In Mind: Chief Executive Joe Rafferty's latest blog on six years in the Trust

Six Years to the Day…

For this week’s blog I’d like to start by thanking those colleagues that have written guest updates in my absence. It’s always good to hear things from a different perspective and from varied parts of the organisation, including Irene Byrne-Watts, our Director of Community Services for Learning Disabilities, Deputy Director of Nursing and Quality Sandra O’Hear, and Executive Director of Corporate Governance and Communications Elaine Darbyshire in recent weeks.

I’m sure some of you will be settling back into a work pattern after your summer holidays, in which case welcome back to Mersey Care. You’ll be aware that we have a Care Quality Commission (CQC) inspection pending and all the work that comes with that but I’m confident Mersey Care’s great workforce can once again demonstrate the hard work, resilience and innovation that makes this such a great organisation.

I can speak with some authority on that these days because today is the sixth anniversary since I started work at Mersey Care as Chief Executive. There have been plenty of challenges since that first day, but also many successes as well as a share of disappointments and moments of great sadness. On balance, however, it is now a very different organisation to the one that I joined. And this was the very challenge that our Chairman Beatrice Fraenkel set me when she offered me the role.

In some ways it has been six years of extremely rapid change; most of it progress and the majority of it aimed at getting the organisation to be a safe and effective place to work and receive care. We’ve expanded our mental health services by acquiring Ambition Sefton and Talk Liverpool, become a Foundation Trust and formed a Specialist Learning Disability Division from taking over Calderstones Partnership NHS Foundation Trust. Perhaps the biggest sea change in the outlook of this organisation, however, has been the move into community care in South Sefton and Liverpool.

Artwork created by an Ambition Sefton service user in a Bootle underpass

We have long argued that physical and mental health have suffered from a nonsensical division and recreating the service connection has been part of our strategy since my arrival. By expanding into community health we see it as a tremendous opportunity to provide healthcare that will serve the patients in their communities. Moreover it will strengthen those very communities by ensuring they are safe, mindful, healthy places. Physical and mental health are two sides of the same coin and shouldn’t be treated any differently.

Another big change to this organisation has been the tremendous progress we have made in improving our estate. I’ve written before about prioritising the development of a state of the art mental health hospital as one of my first tasks. We wanted to provide facilities that provided the right environment for recovery and move away from the tired old Victorian buildings that were associated with mental health up until that point.

We wanted to create a hospital that was clean, bright and provided the same standard of facilities that patients would expect from an acute setting. I think we achieved that and more with Clock View Hospital, which has subsequently won several awards for its design and commitment to patient care.

Clock View, of course, was just the start of our estate development programme. It’s been a long road but we’re all very excited about building a new state of the art medium secure unit, Rowan View, at the Maghull Health Park. This will create a clear Secure Services pathway at that site and link in well with our work at HMP Liverpool, where we provide mental health care.

Using the experience of developing Clock View, and the lessons we learned during that experience, has been invaluable to our other builds. We are progressing well with a new mental health hospital in Southport and have plans to build another on the current site of Mossley Hill Hospital.

Another part of the Trust’s actual as well as philosophical expansion has been the development of the Life Rooms concept - a community and learning hub, which was just in the thinking stage during my early days at Mersey Care. Since then, we have established two Life Rooms in Walton and Southport. Walton was officially opened by the Duke of Cambridge and we are currently developing a third site in Bootle in partnership with Hugh Baird College. This will provide another location where we can offer community services like employment and enterprise hubs, literacy, numeracy and IT skills and a range of courses through our Recovery College.

One of the things I’ve been most pleased about during this period of what often seems like constant change is that any periods of uncertainty have not resulted in any drop in the standards of care we provide for our service users, carers and patients.

That has been underlined by the fact we’ve gone through two inspections of our services by the Care Quality Commission (CQC), achieved improving ‘Good’ ratings, while some areas of the trust – most notably the Specialist Learning Disability Division – achieved ‘Outstanding’ ratings, which was some achievement at a time when the organisation was expanding.

Those of you who know me well enough will know that I am keen on data driven decision making. To assist this I am pleased that we are well into delivering our new clinical information system, and that we are seeing real and profound opportunities emerging out of our work as a Global Digital Exemplar. I am sure that in the next few years the basic work we are doing now on predictive analytics will lead us into new approaches and service offers because of the insights the approach offers.

Perhaps the achievement I’m most proud of during my time here, though, is the commitment we have made towards co-production and involving service users in the decisions that make Mersey Care what it is. That includes our estates improvements, where service users took an active part in the design, and also extends to Trust initiatives and culture. We do so because I believe their experience is vital in guiding us to achieve new standards of care.

Our work with ‘No Force First’, for instance, relies on experts with experience. They provide context to our commitment to reduce restraint, significantly improving both the patient and staff experience. No Force First has been rolled out across the whole organisation and other trusts and prisons are contacting us to share best practice. But its real success has been the creation of a ‘new deal’ between professionals and those using the service that has been - at times - a real challenge for staff having often been trained in a very different paradigm of care. But as always I have been pleased and bowled over in equal measure at the way you have all adapted, learned and looked for the pluses in much of the change that has come your way.

We have also committed to a ‘Just and Learning Culture’ within the organisation, which focuses on the process when things go wrong rather than automatically blaming the person. I’m particularly honoured to work with an executive team and board who have collectively wanted to lead the way on this. It’s been good to have also worked along side honourable and decent front line colleagues and staff-side officials who have diligently help me and the team get out culture shifting away from where it was to where we all want it to be. It has helped improve the trust within the organisation and reduced the time and money spent on disciplinary hearings and measures. Those of you new to Mersey Care may wish to see where the inspiration for all this came, Professor Sidney Dekker, and a short film of his visit.

I’m also delighted to announce that our Just and Learning Culture initiative has been shortlisted for the HSJ awards under the ‘Creating a Supportive Staff Culture’ category. There is still a long way to go and we have a presentation to make to the judges before we know whether we have won, but it still represents vindication of our decision to follow this culture at Mersey Care.

Our other major decision in my time here has been to commit to a zero suicide policy within our care, becoming the first mental health trust in the country to do so. Since that launch three years ago we have concentrated on working with others to identify data that will allow us to better predict risk.

It is still a work in progress and there is a long way to go before we get to where we want to be, but we’re developing a reputation both nationally and internationally for our work. We were also one of the founder members of the Zero Suicide Alliance (ZSA), a collaborative of NHS trusts, businesses and individuals who are all committed to suicide prevention in the UK and beyond.

The ZSA has received a big boost in interest these last couple of weeks following the BBC documentary ‘Stopping Male Suicide’, with nearly 2,000 completing the free suicide prevention training in the last week. Can I ask any of you that haven’t done the training – it only takes 20 minutes online – to please do so and improve the UK’s ability to have difficult conversations with those who are struggling? We have also strengthened our commitment to suicide prevention as an organisation by making a separate training tool mandatory across Mersey Care.

And all of this has been delivered while the trust has remained in financial balance, which is amazing considering the erosion of our baseline funding until recently. Occasionally I’m asked why we don’t “just” overspend - it’s happening in other organisations. My honest view is that maintain balance focuses us on the need to be continuously improving, adapting and adjusting - and that’s the life blood of success. Moreover, in deficit we would have had a lot of external management and leadership ‘help’. Our decisions would not have been our own and I truly believe we would have achieved less, not more because when have maintained the autonomy that has allowed us so much freedom to change. 

There are many other activities that have gone on over the last few years that I haven’t mentioned but they have been no less important. I have singled out the examples above because a new deal with patients, a more social model of delivery, the integration of physical and mental health services in the community, new and more therapeutic estate to make it all happen, a better more intuitive clinical information system and a kinder, more compassionate learning culture were all things you asked me to deliver when I was in post about a year. Those of you who were here at the time will recall the work we did collectively under the ‘Your Voice, Your Change’ banner.  We set some short, medium and long term objectives and I think it’s fair to say we have delivered hugely on the promises we made. I’m proud of that because you have all taken risks for Mersey Care and put your faith in our Board and it’s important that we keep our promises to you in return. It is on these sorts of things that deep trust is built and that is the absolute foundation of an organisation that will deliver for its users and carers.

I should also thank my colleagues on the Board and Executive team, who are supportive of what we are trying to do and the vision that everything we do should be the best it can possibly be, otherwise known as ‘Perfect Care.’

Last, but definitely not least, I’d like to thank each and every one of you for the hard work you put in, day in and day out, sometimes involving caring for some of the most challenging patients in the NHS system. Time, and the size of Mersey Care, does not permit me to travel around and meet you all personally as often as I’d like but rest assured I am constantly amazed by the standards of work you all set and I remain proud to be your Chief Executive.

Joe Rafferty
Chief Executive