15 – 2018/19.  Also, late in 2013, further information was published about the Better Care Fund to support integration between health and social care over the next five years.  In plain English this means that the NHS and local councils will both put in money to reduce duplication and to provide services better together.  I met with executive colleagues today to talk through our NHS contribution to this fund and how we will work through all the guidance to develop plans for the next five years.

Day 84: Individual Treatment Panel

In October 2013 our Board agreed an updated policy for funding individual requests for treatment falling outside what is normally funded locally by the NHS.  Today I attended our regular panel meeting to consider the requests that we’ve received recently.  The panels decisions are based on how exceptional the individual case is, whether the condition treatment is requested for is rare and also how strong the evidence is for clinical and cost effectiveness of requested treatment.  None of the decisions were easy as they all related to individual patients needing treatment, but decision-making was professional and aligned to our policy.

Day 83: New Year Resolutions

Normal blogging service now resumed for the New Year up to Day 100.

Following my 2013 New Year Resolution I made one for 2014 yesterday. This was personal, but important to me and reflects my aim to also improve my work-life balance in 2014.

This doesn’t necessarily mean spending less time ‘working’, but for me to think and act more on how work affects home life in terms of how I allow it to influence my thoughts, behaviours and mood while I am with my family.  I enjoy my work and love my family; striking the right balance is essential.