You’ll all be aware that last weekend marked the changing of the clocks and the countdown towards better weather ahead, or so we’d like. We’ve also marked the year since lockdown began and paid our respects to those who died or have been affected by the pandemic. The clocks have changed and restrictions have eased ever so slightly, but the way we work hasn’t so, as always, it’s important to remain vigilant.
We don’t yet fully understand all the effects of COVID-19, on mind and body, directly and indirectly, but we’re learning to live in a world with the virus. Vaccination gives us the opportunity to see it as a disease that can be more readily managed in the community. Our take up of the vaccine as a Trust has been good and is now available to all of our staff. If everyone has it, we can see a way through to looking at what we can do next, to make things better.
For Mersey Care this means making sure we have all our services in exactly the right places. Those who need our services must feel enabled to access them and while we’ve seen large scale activity in some areas, such as crisis services, there’s a need for better and more joined up physical and mental health.
Next month I’ll write in more detail about how we build back better. We must now restore and properly embed both the lessons we’ve learned and the experiences you’ve told us about, directly and through such mechanisms as the staff survey and culture of care barometer.
Health and social care
I’ve written before about the Government White Paper on Health and Social Care, which is a welcome move away from competition and internal markets towards greater integration and collaboration, better provider collaborations and digital streamlining. I’ve often said that; ‘you campaign in poetry but you govern in prose,’ so it’s a strong overall message which draws you into future benefits, but how it actually operates in practice will be the critical factor as to whether it makes a difference to patients and all of us.
We must make certain we have an NHS free at the point of use, accessible to anybody, and that means not being locked out because of digital or other deprivations. We all want to be in an NHS which works to the highest standards and where the choice – the right choice I’ve always felt – is to integrate physical and mental health as equal parts of the same.
That’s the big message from the White Paper - thinking about the whole patient as a priority, not just the person sat in front of the GP and all the populations they represent, their clinical needs, their protected characteristics and beyond. Some changes are with us very soon. Integrated Care Systems (the former STPs) are to be established on a shadow footing on 1 April. They’ll have two elements – an NHS ICS board, taking over former CCG and specialist commissioning, and an ICS health and care partnership board.
There’s a very powerful blend of responsibilities here for them. For those of us who’ve been around for a while it’s tempting to think it’s just another reorganisation of commissioning. This White Paper is very strong on providers behaving differently, on co-operation as the first instinct and on networking with other trusts, councils and voluntary sector providers. Our experience of the last 12 months does really suggest that there is a very significant opportunity to be had by pursuing this sort of approach.
Shortly after Easter, Director of Nursing Trish Bennett and I will be out in services, meeting staff – carefully and safely of course – in all our clinical divisions. We’ll do this weekly and, great though it always is to be out and about, this will be a real listening exercise. We want to continue to hear and learn from you.
There’s understandably been a lot of attention on the acquisition of North West Boroughs Healthcare and our new community contract in Southport and Formby, so this is a valuable opportunity to take stock of all our services and listen. We’re giving a lot of attention to our new friends in the Mersey Care family but at the same time we must keep everyone in the loop: I’m aware of the anxieties and pressures in the system from Whalley, in our community settings, as we settle into our new builds and the moves from Mossley Hill.
Looking further ahead we will be bringing back the Mega Conversations. Some of you will be very familiar with this exercise and for our newest colleagues, it’s a series of engagement events we really value in Mersey Care. I’d like to think of it as a big family conference. We put things on the table and we look at what’s priority for you in your ward or team. They are honest, challenging and lively – and ultimately constructive and valuable.
Past “Your Voice” sessions gave us really strong material, from your ideas and from staff feedback. The earliest form of restorative just culture came from these sessions and it rightly has its roots in what staff wanted and needed. Likewise, our new Big Hairy Audacious Goal - zero acceptance of racism, discrimination and disrespectful behaviours - comes from some challenges, including in the staff survey, but also from where Mersey Care as a major organisation should be taking a strong lead.
The operational plan and the clinical strategy
At the Board of Directors meeting this week we’ll look at our new strategy wheel and the operational plan. I know the wheel is a familiar sight for some, from many documents and PowerPoints but for others, it may need some introduction.
The wheel is a visual description of our long-term strategy and our objectives, with our vision placed in the middle. The strategy is about population health management, integration in our services and pursuing clinical excellence. It’s about better understanding our population’s needs. This year there’s a difference in that we’d previously describe lots of strategic intentions but this year, as we know COVID-19 will be very present in our world for the next year and beyond, there’s a big focus on managing the recovery as well as looking ahead to our other strategic intentions.
We want to lead the way in whole, life-long person care in safe services, with quality improvement thoroughly embedded, treating people with compassion, dignity and respect, including supporting our own staff to develop and where we really understand, our communities. There’s lots of talk of levelling up, so everyone can get the best – avoiding different opening times, different availability – and our ambition should be to be equal and accessible with a standard operating framework across our footprint. These are good, sensible next steps for us.
We have ambitious plans for our estates, digital technology and corporate services that align with and help deliver changes in our clinical model. They reflect the new ways of working required by the pandemic. As you will see from the documents, our long-term ambition is constant: we are pursuing clinical excellence through perfect care and these strategies set them out in the current post COVID-19 context.
Tackling the challenges facing us needs a human-centred response, based on deep understanding of the people we serve, place and community and people’s experience of health issues and health inequalities. There’ll be a lot of attention in the year ahead gaining greater insight about the experiences of our service users and communities and using this understanding to address inequalities in access to our services.
I’ve already said that striving for perfect care remains, but it no longer means just striving for perfection in an episode of care. Now it should mean becoming more preventative and integrated in our approach, seeing people in the context of their families, their communities and their neighbourhoods.
We introduced our new clinical strategy to managers last week. All staff need to know of its three headline areas - prevention, integration and clinical development. Trust clinicians will deliver a model of care that will better support the population we serve where care is co-produced to enable people to take greater control of their own health and wellbeing, throughout their lives.
All staff must be engaged on this so the care you deliver is clinically excellent. This is about continual professional development to deliver our model of care, and about a partnership with those who use our services and their carers, so we can see and measure the difference we make to their lives.
Here is a good example of that development. There was a positive piece about a local vaccine clinic for people with learning disabilities in the Guardian newspaper the other day. Our own Hilary Harper rightly points out there’s a sizeable demographic who need extra help. We know that people with a learning disability are six times more likely to die from COVID-19 and this is part of a new way to deliver clinics which is finding issues beyond just giving people the jab. It’s great to see Mersey Care’s part in providing proactive care and meeting health needs holistically for a particularly vulnerable group.
Celebrating the season
Finally, can I offer several best wishes to colleagues who may be marking one or a number of festivals just now. I’ve shared good advice for colleagues soon to mark Ramadan and I’ll say Nowruz Mubarak: I know our BAME group heard about Persian New Year last week in a well-received presentation. The last weekend saw Passover and I wish chag sameach to Jewish colleagues.
Yesterday was Palm Sunday, marking the beginning of Christian Holy Week, and for many of our staff there’s extra activity right now for World Autism Week with some excellent awareness raising happening on wards and online from psychologists, OTs and nursing colleagues.
For those taking time off for the two bank holidays, I hope you will be able to enjoy the break and, safely of course, relax.
Prof Joe Rafferty CBE