Day 40: Spinning Plates

General reflections after 40 working days in the role (two months) are…

Everyone has been incredibly welcoming and open to work together; however, recent NHS changes, not just since April mean that there are a number of barriers to effective working.

There isn't a clear, common understanding about CCGs or NHS England Area Teams' roles between NHS/Local Authority commissioners, providers and other partners.

The relative newness of CCGs as organisations means we still have work to do to develop internal processes where previous PCT approaches don’t work.  Administration of our core business needs to improve to release time to focus on the more significant challenges.

Specifically within my team we need to improve our focus on the quality governance framework across the whole health community including for our smaller contracts with care & nursing homes, whilst maintaining sufficient focus on continued improvement through bigger contracts at the same time.

In summary, we can’t just keep plate spinning; they need cleaning, polishing and synchronising as well.

Thanks for reading.

Day 39: The Dog That Doesn’t Bark

“The dog that doesn't bark” was jargon used today (new one to me) to describe a 'measure' that suggests there may be no problem, but behind the measure there are problems!

This was at an Area Team Mortality Workshop today to locally share best practise and learn from Sir Bruce Keogh’s Mortality Reviews of 14 hospitals. Very helpful presentation about the different measures that are used to monitor mortality in hospitals, including the benefits and pitfalls of each.  If you want to know the difference between your SHMI, HSMR or RAMI, Advancing Quality Alliance have written a good paper.

Data is important, but, as the jargon suggests, much more important to work together locally across organisations within a local community and to look at mortality from a patient perspective, not being constrained by corporate boundaries. This needs to include the components of quality (as defined by Lord Darzi & expanded by Don Berwick):

• Safety (avoiding harm from the care that is intended to help).
• Effectiveness (aligning care with science and ensuring efficiency).
• Patient-experience (including patient-centeredness, timeliness and equity)

 We need to locally develop an approach to reviewing mortality at a patient, organisation, pathway, community and population level that is based on best evidence from England and internationally.  Also, and probably most importantly, we must engage with and involve patients and carers in the design and use of this process.  This will also help in communicating what we’re doing to the public to provide clear transparent messages that include appropriate reassurance.

(sorry, wrote 200 words today; could have written much more, such an important and interesting subject)

Day 38: CQUIN – pronounced [see-kwin]

No, this isn’t about Strictly Come Dancing! I attended two ‘Quarter 2’ CQUIN (Commissioning for Quality & Innovation) Review Panels today. CQUINs are schemes agreed with providers intended to secure improvements in quality of services and better outcomes for patients above the expected levels of quality agreed elsewhere in contracts.

The process for evidencing & reviewing actions, which I witnessed for the first time today as a commissioner, is very rigorous.  I was reassured by the robustness and fairness with which evidence was scrutinised by the panel and compared to what’s required before agreeing payment.

In addition to agreeing whether providers have achieved what was agreed, we identified areas for learning and improvement for the process for this and next year, which will make things even more outcome-focussed and further reduce any ambiguity.

Day 37: Public Board

My first public Board Meeting today; I did attend the last one, but that was before I officially started.  We met in a local community centre to be more accessible to the public instead of expecting them to come to the CCG offices.  There was a good number of the public there, including Healthwatch, but not all stayed to the end of a very long agenda.

Many important issues directly affecting patients covered, including agreement of a new policy for handling individual treatment requests, performance against national NHS Outcomes Framework targets, how complaints are managed and progress in meeting our local priorities.

Some good challenge & helpful contribution from Lay Board Members & public, but on reflection I can’t help feeling that we still have work to do to make the information we share & discuss in public more accessible; still too much jargon!

Day 36: Interviews – recruiting for values

Interviews today for Quality & Patient Safety Manager.  We have found a fantastic individual who performed well, demonstrating that calm and composed credibility can be just as influential, sometimes more so, than more extroverted styles of communication.

Very important to our decision-making was getting someone with the right values.  Competence in the role is important; however, QIPP, CQUIN and other acronym-based stuff can be learnt.  Displaying the values, enshrined in the NHS Constitution, are the foundation-stone I look for in anyone I would want to employ.

I believe we've found a great addition to the team and really look forward to when they start with us.

NHS Employers advocates a values-based approach to recruitment including support tools available online.

Day 35: Role Diversity

Another fantastic week; the diversity of my role is truly amazing! Here’s a few things I’ve done this week:

• Communications & Engagement Steering Group
• Reviewing procurement documentation
• Team One 2 Ones
• Equality & quality impact assessment process development
• Quality & Safety Manager shortlisting
• Community services visit
• Integration programme service area development
• Board Patient Safety & Quality Committee
• Safeguarding adults process review
• HSJ reporter interview for piece on Quality Governance
• Meeting Healthwatch
• Acute provider Contract Management Board
• Executive Committee
• Local Nursing & Quality Directors peer group meeting
• Developing action plan to improve QIPP programme progress

To top off a great week, I’ve just had a tweet from Dr Ranj!

Day 34 Difficult Conversations

Contract review meetings with main acute hospital provider today, including difficult conversations about areas where they’ve provided services to patients above contracted quantity.  We have limited resources to pay beyond the contracted levels.  Further discussion to be had with the Trust and at our Board meeting next week.

The Trust and CCG are continuing to work to help patients access the right services; particularly ‘unplanned’ care.  This is an area where patients have different options and A&E is not always the best place for them.  Our ‘Is A&E For Me?’ Campaign aims to help inform better decisions about self-care, seeking advice and using services like community pharmacy, GP out of hours, 111 and where appropriate, A&E.