Kathy’s Blog – autumnal colours, thanks and preparing for April

I always feel that the appearance of autumnal colours is a visible reminder of the year moving towards the festive season.  Christmas (for those of all faiths or none) is a time for family – and for us all in the NHS and care system I like to think of us as a huge family.  So, I want to focus my blog on saying thank you to all of you.  The depth of gratitude that I know exists in our communities for the dedicated and committed work of all of our teams cannot be overstated, but at the same time, no thanks, no clapping, no warm words can compensate for the exhaustion and, in many cases, trauma that I know many of you that have worked without a real break since the pandemic began feel.

I want to add my heartfelt thanks to everyone as we move into winter, as the pressures will be likely to increase and therefore we will all need to find that inner strength and resilience to continue to deliver for those who need care and treatment.

The pressures that we are experiencing are to be found across our system – in community services, general practice, hospitals, emergency departments / urgent care, social care, 111, the voluntary sector, ambulance and transport services and elsewhere – but in particular I want to acknowledge the incredible work of Primary Care.  Our GPs and the wider Primary Care team are the true backbone of our health and care service.  The criticism General Practice is receiving at the moment from a range of sources is extremely disappointing – I know from my own experience and from hearing from hard working GPs that their dedication and commitment is undiminished in the face of rapidly rising demand and constrained resources

We have many things to continue working on together but I think there are three broad areas we need to focus on over the next few months until April 2022. These are the same three things that I have prioritised since I joined the system earlier this year: delivery of our operational challenges (including elective recovery, managing pressures and completing the vaccination programme roll-out); ongoing development of our ‘signature’ transformation schemes as well as the development of our Places and Population Health Management; and to ensure that we are ready to operate as a statutory ICS on 1^st April 2022.

It’s on this latter point that I want to update you on in particular.  Throughout October we are conducting the recruitment process for the Chief Executive for the Integrated Care Board (the new NHS body which will take on the powers of the CCG).  Supporting that Chief Executive when they are appointed, we will need a talented Board for the ICB.  We’ve had some really useful discussions within the current ICS Board regarding this, covering topics like the balance of Non-Executive vs Executive members, the importance of  representation from both of our top-tier local authorities (City and County) as well as ensuring that we have the right level of strategic leadership for integration across the system.  We will soon be able to share more widely the proposed future Board membership roles to ensure that we are making the best initial decisions. April 2022 is just the end of the beginning and the start of the journey.

There have also been lots of discussions about how we will work more closely with our citizens to ensure that they are fully involved and informing us as we develop the work of our Integrated Care System (ICS) and about how we can build on the collaboration and integration with voluntary, community and social enterprise organisations in our area.  All of this will help to feed into the development of our Integrated Care Partnership (ICP) which will act as the ‘guiding mind’ for our system from next April.  But once again, April is the start of the journey, not the end, and listening to partners across the system to influence our work is going to be a signature of our system.

Finally, I would like to stress again how keen I am to be getting out and about to meet with you and discuss your programmes of integrated care transformation from across the system. I’ve particularly enjoyed spending time over the last couple of months with leaders of our Place Based Partnerships.  I am really clear that the change we want to see take place in our health and care system will be driven by our Places and Neighbourhoods (PCNs) – as vibrant collaboratives that can take the strategic direction set by the ICP and the ICB and implement it really creatively and directly with our citizens and partners.  I’ve also really valued meeting in recent weeks with leaders from our Voluntary, Community and Social Enterprise (VCSE) sector and also with Healthwatch.  Working with groups like this, as partners, to support and challenge the development of our approaches will be a critical part of our success in the coming period.

As always, please do share this update with others if they have not received it and please do get in touch directly on kathymclean@nhs.net if you want to discuss something with me or have a question or an idea or want to share with me the work of your team.

My final thought is how we support our colleagues at Nottingham University Hospitals at the moment.  We are a collaborative system so we should all collectively own issues in any one part. We know that that our residents and staff at NUH have not been receiving the quality of service or leadership that they should expect from their NHS.  But importantly, I see the solution for this as being one that is jointly owned by all system partners, on behalf of our citizens and colleagues.  We are only as strong as every link in the chain and I know that you will all join me in looking to support the senior team at NUH to put in place the right solutions and plans to move things to a better place.

I will likely share a further blog this side of Christmas so I’ll save my formal seasonal best wishes until then but for now, continue to stay safe and look after your families and friends and keep focussed on delivering the health and care services for our residents for now and the future.

Best wishes,

Kathy

Kathy’s Blog – making the weather and creating opportunities for our population

When I last wrote to you, it happened to be a glorious sunny day and I am sure we all hoped for a period of good weather.   Well, that hope came good, and I certainly made the most of opportunities to walk up a few hills, with rewarding views. Thinking about the weather I was struck by the reference made by Lord Simon Stevens, outgoing Chief Executive of NHS England/Improvement, in his valedictory interview.

He was reflecting on the challenge ‘of piloting the NHS supertanker’.   One lesson he has learnt is that there will be crunch points “when you have to decide that you’re not just going to take your external environment as a given, but instead you’ve got to make the weather”.

I believe that   here in Nottingham and Nottinghamshire we are pretty good at ‘making the weather’ – creating opportunities to make the changes for our population where there might otherwise be ambiguity.   But alongside this, we are receiving some important external inputs which should help us to accelerate progress.

The first I wanted to share is that I am delighted to have been confirmed in role as chair designate for the Integrated Care Board (the body that will replace the CCG and assume its responsibilities).   Whilst the Health and Care Bill still has to go through the Committee stage of its approval process, in parliament, you will see that many of the major elements of the future are starting to be agreed nationally and locally.

Another of these relates to ICS boundaries and the Government have recently confirmed that the boundary of our ICS will expand to include Bassetlaw.   This means that the ICS has the same boundary as Nottinghamshire County Council – making it easier to deliver joined up health and care.   For residents in Bassetlaw there will be no change in the access to health care, for example they will continue to see by the same local GP practices and will carry on receiving other health and care services in the same way.   I recognise that some partners may not initially welcome this change but my commitment is that we will work carefully to understand any concerns and seek to resolve them as straightforwardly as possible.

Alongside this progress in confirming the foundations of our system ready for April 2022, I am pleased that we are continuing to deliver in the here and now on the services that our citizens expect.   The vaccination programme is coming towards the end of this first phase and I’m delighted that 84% of our adult population has had their first vaccination, with 67% of people already fully vaccinated with their second.   As we prepare for an autumn phase of boosters and also provision of vaccinations for younger people I want to say thank you to colleagues from all across the system for their contributions to this work.   This time last year it was almost inconceivable that those levels of vaccination would have been achieved – well done to all involved.

The work to refocus on non-Covid treatments is progressing well, even with the additional challenges of the current pressures impacting on bed availability.   Using the Elective Accelerator funding from NHSE/I and working together across commissioner and providers, we have been able to ensure that more than 2000 additional people have had their operations and nearly 5000 have had their diagnostic test sooner than expected.

And, despite it being August, planning for winter is well under way.   We are taking all the learnings about joint working across the NHS and Local Authorities from the pandemic and applying them to ensure that we are as prepared as possible for the coming winter – using all our efforts to support care homes and wider social care, enabling colleagues in the hospitals to treat and discharge as quickly as possible and aiming to persuade as many citizens as possible to choose wisely for their health needs.

Supporting the most vulnerable in our society with their health needs is a key focus for us so I’m pleased that Nottingham has been awarded  £3.5m from the Changing Futures programme.   This funding will ensure that much of the work of Opportunity Nottingham will be able to continue, including support for people facing homelessness, those suffering with mental health issues, people with a history of alcohol or substance abuse and victims of domestic abuse.   This is another example of excellent joint working between Nottinghamshire Healthcare NHS Foundation Trust and Nottingham City Council along with other partners within the Nottingham City Place.

I opened this blog with a quotation from the outgoing Chief Executive of NHSE/I so it seems fitting to close it with something from the new incumbent: Amanda Pritchard.   The first woman to lead the NHS, Amanda is a fantastic leader who I know will drive forward the delivery of plans for integrated care.   This short thread on Twitter sets out some of her early thoughts and in particular I would note her commitment to innovation in order to tackle the big challenges around access to care and preventative interventions as well as on the major killers like cancer and stroke.   Whilst I’m mentioning Twitter do check out the ICS’s feed here which every Friday includes a round-up of the latest news and information from across our system.

I hope that when you read this update you will have had a refreshing summer break or that it is on the horizon and that you will be ready to take up these challenges in the autumn.   In the next few weeks we have a great deal of work to do, including agreeing the membership of our Integrated Care Board as well as the Integrated Care Partnership, along with confirming how these bodies will interact with our four Places and the new Provider Collaboratives.   This will all need careful thought but once we have it right these will be the key building blocks for our System.   I am confident we can achieve all this by working together and look forward to continuing to work with you all to progress this exciting work.

Best wishes,

Kathy.