MONDAY
An encouraging
start to the week - our first stakeholder board meeting with Anglia CSU
and the Business Development Unit of NHS England. When any provider is
struggling you want three key things:
1. They openly recognise the depth and nature of the problem, and accept their responsibility for fixing it.
2. They provide a credible plan, which - if fully implemented - has good prospects to bring performance to the required standard
3. They believe that they can be a high performing organisation, and are determined to succeed.
The CSU leadership team have made significant progress on all three elements, and although the recognition needs to pervade the organisation, the plan needs more detail, and determination needs to translate into results; I have a renewed confidence that our local CSU may yet survive into and beyond the 2014 market testing process. I wish them and all their staff success, and we will do what we can through the fortnightly stakeholder board meetings to support their ongoing improvement.
1. They openly recognise the depth and nature of the problem, and accept their responsibility for fixing it.
2. They provide a credible plan, which - if fully implemented - has good prospects to bring performance to the required standard
3. They believe that they can be a high performing organisation, and are determined to succeed.
The CSU leadership team have made significant progress on all three elements, and although the recognition needs to pervade the organisation, the plan needs more detail, and determination needs to translate into results; I have a renewed confidence that our local CSU may yet survive into and beyond the 2014 market testing process. I wish them and all their staff success, and we will do what we can through the fortnightly stakeholder board meetings to support their ongoing improvement.
TUESDAY
A very effective
meeting in public with important decisions on quality of care, service
design, and finances. The two sections that give me the most
satisfaction is our support for the voluntary sector (ring-fencing
current levels of investment as a minimum to 2015, and gradually
realigning the budget to match our health and wellbeing strategy) and
the Co-Production Model.
In the spring of 2012 - during the earliest shadowy days of the CCG - we commissioned the Charity 'Equal Lives' to investigate how we could achieve genuine public involvement in the commissioning of healthcare; to move from 'we design than consult with you' to 'we design it together'. On 5th July we received their report and recommendations (see blog w/c 1st July)
Their central proposal is the establishment of Community Involvement Panels - a group of service users and community representatives to work with us on the redesign and procurement of services. We will be putting their recommendations into immediate effect with a full scale review of community mental health services, leading to a re-procurement planned for April 2015.
The discussion regarding finances was more difficult, with lengthy debate on two important issues. The first is that the Governing Body have reluctantly accepted that we will have to set aside almost three quarters of our 2% transformation fund to meet a legacy debt inherited from the PCT. These are legal claims from patients who believe that they were wrongly denied continuing healthcare between 2003 and 2009, but whose claims were not processed by 31st March this year. This is £2.95 million that should be spent on transforming healthcare, but the books must balance.
Second (and also on the subject of making the books balance) we discussed a more fundamental problem - the simple fact that although we are almost at the end of month 4 we do not actually know what our CCG budget for this year will be. It is officially set at £210 million, but with arguments about the amount deducted for specialised services (commissioned by NHS England) and errors in the 2012 baseline exercise conducted by the PCT, there's a range of about £9 million either way. Our entire QIPP programme for this year is £6.2 million, which gives some idea of the scale of the problem. My Finance Director has planned prudently, but if every decision goes against us we will have a £4 million shortfall, and only 6 months to find the money. The solutions will either be a deficit position, or very unpalatable cuts to services. We will be unlucky indeed to end up in this worst case scenario, but we cannot use a 'cross your fingers' approach to financial planning. The September meeting of the Governing Body may potentially be facing some very difficult choices.
In the spring of 2012 - during the earliest shadowy days of the CCG - we commissioned the Charity 'Equal Lives' to investigate how we could achieve genuine public involvement in the commissioning of healthcare; to move from 'we design than consult with you' to 'we design it together'. On 5th July we received their report and recommendations (see blog w/c 1st July)
Their central proposal is the establishment of Community Involvement Panels - a group of service users and community representatives to work with us on the redesign and procurement of services. We will be putting their recommendations into immediate effect with a full scale review of community mental health services, leading to a re-procurement planned for April 2015.
The discussion regarding finances was more difficult, with lengthy debate on two important issues. The first is that the Governing Body have reluctantly accepted that we will have to set aside almost three quarters of our 2% transformation fund to meet a legacy debt inherited from the PCT. These are legal claims from patients who believe that they were wrongly denied continuing healthcare between 2003 and 2009, but whose claims were not processed by 31st March this year. This is £2.95 million that should be spent on transforming healthcare, but the books must balance.
Second (and also on the subject of making the books balance) we discussed a more fundamental problem - the simple fact that although we are almost at the end of month 4 we do not actually know what our CCG budget for this year will be. It is officially set at £210 million, but with arguments about the amount deducted for specialised services (commissioned by NHS England) and errors in the 2012 baseline exercise conducted by the PCT, there's a range of about £9 million either way. Our entire QIPP programme for this year is £6.2 million, which gives some idea of the scale of the problem. My Finance Director has planned prudently, but if every decision goes against us we will have a £4 million shortfall, and only 6 months to find the money. The solutions will either be a deficit position, or very unpalatable cuts to services. We will be unlucky indeed to end up in this worst case scenario, but we cannot use a 'cross your fingers' approach to financial planning. The September meeting of the Governing Body may potentially be facing some very difficult choices.
The Governing Body papers and a summary of the meeting can all be found on our website at www.norwichccg.nhs.uk (About Us - Governing Body)
THURSDAY
"You are not a PCT, we are not the SHA, and this is not a performance meeting."
On my experience of
them to date, the leadership of the Anglia Area Team are a credit to
NHS England. Our three and a half hour checkpoint meeting was
professional, well informed, focussed on areas of genuine importance,
and saved us hours of box filling by basing the discussion on
information already produced for our Governing Body. We were
congratulated on having our final authorisation conditions removed, and
credited for our approach to urgent care reform and the contract and
relationship management of our local hospital. Where we need to improve
they provided us with good practical advice that offered technical and
tactical solutions.
The meeting was
never cosy, and there was robust challenge on stroke performance (below
standard and needing more urgent action), financial planning (we need
more contingency planning if the current uncertainty about our
allocation all goes against us), and Continuing Healthcare (more pace in
the reform of the system). But even at points of disagreement the
meeting remained professional, respectful, and good humoured. They
recognised that their management of Primary Care had not been good
enough in the first quarter, and set out in detail what had been done to
put it right for the future.
It's early days in
the relationship, and the true test will come when the NHS is under real
operational and political pressure. But if we are able to maintain this
productive approach I have no doubt that we can develop a culture of
transparency, a partnership approach to quality improvement, and slowly
rebuild the reputation and public confidence in our local NHS.