MONDAY
Meeting with the
hospital CEO - this week we just talked stroke for an hour. We agree
that stroke services for Norfolk must improve; we're not yet in the same
place about money - whether 24/7 specialist stroke care can be
delivered at tariff, or whether it needs additional funding. We've
agreed to follow the facts, and ask the strategic network to conduct
financial and performance analysis on acute providers across the East of
England. In the meantime, we will find Trusts with a similarly large
stroke service (1,250 admissions per annum) and arrange some joint
visits for our clinicians to identify good practice in service
management and bring it back to Norfolk.
Stroke is rising to
the top of our agenda with the Trust partly because there has been such
significant improvement in so many areas - A&E performance (97%),
ambulance handover delays (average wait now below 15 minutes, and no
more than 1 or 2 60 minute breaches per week), elective waiting list
(less than 3% waiting over 18 weeks), MRSA (no cases for over a year),
and their level of engagement in whole system improvement. Older and
wiser men tell me that our winter planning is the most robust and
detailed they have seen in 20 years of NHS management (even as I write
this I know they are touching wood, rubbing charms, and cursing me under
their breath) and so the quality of stroke care receives a greater and
greater focus.
Like many other people I read the article
by Jackie Ashley about caring for her husband Andrew Marr, and
recognise that improving stroke care means more than hyper-acute
services. The next challenge for our Community Involvement Panel should
perhaps be to bring together a group of people living with the effects
of stroke to share their experiences, and help us ensure that the
support for patients and their carers does not fall away after they have
been discharged from hospital.
A plug for Nelsons Journey
- a Norfolk Charity that supports bereaved children. They enable
children to share their experiences through a series of one to one
sessions, and then a residential weekend where they meet other children,
share their experiences, and begin to come to terms with the loss of a
parent or sibling. The currently receive no statutory funding. The cost
of the service is less than £500 per child, and they are hoping the NHS
will fund them for the referrals made to them by NHS staff. I am hopeful
that our review of voluntary sector funding will release sufficient
funds for us to provide them with some support.
WEDNESDAY
There is a guilty
pleasure in having two days in the office with almost no meetings in it.
The NHS does a lot of its business through meetings - we review
information and proposals, keep people informed and on board, make
decisions, and take away actions. We agree to meet every 2, 4 or 8
weeks, then go on to the next meeting and do it again. Before we know it
the follow up meeting has arrived and we often haven't acted on the
decisions or undertaken the actions, because...we were in meetings. On
bad weeks it can feel like the Winnie the Pooh quote
'...coming
downstairs now, bump, bump, bump, on the back of his head, behind
Christopher Robin. It is, as far as he knows the only way of coming
downstairs, but sometimes he feels that there really is another way, if only he could stop bumping for a moment and think of it.'
It was nice to stop bumping; clear the inbox, catch up on the reading pile, and have some thinking time.
FRIDAY
Workforce Planning
in Norfolk (I don't know about the rest of the Country) seems to have
historically been treated by Commissioners as a 'provider issue'. The
current shift towards measuring providers on outcomes takes this even
further as we become less involved in their methods and more focused on
their results.
But I suspect the real reason we haven't got involved is that it's really, really difficult.
If you ask non PbR
providers to describe workforce needs they will look at their block
contracts, their efficiency plans, perhaps their Foundation Trust
business plan, and predict a reduced community workforce of 5-10% less
nurses, physios and OTs.
If you look at the
commissioner 'plans on pages' there are ambitious proposals to move care
closer to home and we need an increase of 5-10% in community based
health professionals. If we don't get this then recommissioning will be
futile, because we won't have the workforce to deliver the new service.
If you look at
population predictions about how many people will need nursing care -
from public health and the RCN - you get an increase of 10-20% over the
next five years.
We haven't yet factored in current vacancies, planned retirement, maternity leave, university dropout rates, career changes....
What I didn't
realise (forgive me) is that we can't afford to increase university
places for nurses, physics, and OTs by 20%, because the NHS fully funds
the degree course and pays an annual bursary to many of approximately
£9,000 per annum. And at c£60,000
investment for every nurse we train, we need to train the right number,
which is somewhere between -10% and +20% of the number we commissioned
last year...
I'm too ignorant to
comment on this with any confidence (so please explain it to me rather
than take offence), but I was surprised that - in an NHS where cash is
tight, and the market is our anointed solution to quality and efficiency
- we are using such expensive command and control planning processes
for workforce. Personally I'd like a little less market in my
commissioning (where it seems to add more cost and complexity than
efficiency and quality), and a little more market in my workforce.
This was my first
briefing as deputy chair of the Norfolk & Suffolk Workforce
Partnership, and my head is still spinning slightly, particularly from
the comment 'you can only really do effective workforce planning on a
continental level'. Perhaps this needs some thinking time the next occasion that I stop bumping...