Chris Butler's blog

Dark days, new resolve

2011-12-23T01:08:00.000-08:00

I am writing this on the day of the winter equinox, the shortest day of the year or, to put it in another way, the darkest day of the year. In some ways this is emblematic of other things happening right now including uncertainty in the national and international economy; rising numbers of people without a job; and people’s incomes shrinking in real terms.

For us in our Trust we are affected by the need to follow through large scale change programmes. This is compounded by other things such as uncertainty over pensions, in the context of some people presenting these as being “gold plated” – whatever that means. None of us are immune from this, including senior managers, and it is not surprising that people’s trust in each other is getting frayed at the edges. This is evidenced for me by a couple of surveys of staff recently conducted in the Trust. These surveys, and the comments submitted with them, show that people are under pressure at work, that the changes being made are at times – albeit unintentionally – having a negative impact on people, and that there is a feeling of disconnection between the top of our Trust and frontline services. These are serious issues and I am not going to indulge in simplistic answers here, but I will be thinking this through with my colleagues over the next couple of weeks. Expect to see more about this in the New Year.

Anyway, how does this connect to the darkest day of the year? Well, in contrast to the short days you cannot help but notice that people, regardless of the prevailing circumstances, bring light into the world. You see this all around you. Christmas trees, “fairy lights” (do people still use this term?), and other decorations – some people even decorate their desks. This suggests to me that people always stretch towards a sense of something being “better” even when things are very tough, perhaps especially so.

In the context of working in the NHS, the NHS depends on people going the extra mile no matter what their job. All of us do what we do because we want things not only to be different but better – moving from shadows into light if you will. This is why what can be perceived as attacks on our work can have a negative effect, from the public thinking that people in the NHS are in some way in overpaid easy jobs, through to people seeing internal changes as in some way fundamentally devaluing the work that they already do.

How should we as individuals and as a collective respond to this? Firstly, we need to hold our heads high and be proud of what we do and why we do it. Every day I see people changing the world for the better in our Trust. I am so proud of you and to be associated with you. Secondly, we need to steer and influence our future as much as we can and keep faith with one another. Change is unavoidable and we can never be in absolute control of things. We need to see things coming and steer them as best we can, from becoming a bigger organisation to developing a single point of access and better care pathways for service users and carers. Thirdly, we need to be honest with each other. Honest about how we are feeling, and honest about mistakes we make along the way with a resolution to learn and improve. We also need to continue to care for each other as best we can, as well as the people for whom we provide services. With you, I want us to be excellent in our work and there is a very small gap between how we are with each other and the experience of service users and carers. What we say and how we say it is of vital importance.

Some of you may think, “here he goes again!” However I am clear that whilst these are indeed warm words they are very hard to put into action. I am up for the challenge and I know enough of you to know that you are too.

Have a great holiday. I hope that all of you will get some down time.

Thank you for taking the time to read this and please do comment below, or email me at christopherbutler@nhs.net

Under pressure

2011-11-03T05:26:00.001-07:00

Following my last blog I received an interesting anonymous letter. This expressed concern about the pressure that people are feeling as a result of all of the changes happening in our Trust.

The background to this is the “Transformation Project” which is our plan to find better ways of providing care, treatment and support for the people who use our services, whilst making financial savings. We are working with people to find out what works best for them. Our aim is to make sure that people have a positive experience of using our services and achieve their goals for improving their health and lives.

Redesigning our services will enable us to focus on what adds most value to service users and take away things that don’t. We must save £8.7 million from within care services over the next three years and we want to do this by being more efficient at the same time as improving quality.

These changes also include systematically working through how people get to access our services and tightening up our appraisal system as I mentioned in a previous blog.

A lot of you, particularly members of the public, may say, “What’s wrong with that, any good organisation does that sort of thing”. Yes, good organisations do, but it will involve an expectation for people to work differently and it is important that we work with our staff and the Staff side committee to ensure the process is fair for all. The changes will affect a good number of our staff, but this does not mean that people will lose their jobs. I want to be absolutely clear that I see spending money on such things as redundancy is money that we should be spending on providing services to the public. In other words, redundancy money is wasted money. It follows that though some staff will be put “at risk” while we go through the process of redesigning our services, and some people may have to work differently in the future, I am determined that redundancies will be kept to an absolute minimum.

The letter also touched on a concern that as a Trust we could end up looking good on the outside whilst having problems inside. One example cited was the positive campaigning work we are doing to tackle the stigma associated with mental health issues, with lots of positive reporting in the media, in the context of the things I have touched on above. I am grateful to the writer for drawing this to my intention. The work we do to raise awareness and combat stigma makes it easier for people with mental health problems to be part of their local communities - which helps their recovery and keeps them mentally healthy. What we spend on this campaigning work is only a tiny fraction of our expenditure and makes an important contribution to our Trust strategy. Of course we also need to make sure that we are communicating well with staff internally; so it is vital that we get the balance right. I would welcome ideas about how we can do this internal communication better.

Finally, my door is always open and I hope that people will all feel free to contact me, even if they have something to say that they think I won't want to hear. It's only by being prepared to listen to the negative as well as positive messages that individuals and organisations learn and improve.

What do you think?

Thank you for taking the time to read this and please do comment below, or email me at christopherbutler@nhs.net

PS: the research on blogs say that you should aim for 200 words – failed again!

Not enough hours in the day

2011-10-11T01:47:00.000-07:00

Firstly, sincere apologies for the delay in this posting. Over the past few weeks so much water has flowed under the bridge it's tricky to know what to focus on.

The week before last week was pretty frantic – all for the right reasons. On the Monday afternoon I did the BBC Radio Leeds version of “Desert Island Discs”. As well as being an interview about aspects of my life, it was also an opportunity to discuss aspects of our work with service users and carers.

That evening I was in York to meet with partner agencies across health and social care to discuss the implementation of the Independent review of health services in North Yorkshire and York. The report references improvements that can be made to mental health services.

It was the first opportunity that I have had to see all of the key people involved in one setting.

Tuesday was our Annual Members’ Day which included our Annual General Meeting. Our day-time guest was none other than Ruby Wax who is involved in the national Time to Change campaign which combats the stigma and discrimination experienced by people with mental health problems. Readers of this blog will know that our Trust is fully engaged with this work spearheaded by Victoria Betton, the Communications Team, Tricia Thorpe, and our fantastic team of Time to Change volunteers. The formal proceeding ended with a tea party with home-made cup cakes and vintage crockery! The evening saw the launch of our “Love Arts” festival with the GP and comedian Phil Hammond. Love Arts positively links together mental health and the arts. As far as I know it is the only festival of its type in England. To view the full programme see, Love Arts Leeds website. It was a great day but exhausting for everyone involved.

On Wednesday evening I attended an event hosted by Cape UK is concerned with how creativity can help prepare children and young people to face the future with imagination, innovation and life skills. Cape is also interested in mental health issues and it was a good opportunity to share our respective perspectives.

Thursday evening was the Annual General Meeting of the School Governors St Josephs Roman Catholic Primary School in Brighouse where I am a Foundation Governor.

On Friday, with the Board of Directors, I was back in York. At that meeting we decided that we will ask our economic regulator, Monitor, to agree to us taking into our Trust the mental health services across York, Selby, Tadcaster and some county-wide North Yorkshire services. This is a very important decision as it will change the nature of our organisation, as well as our name; we will become Leeds and York Partnership NHS Foundation Trust. More about this in future posts.

On balance, in different ways, I think that it was a great week for people with mental health problems and learning disabilities; and also for our Trust.

And the weekend? Enjoying the late summer sunshine; Monday came around very quickly!

That's all for now. Thank you for taking the time to read this and please do comment in the box below, or email me at christopherbutler@nhs.net with any feedback.

PS: Sitting here with a heavy cold (aka Man Flu!), this reminds me of the importance of getting a flu jab if you needs one for health reasons or if you work in the NHS.

Iceberg - right ahead!

2011-08-22T08:48:00.001-07:00

Do you remember that line from the film “Titanic” when all of a sudden the iceberg is spotted? I watched the film for the spectacle. I don’t do romance or, for that matter horror. I am not squeamish at all in real life, when I was doing general nursing I did not have a problem with blood and other things related to bodies, in fact I still don’t, but seeing it dramatised on film or on the TV that’s a different matter for some reason. Anyway, back to icebergs, why do I mention this? Read on and all will be revealed!

Every month the Board of Directors of Leeds Partnerships meets to consider what’s going on in our Trust. Some discussions, not surprisingly, concern things like how we are measuring up in delivering our contract with those who commission services from us (for us mainly NHS Leeds), through to how much money we are spending, and how we are doing with levels of staff sickness. For those of you interested in the type of papers we work with have a look at July 2011 Board of Directors papers. You will see in these papers that every month I prepare my own report to our Board. My colleagues on the Board have asked, in addition to the “business items” in my report, to include something about what’s on my mind with regard to the NHS more generally. I thought that I would share some of my thoughts with you too. By the way, before I get into this I need to issue a “jargon alert” (in my own defence it’s other people’s jargon and not my own)!

In common with the rest of the NHS our Trust continues to experience the effect of a lot of change happening across the NHS and social care also, more peripherally, the economy and society generally. There are major management changes underway. For example, until the “Clinical Commissioning Groups” get off the ground, NHS Leeds and NHS Bradford and Airedale are being, what is termed as “clustered” together.

From the perspective of the patient/service user and carer having what can seem like having fewer deckchairs on what may seem to be “NHS Titanic” for managers to sit on may seem to make no difference or even be a good thing. However, the NHS is a complex place that cannot run itself. In fact the money spent on managing the NHS always has been rather less than that spent in other places such as the USA. Don’t misunderstand me, as a nurse I want to see as much money as possible spent on the people who use NHS services, but one of my former bosses once said to me that in organisations things, good or bad, don’t happen by accident – he was right. The fact is that poor leadership and management directly leads to poor care – Castlebeck and Mid Staffordshire show this in stark terms. For me, along with wanting our Trust to have the best possible clinical staff I unashamedly want to work with the best possible managers – the two working together is an unbeatable combination.

How does this relate to the changes happening outside our Trust? Well, having commissioners (that is, people who buy our services) who understand mental health and learning disability issues is vitally important. The risk is that with all the changes going on that people with this experience simply may not be around in the future which, further down the track, could impact in some way on what we do in providing services; time will tell.

And the “NHS Titanic”? Well, all of us have spotted the iceberg some way off so we are in a good position to avoid it and prepare ourselves for the future. I am personally working with colleagues in Leeds – both in the NHS and the City of Leeds – to ensure that we all do our best to get the most out of the changes already underway. It’s a challenge but we are all committed to doing the very best for people who use our services. We may end up with a few “dints in the hull” but I am determined that we will not be “holed below the waterline”. I am going to get out of this metaphor right now!

Festival!

I keep two things on my desk, one is a copy of “Roget’s Thesaurus”, which I bought when I was in the LVIth at school (in the new money, that’s year 13 I think), also a copy of the “Collins English Gem Dictionary”, given to me by my mother.

As part of our purpose as a Trust of “Improving Health, Improving Lives” we are planning a festival in Leeds. With this in mind I looked the word festival up – “Festival: festal day, merry-making, periodical musical or other celebration” (the Dictionary); “jubilee, commemoration, solemnization, ovation, paean, triumph” (the Thesaurus). These fit the bill for what we are planning.

This year sees the first fully fledged arts festival in Leeds with a theme of mental health and wellbeing – “Love Arts Leeds” which will take place between the 27th of September and the 16th of November. The programme is now available and it includes contributions by Ruby Wax, Phil Hammond, James Rhodes and loads more fantastic events. To find out more have a look at the Love Arts Leeds website, or click here to download the festival guide.

Many people have been involved in pulling this together including 13 Sponsors and a staggering 38 Partner organisations. I want to give a special “thank you” to Victoria Betton our Trust’s Associate Director of Partnerships, without whose drive, commitment and imagination this would simply not be happening. For me, I can’t wait to merry-make!

“One volunteer is worth ten pressed men”

2011-08-18T02:24:00.000-07:00

I think that the origin of this quote comes from the Royal Navy in the eighteenth century when working conditions were so awful that “press gangs” used to prowl around towns kidnapping people to join up – hence the “pressed men”.

We are lucky enough to have over 170 people who volunteer their time to work with us in, to paraphrase our Trust’s purpose, “improving health and improving lives”. It’s the nature of volunteering that volunteers come and go, however I want to spend a moment reflecting on the contribution made by one of those special people.

He is Gordon Wilson. Gordon was one of the people in our Trust termed “Mental Health Act Managers” (MHAMs). MHAMs are volunteers who consider if seriously ill service users are appropriately detained under the Mental Health Act. MHAMs, sitting as a panel of three, can discharge a person from detention if they consider this to be the right course of action. Gordon has been doing this continuously since 1994. Year in and year out Gordon has been unfailing in championing the needs of service users whilst carefully balancing this with his legal responsibilities. I know that Gordon will be very much missed by so many people.

A “Big Society” can only be sustained by the work and the commitment of big-hearted people like Gordon.

And the link with “ten pressed men”? I really do value the work of everybody in our Trust, but having met a number of our volunteer colleagues I really do think that our 170 plus volunteers do offer that “ten-fold” contribution to our work. It is not about the Trust exploiting volunteers as cheap labour, even though it is true that we would be a poorer service without their contribution. I think that volunteering in our organisation has a number of different facets to it. Some volunteers use their own experience of mental health problems or learning disability to enable “the professionals” to be more attentive in the work they do, as well as, for some, being a way to continue with their recovery leading to paid employment. For others, without any experience of mental health problems or learning disability, it’s about wanting to know more about the issues as well as wanting to make a practical contribution to our work. Yet again, for some volunteers, it’s about making a public statement, in the context of a campaign, that mental health problems are as “ordinary” as any other experience of ill health.

Find out more about volunteering on the Leeds Partnerships NHS Foundation Trust website volunteering page

Compassion into action

You may recall that from time to time our staff are polled via our intranet; we term it our “Barometer”. We normally ask what people in other organisations may consider to be tricky questions. Personally I am OK with this as there seems little point in asking people questions to which you already know the answer which would be like asking someone the time when you are already wearing a watch! Last time around we asked:

‘Compassion is one of our Trust values, which aims to ensure that we respond to everyone’s experiences and deliver care with empathy and kindness. Do you think that we live up to this value through our relationships with service users and carers?’

356 people responded. The responses were:

Yes: 99 people (28%)
Yes but could do more: 211 people (59%)
No: 46 people (13%)

“Compassion” is one of our Trust’s values

I am encouraged that 87% of my colleagues responded positively, albeit with the vast majority saying that we could do more. Words like “compassion”, “kindness” and “empathy” are words in common use but the practical actions associated with making such sentiments a reality are hard to do in a sustainable way. None of us are perfect and we will not get things right all of the time – I certainly don’t. There have been times, and will be times in the future, when I let people down either by action or omission, albeit in a context of desiring to do the right thing. What do I do in such circumstances? For me the two most important things are to first own up and then apologise, followed closely by a resolution to be better in the future.

59% of responders said that we as a collective of colleagues could “do more”, what do you think “more” looks like in this context?

See Me

I happened to be in a presentation recently concerning the work of our Personality Disorder Network Personality Disorder Network. It involved research into the work of the Network, including the impact on service users of the use of the term “Personality Disorder”.

You will by now be aware of the campaigning work of our Trust in challenging the stigma associated with having mental health problems – “Time to Change”. This stigma is amplified if you have “PD”, not only on the part of the public but, perhaps surprisingly, on the part of people in the “caring professions”. Why is this? People with serious personality problems often give a sense of being very chaotic and impulsive which can cause disruption to whatever setting a person happens to be in. This can be amplified if a person has a serious mental health problem, such as schizophrenia or a bi-polar disorder, at the same time. This can be a cause of tension in, for example, a busy acute mental health ward. Sometimes people with serious personality disorders frequently harm themselves as a source of relieving stress. Most people find this difficult to comprehend as people wonder how harming yourself with a razor blade, or taking an overdose, relieves stress. Instances of self harm are self evidently distressing for carers and professionals to see and deal with. It is not surprising, therefore, that people with such problems find themselves pushed not only to the margins of society, but also to the margins of services designed to help people in need, not only mental health services, but also primary care and acute hospital services.

The Network has been working in a systematic way with help with this dilemma by offering training to staff working with people with personality disorders to increase their awareness and understanding. This provides an opportunity for participants to explore their own preconceptions to help them see the “person” with a personality disorder not only the “behaviour”. The training is delivered with service users as trainers. This is a powerful message for staff considering the negative feelings associated with people with personality disorders.

Though it’s early days it’s a fascinating and essential area of work, the network has a lot of evaluation and outcome work going. I will do my best to feature this from time to time.

True confession

2011-07-15T06:30:00.001-07:00

It's my first day back from a weeks’ annual leave. It's 8.40 in the evening and I am sitting on a train hurtling towards London. I have a meeting in Whitehall tomorrow morning as I have been invited to join a Department of Health “taskforce” concerning the development of medical education. I'm going the night before as the meeting is first thing tomorrow and I cannot get a train early enough without being up at about 4.30 in the morning!

My kind of job means that I am sometimes invited to do regional and/or national work. I do some of it as it is important that others get to know about some of the good things we are doing, as well as me finding out about the work of others. However I am careful as to how much “external work” I agree to do as I get a bit uncomfortable I am not in our Trust as much as I think I need to be. This is not because I do not trust my colleagues, quite the contrary, but because I see my primary obligation as being firmly with service users and carers, and my colleagues, “back at the ranch”.

My weeks leave was the first extended break I have had since April. It was a bit of a “busman's holiday”. Some people know that I am a practising Roman Catholic (actually more “amateur” than “practising”!). For the past few years I have participated in an annual pilgrimage to the Catholic shrine in Lourdes in the foothills of the French Pyrenees. Some of you may be aware that Lourdes draws to it many hundreds of thousands of people from across the globe every year and it is associated with healing. It's a place where people with problems are given pride of place. To cut a long story short, I decided in common with others – including as it turned out, and unknown to me, one of our colleagues – to volunteer to work there, in my case as a nurse.

This was a bit of a risk as I simply had no idea of what this involved. I attended a pre-trip training session which enabled me to meet some of the people I would be working with for the week. We were from a range of backgrounds ranging from university students to “senior citizens” (who seemed to have more energy than me I may add!). We were united by a common resolve to do our best to care for the people we would be trying to help, as well as being helpful to each other. The people we were looking after also spanned the age range, along with a spectrum of conditions, physical and psychological, sometimes both, some with progressive illnesses and others with life limiting illnesses.

Well, I survived the week – including a horrendous shift-pattern which our e-rostering system would have rejected! When I got back I was absolutely shattered and I must confess to having had a bit of a “never again” moment, but, looking back, it was one of the most satisfying, as well as challenging, experiences I have had for a while. Will I do it again? I will let you know next year!

More broadly it has made me reflect on how I interact with our own services, clinical and non clinical. Currently this is very episodic and I sometimes feel that it lacks a sense of continuity. My experience in France, working for extended periods, felt very different in that regard. I will give this some thought as it may be better for me for try to carve out of my diary more extended periods when I am out and about rather than spending a few hours here and there.

And the true confession? “Fessing up” to religious belief I guess, also admitting to being eccentric enough to doing over 60 hours of nursing as a “holiday”. Was this a strange or inspired decision? You decide!

(PS, for those of you doing the “Global Corporate Challenge”, in one day in France I did chalk up 31,524 steps)

We are all in this together
You may have heard this phrase doing the rounds!

It is certainly true in our case. One of my blog commentators has helpfully reminded me that there is more to our Trust than the contribution made by doctors and nurses. This is certainly true. I see evidence of it every day, physiotherapists, occupational therapists, and psychologists to name but a few. Let's also hear it for our stores and transport colleagues, our catering and cleaning colleagues, also other colleagues who also enable our clinical work, including people working in informatics, finance, human resources, training and development, and communications. I also want to take a moment to reflect positively on the work of voluntary services (do you know that we have over 200 volunteers, including our anti-stigma “Time to Change” volunteers?). With this wealth of contributions made by so many people we really do have an “embarrassment of riches” and we are truly greater than the sum of our parts.

Whilst I was away doing my stint of voluntary work, for the first time since joining the Trust, I missed our annual Trust Awards. For those of you who don't know, people nominate their colleagues under a number of award categories, the nominations are then considered by a judging panel.

We would like to say a big thank you to everyone who nominated someone for an award this year, and to all those who helped make this year’s awards a success. As announced on the night, the awards went to:

Improving Health & Lives Award - Healthy Living Team

Safe Care Award - Ward 1, Becklin Centre

Positive Experience Award - Charlie Place and Graham Paley

Involving People Award - Film to Change Team

Working in Partnerships Award - Carol Berry

Valuing & Developing People Award - Pat Moody

Support Services Award - Janette Bunnell

Living Our Values Award - Millside Admin Team, OPS

Volunteer of the Year Award - Brian Boffey

Open Category - Derek Collett

Well done to you all; also well done to all of the nominees!

Catching up

2011-07-05T05:59:00.000-07:00

Catching up
My goodness, it’s just over four weeks since my last blog. Perhaps it’s a function of age, but I really do not know where the time goes!

“Your Heart Matters”
On the 19th of May I was invited by NHS Leeds to the launch of “Your Heart Matters”. It’s a resource to enable people working in cardiac (ie heart) services to work more effectively with people with learning disabilities. There is also a separate resource pack for someone with a learning disability to understand how they can best look after their heart, as well as helping a person to understand those things professionals do with patients with heart problems.

Every time I go to an event designed for people with a learning disability I am always struck by the inventiveness of our colleagues in getting complex messages across in a simple accessible way. My colleagues in our Learning Disability Service did an excellent job of pulling the materials together. My experience of working with people with learning disabilities shows me that people with learning disabilities often get to the crux of what can be complex issues very quickly and, rightly, expect an easily understandable answer. Some complex policy documents are issued in a format for people with learning disabilities; those are the ones I always read rather than the full versions! Why aren’t all documents (including mine) written in this way? I would save a lot of time and mental energy!
During the launch I was persuaded to have my blood pressure taken.

Cripes – it was up! Not disastrously but enough to warrant a visit to my GP. I am doing a bit of monitoring of it at home and will go back to my GP soon to tell him how I am getting on (thankfully it’s within a normal range) as well as getting the results of a blood test. As someone who is relatively fit, it just goes to show that you do need to keep an occasional eye on these things.

From Leeds to London
Last week was Learning Disability Awareness Week and colleagues worked in partnership with a range of organisations across Leeds on what was the most high profile Learning Disability Week ever to be held in the city.

Our Service User Governor, Jonathan Butler played a leading role throughout the week, particularly with regard to the ‘From Leeds to London’ initiative which saw Jonathan and his wife Anne-Marie join a delegation of 12 people visiting Leeds MPs at the Houses of Parliament. During the visit, the MPs signed up to The People's Promise and make a promise about what they intend to do to help people with a learning disability feel more welcome, respected and involved.

Time to think
Do you find that what with everything going on at work that time to stop and reflect gets crowded out? I do. Even though most of us complain about it, trying to do lots of things at once (which nurses get used to doing) can be strangely seductive. Of course I have regular conversations with my Executive Team colleagues, and we, in turn, work in close collaboration with the Non-Executive Directors on the Board of Directors, as well as our Board of Governors.

However, I am keen to find the time to have a couple of hours with other people with big areas of responsibility in our Trust, such as the person responsible for running our Older People’s Service, and the person responsible for our management and clinical information systems. I find that if time is not carved out for this it simply does not happen.

With this in mind we have set up a Senior Leaders Forum (apologies for the jargon). The Directors of the Trust at regular intervals come together for a couple of hours with other senior managers to discuss what’s going on in our Trust and the NHS more generally. Is this an expensive waste of time? Not for me. It is crucial that people in responsible jobs have time to meet with each other to have a bit of time to think about how things are with the added advantage of bringing into the discussion their own experience and that of their colleagues nearer to the “coal face” of providing services. We have an honest exchange of views rather than people thinking that they need to tell me what they think that I want to hear. Feedback from the Senior Leaders Forum can be found in the Trust Brief emails.
At the last meeting we focussed on how we are doing on putting our values into practice. Our values, derived from the NHS Constitution, are:

• Respect and dignity
• Working together
• Compassion
• Commitment to quality of care
• Improving lives; and,
• Everyone counts

Why are values important? For me, rather than just relying on targets and numbers, they provide a yard-stick against which we can look and examine what we do. Service users are not really interested in “numbers” as such, they are more concerned about how people behave in trying to help them with their problems. We only have to look at the scandals in the NHS, and other care settings, to see that when people lose a sense of how to behave with service users and each other that things go dramatically wrong.

We decided to do some things to promote positive behaviours without it costing much money. For example, in recruiting new staff to our Trust we will consciously ask for evidence of a commitment to our values as part of the recruitment process, in order to test whether people not only have the right technical skills, such as a professional paper qualification, but can convince us that they have the right attitude to their work.

Tightening up
Like many NHS foundation trusts our staff are employed under national NHS terms and conditions. In theory we could use something totally designed by ourselves but in practice very few NHS foundation trusts do their own thing. Not surprisingly, however, we are always looking out for ways in which we can increase our efficiency and reduce our costs. As most of the money we spend on behalf of the taxpayer is spent on staff, things such as managing levels of sickness are important to us, not only from a money perspective but we also want to be a good employer with regard to staff welfare more generally.

Bearing these things in mind we have decided to make two local changes to national terms and conditions for new staff starting with us from 1 July and, for existing colleagues, who change their contract of employment with us when, for example, when a person is promoted.

The first of these changes concerns extra money that people earn as a shift allowance when they work evenings, nights or weekends. Currently under the national scheme if a person is working for example, a night shift, but in the event they cannot do it - most commonly due to sickness - they get the same “extra” pay for the shift as the person who is actually there. In other words a person gets a shift allowance if they are at work or not. This is perceived to be unfair by not just me but by other colleagues who have raised this with me when I am out and about. From 1 July 11, for new colleagues and those with new contracts, we will only pay the shift allowance for actually being at work.

The second change concerns the pay uplift that people get every year in addition to the annual ‘cost of living’ pay award, we call it “incremental progression”. Under national terms and conditions incremental progression is supposed to be linked to satisfactory performance at work. The reality is that we have not defined what “satisfactory performance” is. We have decided to define this more clearly, for example if you have a disciplinary notice on your file this is one definition of “unsatisfactory performance”; another is not achieving the objectives agreed with your boss; a third is not completing the compulsory training that our Trust expects you to do, for example fire safety; another example is having a good attendance record.

The intention is that the incremental progression you get on top of the ‘cost of living’ pay award every year (though this has been recently curtailed by the Government for “higher earners”) will be directly linked to a your performance rather than it just being automatic process as it is right now. If your line manager is of a view - based on evidence - that you have not delivered what you both agreed in your annual appraisal then your incremental progression will be slowed down until things improve. These measures will apply to new staff and new contracts issued from 1 July 2011 and yo all staff from 1 September 2011.

I know that some colleagues will be unhappy with what I see as relatively minor adjustments which will, in practice, have no impact on most people. Our trade union colleagues are very concerned about these changes and I can understand why this is. Is this the thin end of the wedge which will lead to dismantling national terms and conditions at Leeds Partnerships? No. The aim of these measures is to support staff at work, while maintaining a quality service and to help to preserve jobs in a challenging financial environment.

As I mentioned in an earlier blog, even in these difficult financial times I am intent on providing the best possible service to service users and carers to improve health and improve lives. This means keeping within our organisation the right people with the right skills and attitude. These measures in themselves are directly linked to this as having sharper appraisals will help people better understand what they are here to do and linking reward to performance at work is not, I would suggest, an illogical thing to do. It will also save money and secure jobs.

Running out of road
Good grief, typing this on Microsoft Word, I am on page three with over 1,700 words! There has been a lot going on over the past few weeks and I can’t fit it all in. Must do another entry sooner than later!

A bit obsessive compulsive?

2011-05-19T08:08:00.000-07:00

In every garden there is a lot to do this time of the year. I don’t mind getting my hands dirty and I like to do some manual work (could it be linked to being the son of an Irish labourer?). There is nothing more satisfying to me than having a go at trying to bring order out of chaos; when I have tidied up an unruly border in the garden it always gives me a good feeling. I’ve always been a bit like that. I hate the house being untidy, I am keen on ironing my shirts properly (even though I hate ironing!), and I have to leave the kitchen clear when I leave for work in the morning. Anyone at work will tell you that I am keen on having an orderly office. Is this a good or a bad thing? My desire for order does not take over my life, but it has come in handy over the years working in the NHS with so many things always happening at the same time. I am conscious, though, of not imposing my own preferences on others. How did I get onto this? As yes, doing the garden was a refuge from the Royal Wedding!

Meeting, greeting and learning

Since my last blog I have spent some time getting out and about and meeting people in our Trust and further afield.

I spent a morning with the clinical leaders of our Trust’s Leeds Addiction Unit (LAU). As well as reflecting on its day to day work, it was a good opportunity to catch up on the intentions of the commissioners of the different elements of addiction services in Leeds. One of the things that the LAU does is provide care specific to women with dependency problems who are also pregnant. Our Trust does a lot of teaching undergraduate and postgraduate students, and the LAU works closely with the University of Leeds in this regard. They are also involved in research and development; in short there is a lot going on there!

Interestingly for a number of years they have filmed their staff in their interviews with service users (of course with the service user’s consent and in a way which does not reveal their identity, also all of the interview rooms are equipped for this purpose). The recording is then used in “supervision”. Supervision in this context is the process by which a clinician discusses their clinical practice with another professional. In this instance, the interview conducted by the member of the staff is discussed with the supervisor using the recording. The discussion focuses on the positive features of the discussion, also on improvements that can be made in the future. I think this technique is interesting as the principle is similar to a surgeon not performing an operation until they are observed as being competent to do so. Our ‘surgery’ is the nature if the interaction with the service user. Not all professionals are comfortable with such an approach, though I remember such sessions being recorded back in the late 70’s for similar purposes and then, as now, seeing it as having its uses. If you are a service user, carer, or staff member, do you have any strong views about this method?

The day after this I did a slot at our corporate induction programme. It’s a great way to get to meet new colleagues as well as getting some instant feedback on their impressions of our Trust. Participants are always a good mix of clinical and non-clinical people. In fact other than meeting each other on the induction programme, and given that we are spread across well over 40 sites, most of them will never see each other again! The thing I really like about doing the induction slot is the question and answer session at the end as the questions asked normally hit the nail on the head concerning things going on in the NHS and what our Trust could, or should, be doing. First impressions are normally the best and most incisive ones!

I have mentioned in a previous blog the “Lounging with leaders” conversations I have had with our team managers about the leadership issues they face every day. Well, over the last couple of weeks I have met with some of these front-line leaders again. We discussed how we all can keep an eye on what people in teams are doing through the appraisal process whereby a person’s objectives for the year are set and their implementation reviewed over time.

In our Trust in are in the process of introducing a simpler system than the one we used previously. We also discussed the idea of, whilst not going for a fully-fledged performance related pay system, using the provisions of the national pay system we use (known as Agenda for Change”) to more effectively and actively reward the good work that people do.

Our ‘arry

I was also in York as I was invited to the re-opening of the inpatient wards as Bootham Park Hospital. A huge amount of work has been done to improve the environment – last time I was there it really was a building site! Harry Gration of BBC Look North was the guest of honour and lots of people were keen to have their ‘photo taken with him. I personally hate having my ‘photo done so did not join the queue (no offense Harry!)

Asking difficult questions

From time to time on our intranet we ask our colleagues for their views on topical issues. Most recently we asked staff:

‘To what extent the current climate is having an impact on staff morale?’

The results were:

	Responses	Percentage
To a great extent	364	67%
To a little extent	141	26%
To a limited extent	23	4%
Not at all	16	3%

I guess this is not surprising given the extent to which the NHS is being covered in the media right now. I will discuss the results with my Director colleagues at our next meeting and feedback as to the outcome of the conversation.

Uniformity

Following a pilot project and an evaluation, all of my colleagues working on our inpatient wards will soon be wearing a modern uniform. Is this retrograde step? Interestingly whilst my colleagues in inpatient services do have some understandable ambivalence, the service users and carers who were involved in evaluating the pilot areas think that uniforms are a good thing. In practice the “dress code”, where people wear their own clothes to work, has proved difficult to operate with people applying different standards. Community staff will continue to wear their own clothes. I have been fitted for my set of uniforms as has Michele Moran, our Chief Nurse (fitted is a bit of a misnomer as it involved trying different sizes behind a screen you routinely see in a doctor’s surgery!).

Part of the union

2011-05-06T07:26:00.001-07:00

I have been a member of the Royal College of Nursing (RCN) for a number of years. I first joined its student section in 1978. It was through the RCN that I first got involved in the politics of healthcare through engaging with local, and then national, membership structures. The RCN is an interesting hybrid organisation being both a certificated trade union, whilst also concerning itself with professional issues. I guess that it some ways it is similar to the British Medical Association. Once a year both elements of the RCN come together at an annual Congress. I attended the 2011 Congress in Liverpool as part of the delegation representing the RCN’s Nurses in Management and Leadership Forum.

During the time there I was invited to give a presentation at the Forum’s fringe event touching on the impact of the NHS Bill on nursing leadership; I also contributed to a number of debates in the main auditorium. As you will have seen or heard in the media the Congress meeting was a high profile event with significant political ramifications.

For me it was also good to connect with colleagues to get a broader sense of what is happening across the health service. In fact some of the people there I have known for many years and they are still activists at the ‘coal face’ of the NHS. It was also an opportunity for me to network with some of the ‘great and the good’ of the nursing profession! I also used it as an opportunity to talk to people about the work we are doing here in “Improving Health, Improving lives”. Listening to the experience of people in the NHS, though we have our own challenges in our Trust, I think that for others out there things seem to be more difficult (By the way, this is not a recruitment advert for the RCN!!).

More generally, I am a great believer in union membership. The collective of unions here, known as ‘Staffside’, do a great job in ensuring that the interests of their members are well represented and work with us to improve our services. Though we do not always agree with each other I know that Staffside are as interested in the quality of the services we provide as ‘the management’ and we work well together to continue to improve what we do.

Simple idea – huge impact

Most people in my sort of job do other things, regionally and nationally, to help develop the NHS. For example, I am involved in the work of the Yorkshire and Humber Strategic Health Authority (SHA) to foster innovation and improvement in NHS services. To do this I am a member of the SHA’s Regional Innovation Fund panel. A little while ago we spent some time looking at proposals from NHS colleagues to bring about improvements to NHS services ranging from spreading tele-medicine across Yorkshire to improving the uptake of diabetes services.

We looked at the proposals using a bit of a ‘Dragon’s Den’ format as we wanted to understand how the ideas presented would both improve the experience of patients/service users but also improve the efficiency of the NHS. After we agreed which ideas we could support financially each member of the panel agreed to “sponsor” one of the projects. This involves following the progress of the project and being available to help and support the work if needed.

My project is ‘do not attempt cardio-pulmonary resuscitation’. What does this mean? By agreement with a patient, and as part of a patient’s plan for palliative/end of life care, the intention is to have one process across Yorkshire and the Humber to ensure that when the patient dies cardio pulmonary resuscitation (that is someone giving the “kiss of life” along with pressing down on someone’s chest, and sometimes more drastically inserting a breathing tube and shocking someone’s heart with electricity) is not commenced. This enables someone to ‘die with dignity’ without health professionals starting unduly intervening.

Having been involved looking after my partner when they were dying I do understand the need to get the end of life as right as it can be both for the patient and the relatives. You have thought that the NHS already had a single commonly accepted way of dealing with such issues, but unfortunately the experience of colleagues working in end of life care illustrated that this was not the case with most localities having their own way of doing things. There seemed to be times when a person died of a terminal illness in the absence of a common way of doing things some relatives had an unacceptably negative experience. The project has involved drawing up a single set of guidelines and progressively rolling out their implementation across the SHA. The work is progressing well, so much so that my active help has not been needed. It’s also interesting in that such an improvement can be implemented with some financial support but certainly not ‘big bucks’.

North Yorkshire

Work still continues regarding mental health services in York, Selby and Tadcaster, also some services across North Yorkshire, into our Trust.

I recently attended my first meeting of the North Yorkshire Review Reference Group. The group has been set up by the SHA to look at how best NHS resources across North Yorkshire and York can be best used given the need for the NHS to be ever more efficient in an area which continues to have problems in balancing its books. I was good to meet for the first time with a range of different people with an interest in health issues, including people in the voluntary sector. It was very much my first meeting but I will keep you up to date with how things shape up.

That same week I went to Selby War Memorial Hospital to have an open meeting with staff who may be transferring to our Trust later this year it was good to swap notes concerning our respective organisations and great to get a sense of the excellent work being done by our colleagues up the A1.

Zambia

Do you know that we are involved in helping to improve mental health services in Zambia? For a couple of years we have been working with Chainama Hills Hospital in Zambia to improve the skills and abilities of the staff that work there. Chainama Hills is the only mental health facility in Zambia.

Alongside our Trust’s work, we are associated with Action Zambia. Action Zambia is a small charity set up by myself with other colleagues in our Trust to provide some things that cannot be done directly by the NHS. There was an article in the Yorkshire Evening Post which shows how the work of the Trust with Action Zambia links together towards a common good. If you are interested in contributing to the work of Action Zambia there is more information at charityportal.org.uk.

And finally…A Royal “well I never!”

Are you aware of the history of St Mary’s house, one of our buildings on Leeds? It was the home of the Lupton family – Kate Middleton’s Father’s family. It was their home until sometime after the First World War, in which tragically two of Lupton sons died. After this I understood that the family donated the house for orphaned children.

That's all for now. Thank you for taking the time to read this and please do comment in the box below, or email me at christopherbutler@nhs.net with any feedback.

Lazy days (2)

2011-04-06T03:31:00.001-07:00

The week before last I had another week’s leave – part of the mad dash to get annual leave out of the way – hence the delay between my last blog and this one. Unlike my last week of leave I did manage to get at least some of those niggly jobs around the house done. As the weather was so good I also had a foray into the garden to do a bit of tidying up.

Feline fleabag!

It will be two years this summer since Sooty turned up on the doorstep with sad face and a torn ear. Given the absence of any micro-chip and any clue as to its previous home, my partner insisted on adopting ‘her’ (who turned out to be a “him”). I wanted to give the mysterious guest the adopted name ‘Sphinx’ but my partner was not keen so we settled on Sooty. I had my reservations at the time but with the death of my partner 10 months or so later, Sooty has turned out to be rather good company. When I get home in the evening I commonly find him sitting atop the gatepost waiting for my arrival – or more accurately the arrival of his dinner! I love spring and right now the daffodils have appeared. Less positive is the emergence of, from relative hibernation, cat fleas! Last week I had a game of ‘cat and mouse’ with Sooty in order to give him his monthly flea treatment. I don’t know which of us is more traumatised by the experience but at least it’s done for now!

Under Pressure

From time to time colleagues in the Trust are asked to post responses to questions through a ‘Barometer’ on our intranet site. The Barometer commonly asks questions associated with ‘tricky’ topics, the sort of things that some managers in some organisations are a bit reluctant to ask. The last Barometer question asked staff about the pressure they perceive themselves to be under and how this impacts on them personally and professionally. The questions asked and the responses were:

To what extent do you currently feel the demands of your job outweigh the time you have to do it?’ The results were:

Answer Responses Percentage

To a great extent 316 59%

To a little extent 160 30%

To a limited extent 42 8%

Not at all 17 3%

These responses were considered by a group of senior managers last week. Colleagues were reminded about the questions along with a considered response. What followed was a round table discussion about the reasonableness of the responses themselves and if anything was missing by way of things that can be done to help. The responses will be circulated in the next Trust Brief.

From this you will see that some of the responses acknowledge that life is difficult and complex for all of us; other responses point to some actions that will be taken to address, at least in part, some of the issues. As well as confessing that I do not believe in Father Christmas, I also do not believe that rabbits can be pulled from hats. I say this because all of us, me included, live in a highly pressurised rapidly changing world. Notwithstanding this I do want to restate my personal commitment to enabling us to continue working together to improve things when we can, whilst being honest and realistic about those things to which there are no ready solutions.

'Better Together' - North Yorkshire and York

We are still working on the idea of bringing mental health and learning disability services in York, Selby and Tadcaster, also some ‘county-wide’ services, into our Trust. After my last blog I have had an opportunity to meet with the Chief Executive of North Yorkshire County Council, Richard Flinton, and the Chief Executive of NHS North Yorkshire and York, Jayne Brown. Both meetings provided an opportunity to share perspectives from our respective organisations.

Our colleagues are also having introductory conversations with people in the statutory, voluntary and the ‘third sector’. It is still our intention to conclude matters with NHS North Yorkshire and York by the 1^st of October, but there is still a lot of work to do to make this aspiration a reality. We will at some point soon be consulting on changing our name as an organisation – more about this later but you heard it here first!

'Helping or Telling'

I also participated in a recent Leader’s Lounge as part of our Fit for the Future middle management development programme. I have referred to the Leader’s Lounge concept before; It’s an informal discussion forum for course participants with one of the ‘top brass’ of the Trust. This time we discussed if we are, or how we can become, an organisation managed through ‘coaching’ rather than ‘telling/directing’ people. We all discovered that we are in ‘coaching-mode’ with our colleagues more often than we think we are! One practical action from the session was to remind people in our Trust that we do have a pool of trained and accredited coaches who are there to help with tricky problems as well as other coaching resources. For further information, contact: Maria Warner, Head of Development & Events (mariawarner@nhs.net).

NHS Leeds Community Healthcare

By the time you read this community services provided through NHS Leeds will be a new NHS Trust with Rob Webster, latterly the Chief Executive of NHS Calderdale, as the Chief Executive. I have known Rob for a number of years and it will be good to have him as a colleague on the patch. I want to sincerely wish colleagues in Leeds Community Healthcare all the best as they move into their new organisation.

Meeting with Service Users

I also recently met with the Peer Support Group of our Gender Identity Service (GIS). We shared perspectives on reforms to the NHS and how this will affect commissioning arrangements. This is of concern to this group of service users as the GIS provides services across the north of England and service users perceive that different commissioners have different approaches to enabling transgendered people to access specialist services. Related to this, timely access to surgery as part of the care pathway is also clearly an issue. This could be linked to specialist surgical skills which are not always available at the right time in a person’s care. We also shared perspectives about what our Trust does well, along with other ways in which we can improve.

Inkwell

Our Trust is supporting a proposal for the development of the Arts and Minds Network through closer partnership working with Leeds Mind’s Inkwell project. Arts and Minds will be co-located with Inkwell as a central point for arts and mental health in Leeds. Inkwell is a community arts space in North Leeds that requires investment to realise its potential to be a resource for people using mental health services and the local community. It is intended that this becomes a largely self-funding operation that is supported by a diverse range of income streams as well as some core funding. Inkwell will provide a resource for our Trust for meetings and workshops that will enable our organisation to reduce our annual room hire costs. We are making a one-off contribution to support capital developments and project management to support the Inkwell development.

There’s a lot going on but that’s all for now!

Lazy days

2011-03-09T02:55:00.001-08:00

It’s over a week since my few days of annual leave. At the beginning of my time off I had all sorts of good intentions of dealing with that large number of small things that irritate you at home. You know the sort of thing, that a bit of minor DIY; a bit of extra house cleaning etc. I am sorry to admit that I did not do any of it! I spent most of the time seeing a few friends over lunch with - shock, horror - a glass of wine (or two) and just going to a few places for a look around, such as Manchester (I always come into Leeds city-wise). On the down-side I still have all of those niggly jobs to do. It’s almost as though they “look” at you making you feel both guilty and irritated. Oh well!

Minsters and travellers

Before going on leave, with some of my Director colleagues, I was invited by NHS North Yorkshire and York to attend an open meeting in York with their staff who may be transferring to our Trust. If it all goes to plan the transfer of mental health and learning disability services in York, Selby and Tadcaster, also some ‘county-wide’ specialist services, will take place no later than October or earlier if we can manage it.

I try to use public transport as much as possible. The advantage to this is that, as well as being ‘carbon friendly’, it’s a good way to get a sense of different communities. For example, using a bus to get somewhere is what most of our service users and carers do, and having the experience yourself can be very illuminating in terms of how easy or difficult it can be to get around. Anyway, arriving in York by train and stepping out of the station you can see the lovely Minster nearby (by the way I always admire the inside of York station, the curve of the station shed is a wonderful work of engineering and great beauty). I got a bus from outside the station to the location of the meeting on the fringe of the city. Unless you live there, for most people visiting York, it’s a wonderful place full of interesting things. Going out of the centre it was good to get a sense of the communities that live on the periphery. Where travellers come into this is that as the bus passed through a council housing estate we passed by a pony and cart that was picking up stuff from somebody’s house. Where I was brought up, a small town in Derbyshire called Clay Cross, a chap called Sam used to do that sort of thing but that was a very long time ago! What’s the relevance of this to providing mental health services in York? Well for me it’s about not taking communities at face value – in this case looking deeper than the facade of a prosperous city centre – and taking the time to see for yourself where people live as well as getting a sense of who they are.

The meeting itself was attended by over 50 people. I had an opportunity to say something about our Trust, but more importantly an opportunity to share questions and concerns, as well as getting a sense of the great work that people are doing in York, Selby and Tadcaster. It was also a chance to share the good things that we are doing in our Trust. More of these meetings will take place; as I write this we did another one last week.

Barometer

Since we started the Barometer Poll on StaffNet around 500 members of staff have replied to each one. This is a great response and I would like to thank you all for contributing. The latest poll asked you to consider if the current demands of your job outweigh the time you have to do it?’ 59% of you felt that this is true to a ‘great extent, with 30% agreeing to a ‘little extent’. With 89% of you saying that the demands of your job are of concern to you, this is really valuable feedback. The Executive Team spent some time discussing this issue last week and we will be sharing some thoughts about what to do differently with the Senior Leaders’ Forum at the end of the month.

Everyone’s a winner!

Last week with Frank Griffiths, our Chair, I attended the second annual Leeds Health Stars event. This is organised by NHS Leeds to recognise the many wonderful contributions made by people working across health and social care. As I mentioned in my last blog, the public sector has tough times ahead but amongst the difficulties it’s still important to take time to reflect on what is going well and to give people in the front line time for a bit of special recognition. There were over 50 entries and two of our work areas made the finals.

Our Learning Disability Services won the “Mental Health and Wellbeing Award” with their Your Health Matters work. This involves Learning Disability colleagues in our Trust working to improve how people with learning disabilities access those health services that we take for granted. There is lots of evidence that people with learning disabilities have serious problems in getting through the front door of services in the first place and that services are sometimes not geared for helping people with learning disabilities. As a consequence people can, at best, get a poor deal or, at worst, appalling treatment or no service at all.

Also in this category our Time to Change work was “highly commended”. Well done to everybody, I am very proud of you and your hard work!

Chris Butler’s “Ongoing Jargon Situation Alert”

I am grateful to you who take the time to read my musings and give me feedback.

Some recent feedback concerned my use of jargon such as:

“to better integrate our work with theirs” and, “the city-wide transformation partnership” also, “re-engineer the experience of people”.

Ouch, spot on! I will try to do better!

Tough Times

2011-02-15T08:13:00.000-08:00

The proposed closure of the Crisis Centre run by the Adult Social Care directorate of Leeds City Council has been generating considerable interest in the media. Many of you will have seen my quote in the local press. I know that this has made uncomfortable reading for some of you and that some of you have strong feelings about this.

This is a tough time across all of the public sector, including us. All of us are having to re-examine everything that we are doing, including some of those things which are ‘special’ to us. There are benefits in this, as trying to be more ‘efficient’ is also about us doing our collective best to simplify how service users and carers access, use, and exit, our services.

Recently, at a joint workshop between the Board of Directors and Governors, we looked at a hypothetical case of a service user being referred into our service. Depending on how you describe the world, parts of the referral and treatment pathway looked like a large plate of spaghetti!. This meant that the service user would have not really known who was doing what. Organisationally, in such a scenario, staff would also be expending a great deal of time and effort for not a lot of result – hence inefficiency and a poor use of what will be increasingly scarce resources.

Reflecting on this, I guess that part of this has been, over time, people with the very best of intentions adding in bits of process without pulling back and looking at the whole picture. I know that I have done this whilst thinking that I have been ‘improving’ things. Have you? Getting back to the Crisis Centre, this was set up before the development of primary care mental health workers and, most recently, the Improving Access to Psychological Therapies programme. These are funded by NHS Leeds though not provided by us. These services are explicitly set up to help people in such circumstances and my personal view is that these services will routinely be the first port of call for people with mild to moderate mental health problems in Leeds.

My quote in the media relates to me being confident that for those people who are felt to have serious and ongoing problems (including being a risk to themselves or others), we can provide a safe and effective service, just as we do today. I would go further and say that for people in extreme circumstances we should always be the first point of contact. I do accept that you may not agree with me and have sincerely held views to the contrary but I hope you understand my viewpoint, even if you don’t agree with it.

It’s good to talk

Last week I was invited to spend some time with the therapists providing psychological interventions as part of our service for adults. I deliberately use the term ‘therapists’ as the group was a mix of people with different professional backgrounds. Vivid pen-pictures of some of the issues they encounter were painted for me. As well as being grateful to these colleagues for alerting me to the complexity of their work, and the distress they help others to deal with, I was usefully reminded that we need to ensure that we are always positioned to deal with people in a ‘psychologically minded’ way. What do I mean by this? My friends at Wikipedia describe ‘psychological mindedness’ as “a person’s ability to see relationships among thoughts, feelings, and actions with the goal of learning the meanings and causes of ... experiences and behaviors” http://en.wikipedia.org/wiki/Psychological_mindedness (by the way, I don’t entirely agree with the whole of the content of the particular Wikipedia reference!).

Sometimes people need to be navigated through some dangerous rapids and we should always have the capacity to do this. This is easy to say but hard to do particularly in busy wards or when our colleagues in the community are seeing people in rapid succession at home. One of the values of having experts in psychological mindedness in our Trust is that, as well as providing services to service users and carers, in providing supervision to staff and teams, they also help us to pause and reflect on the human impact of our work. This can only be a good thing.

Rainy Sunday rugby

Title to a song perhaps? Not really! Leeds Metropolitan University have close links with Leeds Carnegie RUFC and were kind in inviting our Trust to do some work at Sunday’s match between Leeds Carnegie and Leicester Tigers promoting our local Time to Change campaign It’s a long time since I have been to a rugby match and unfortunately Leeds lost by the narrowest of margins. The real heroes of the day, however, were our wonderful Time to Change volunteers and members of our Communications Team who, whilst I was ushered off to corporate hospitality (a first for me!), braved the elements in getting out anti-stigma information – what a group of stars!!

By the way, Leeds Metropolitan University are doing a lot of work on men’s health, an area largely untouched by the media. Their Professor of Men’s Health, Alan White, has edited a book called “Promoting Men’s Mental Health”, it’s well worth a look.

And finally.........

I am taking a few days’ leave next week! On the subject of holidays, with my Executive Team colleagues, I have decided to fully recognise the day of the forthcoming royal wedding in terms of pay and time off. Our collective view is that it is the right thing to do, as well as giving us an opportunity to recognise the everyday contribution that our colleagues make to our NHS.

That's all for now. Thank you for taking the time to read this and please do comment in the box below, or email me at chris.butler@leedspft.nhs.uk with any feedback.

Chris

Oh dear, am I getting old and grumpy?

2011-02-01T07:07:00.001-08:00

I have scrounged a desk at a Community Mental Health Team base after a meeting at St Mary’s Hospital about likely changes to health and social care services across Leeds over the next couple of years. It's interesting to move from “macro” to “micro” issues. What do I mean by this? Well, a few minutes ago I was with health and social care leaders in the City, including leaders of the Practice Based Commissioning Consortia, talking about some big changes that might be on the way in Leeds.

After this, rather than going back to my office, I find the vacant desk sitting in an office with some CMHT colleagues. As background to the hurly burly of phone calls, people popping in and out etc, the radio is playing softly in the background. It's tuned into Radio 2. Good heavens I don't recognise a lot of what's on other than a vague recollection of a song by S Club 7 (remember them?) currently playing! This could be because I don't have much time to listen to contemporary music, or any music for that matter. As an aside, I am definitely not one of those people who seem to need their head constantly filled with noise (you know the type of person seemingly permanently attached to headphones with a vague sound you can hear and/or vibrations you can feel). My goodness, I am not only middle aged but having a grumpy moment!

Back to business! Sitting around, and trying to be invisible, is a good way of finding out what is going on, from what is happening with a team that day, service users and carers, along with the day to day pressures that people encounter. Good management is often about moving smoothly between “big issues” and seemingly inconsequential day to day events.

A week is a long time in the health service!

A lot happens in the NHS. Here are a couple of examples. Recently Frank, the Chair of our Trust, and I had one of our catch up meetings with the Staff Governors. It’s always a good opportunity to explore what is happening from their special perspective. They are excellent advocates for issues specific to staff whilst understanding the wider challenges faced by out Trust.

That day I was also supposed to be spending the afternoon in the community with colleagues in the Older People’s service, however 24 hours or so earlier I had a minor tummy bug (AKA “man flu”). Michele, our Trust’s Chief Nurse, reminded me of the requirement to be free of gastric symptoms for 48 hours in such circumstances before going anywhere near a service user. This meant that my time in the community has to be rearranged. Well done to Michele for reminding me of the need for me to follow the Trust’s rules!

The following day I attended part of our new Audit and Assurance Committee. This is a Committee of the Board of Directors, the membership of which is exclusively drawn from our Non Executive Director colleagues. As it’s a new Committee it’s still finding its feet. We had an interesting discussion about what is the nature of “assurance” in a large, complex and dispersed organisation. One indicator of assurance is the ability to look at issues using more than one source of information and evidence. There is a link between this and the meeting with the Staff Governors as an example of me personally not just relying on my own perspective but taking time to compare what I think with the experience of others.

The day after that I was on the 0656 train from Huddersfield to London. I was invited to have a sandwich with the current chairman of Monitor, the independent regulator of NHS Foundation Trusts. There were a number of Chief Executives there drawn from across the different types of NHS Foundation Trusts. It’s a bit of a mystery as to how you end up being invited to such things, names drawn from a hat perhaps? We share perspectives on how the NHS is right now and swap ideas about what the future could look like. For me I try to strike the right balance between doing “national stuff” including using opportunities to influence things nationally without becoming detached from our day to day work, though I do know that I have to do both. As a rule of thumb I get a bit twitchy if I am away from our Trust for a couple of days.

“Northern exposure”

You will have seen in my last blog the potential for us forming a bigger organisation with colleagues from North Yorkshire and York is very much a reality. The commissioners, NHS North Yorkshire and York, have asked us to agree a contract with them to provide services in the York, Selby and Tadcaster localities. Some services will span North Yorkshire, including inpatient accommodation for children adolescents with mental health problems also services linked to the national “Improving Access to Psychological Therapies” programme. If it all goes to plan we will be welcoming some fantastic people to our Trust as new colleagues. As I have mentioned before I am not especially interested in us being “bigger” but I am very interested in us being “better”. Having met some colleagues over there I know that there is a wonderful opportunity to learn from and imitate some of the great work happening over there. I will keep you up to date with how this develops over the coming months.

At the same time we also have major changes happening within our existing organisation, such as continuing to work with colleagues in Adult Social Care in Leeds to better integrate our work with theirs, also our internal Transformation Programme. This is different from, but complementary to, the city-wide transformation partnership, including NHS Leeds and Leeds Teaching Hospitals, which intends to re-engineer the experience of people with, for example, long term conditions. Our Transformation programme involves moving away from age related services, such as services for older people and working age adults, towards integrated care pathways. This will enable us to do a number of things, including abolishing any hint of age discrimination in what we do, and, by using “lean” and “six sigma” technologies (which are used in industry), improve how service users and carers use our services, mitigate risk, and enable us to use our resources more effectively.

I feel tired just writing this!

Joking apart, all of these changes directly relate both to our purpose of “improving health, improving lives”, also our ambition of, “working in partnerships we aspire to provide excellent mental health and learning disability care that supports people to achieve their goals”. For all of the time I have spent working in mental health and learning disability change has been a constant feature of our work. Our common task is to ensure that things are better tomorrow than they are today. Working with you, also service users and carers, I am confident that we can and that we will do this.

That's all for now. Thank you for taking the time to read this and please do comment in the box below, or email me at chris.butler@leedspft.nhs.uk with any feedback.

Chris

Better Together

2011-01-31T06:56:00.001-08:00

Following on from my email last week, I can now confirm that the Board of NHS North Yorkshire and York (NHS NY&Y) have confirmed that we have been selected as the “recommended bidder” to provide mental health mental health and learning disability services in York, Tadcaster and Selby.

In addition to this, we have also been chosen as the recommended bidder to provide a number of services across the whole of the NHS NY&Y area. These services include:

· Forensic services

· Improving access to psychological therapies (IAPT)

· Perinatal services

· Psychiatric intensive care (PICU)

· Inpatient “tier 4” child and adolescent mental health services (CAMHS)

· Community eating disorder services

I am delighted to be able to share this good news with you all. This is still subject to legal checking, contract negotiations and an intense period of work to transfer services in a safe and effective way. There are many fantastic people doing excellent work in York, Selby and Tadcaster, as well as in the specialist services, and, with you, I am looking forward to welcoming them as new colleagues to our Trust.

This really is excellent news for us all and for service users and carers both in Leeds and in NHS NY&Y. Working with you, it is my intention that our new integrated Trust will bring about many opportunities to improve the health and lives for a larger community consistent with our aspiration to provide excellent services.

It is also not without its challenges and a great deal of work will be needed both to safely transfer in services that will be new to us, and then to fully integrate all services into our new Trust. This will be a demanding time for us, however both our Board of Directors and our Board of Governors are firmly of the view that the benefits that the new organisation will deliver, will more than outweigh the costs of the integration period.

I will keep you fully informed of progress, but next steps and indicative dates are as follows:

“Recommended Bidder” Stage

The period when we as the recommended bidder will work with NHS NY&Y to finalise the Contract for signature. Work to be undertaken in this stage includes:

· Consultation with transferring staff

· Clinical, financial and legal “due diligence”, that is carrying out all required checks on clinical quality, legal and financial aspects to assure ourselves that the transfer can go ahead safely

· Preparing a business case for Monitor, the independent regulator of Foundation Trusts

· Putting in place detailed project plans for service transfer

Contract Signature

The signature of the Contract between NHS NY&Y and our Trust as the provider of the service. The timescale for the completion of the contract will be agreed with NHS NY& Y.

I will keep you updated on our progress in my blog and through Trustwide communications over the coming weeks.

Chris Butler

Chief Executive

Bugs

2011-01-10T06:58:00.000-08:00

Well actually, I am referring to the flu virus that’s doing the rounds. As of today (Monday the 10^th) we have 175 flu vaccines left over in our Trust from before Christmas. We are prioritising clinical staff to be offered these and the following clinics have been booked:

11^th January – The Becklin Centre (Treatment Suite, first floor from 10am to 1pm)

17^th January – St Mary’s Hospital (Boardroom, Admin Block, 10am to 1.00pm)

20^th January – Asket House (1-2pm)

21^st January – The Newsam Centre (1pm-3pm)

Like the January Sales it’s “first come first served” so come early to avoid disappointment! Joking apart, I do know a couple of colleagues who have had the flu this year and it has really knocked spots off them. More generally, if you are in “vulnerable group” it’s worth checking things out with your GP surgery. NHS Direct is also a good source of information NHS Direct. In the interim remember to “catch it, kill it, bin it” with hand hygiene being particularly important. I have had the jab myself when we were doing the first round of vaccinations so for me if I come down with something it’s more likely to be an acute case of “man flu”!

The Politics of Health

Last week Frank, our Chair, and I met with Stuart Andrew MP. Stuart was previously a Member of Leeds City Council and was elected to Parliament at the last General Election as the Conservative MP for Pudsey. Stuart is leading on behalf of the MPs in Leeds on health issues. He was very interested to hear of our work in providing services for people with mental health problems and learning disabilities in Leeds and further afield, also our broader work associated with “Improving Health, Improving Lives”, such as our social campaigning through ‘Time to Change’. Frank and I suggested to Stuart that he may wish to visit our Trust to get a better understanding of our work. Stuart is keen to do this and do don’t be too surprised if you see him around sometime soon. More information about Stuart’s work as an MP is available through www.theyworkforyou.com.

“Don’t Panic Captain Mainwaring!”

That same morning I was at a meeting in Wakefield to discuss different commissioning issues in West Yorkshire. We also discussed how our NHS has been coping with the consequences of bad weather, flu etc. There is no doubt that things are tight in a number of areas, and that things were very stretched across the whole system with the ice and snow. However, people continued to get the service they needed albeit with some limitations. My observation at the meeting was that winter is not over yet, also that we need to improve our collective understanding of how the potential for curtailments in one service, including social care, can impact on another. The upshot of this is that the NHS in West Yorkshire is going to have a look at how the system shaped up as a whole over the past few weeks in order to do things better in the future. This is not to say that things did not work but as in most things in life you can always do better with a bit more thought.

“He who has never learnt to obey commands cannot be a good commander”

Who said this? I will tell you in a minute!

For some reason I was reminded of this when I went to a talk a few weeks ago with some of our colleagues. The talk was given by a person some of you may have heard of called Professor Beverly Alimo-Metcalfe. It was one of those lectures that had a big “wow” factor because it was just so engaging.

It would be impossible of me to replicate the key messages on the day, but I would like to leave you with some thoughts that struck a chord with me with which I strongly agree. The first is that leadership is not about ordering people about but it’s more about modelling a concept or an ideal for others to emulate. It follows from this that a person who aspires to lead must have a concept and direct experience of what being “of service” to others is about (which links to the title). It’s as much about a vocation and calling as anything else. It’s sometimes about “the leader” balancing, and processing on behalf of a team or group, the worries, hopes, and positive ambitions that others have for the future. All of this is very difficult to do well in a sustainable way which is why anyone in a leadership role has a tough job to do. Does this strike a chord with you? It does with me. It also connects to our values as a Trust.

By the way, the quote is from Aristotle, 4^th Century BC Greece.

That's all for now. Thank you for taking the time to read this and please do comment in the box below, or email me at chris.butler@leedspft.nhs.uk with any feedback.

Chris

All's well that ends well

2011-01-04T06:01:00.001-08:00

2010 is rapidly running out of road. How has it been for you? If you are anything like me, it has felt like a jumbled series of events with highs, lows, and the occasional opportunity to reflect.

At work, there has been a lot of change for me, particularly changes to the people who I work with on a daily basis. The Board of Directors has seen the retirement of David Newby and Mike Doyle with the decision of Ian Hughes and Merlin Wilce not to seek reappointment. Frank Griffiths joined our Trust as the new Chair. Three new Non-Executive Directors were appointed, with two reappointments. There were also some changes to the Board of Governors. On the Executive side, Jill Copeland joined the team. I feel exhausted just typing this out! Joking apart, I do miss all of our former colleagues, but our new ones have brought a fresh perspective to what we think we are here to do.

More generally, regardless of our role in our Trust, we have provided excellent services to thousands of people when they are at their most vulnerable. This has been characterised by us offering hope for a better future allied to a determination to help service users and carers to improve their health and their lives. All of us have worked hard at challenging society more generally concerning stereotypical views of people with mental health problems and learning disabilities. As a collective we have achieved regional and national recognition for our work. None of this is easy. It calls for guts, persistence, and sheer hard work. It will not go right all of the time. Well, I am proud to be associated with all of you and I want to thank you for the daily encouragement you give me as well as each other. I know that this is a sentiment also shared by Frank, our Board of Directors, and our Board of Governors.

Most of you who know me will know that as well as having a tendency to be rather hard-nosed business wise, I also have a habit of wearing my heart on my sleeve. Reflecting on the latter, I want to take a moment to thank you all more personally. As I alluded to in my last blog, I experienced a personal bereavement in March. During the time leading up to it, and afterwards, all of you who discovered what was going at home offered to me sincere and heartfelt support for which I am grateful.

What is the link between my personal circumstances and what we do at work? For me both what we do at work, and the support offered to me personally, shows to me that we do put into practice key aspects of our values. I believe that what I experienced from so many of you is the common experience of service users and carers.

Well, turning to the future, change is on the way. Over the coming weeks we will know if we will become a bigger organisation. I deliberately say “bigger” rather than “different”; if anything, depending on how this pans out, we need not only to be “bigger” but also “better”. In house we already have underway the work to design our organisation around care pathways. We also need to ensure that we deliver our financial plans in order to give us the headroom to invest in what we do. We will only do this through working as a collective and with sustained effort. This includes working in partnership our external stakeholders and with our trade union colleagues and I am confident that we will do this.

Finally for now I want to leave you with a couple of thoughts from a person called Cecil Reddie. Cecil Reddie was a Victorian educationalist who founded the school where I did my O Levels (remember those?!) and my A Levels. He’s worth looking up on the web because he was both fascinating and a hugely intelligent eccentric. His life would make a great TV documentary. In his time he thought that education was concerned with filling kid’s heads full of rather useless stuff disguised as knowledge (which sounds familiar in this day and age I think). Anyway, he said that,

“In giving away our life, we shall discover the greatest mystery of all, that mathematically as we give away our life, our life grows wider and more intense.”

This strikes me as being true for all of us both personally and professionally.

With regard to how things change he said,

“…honouring the good in past days, but ever reaching after the greater good the future has in store.”

This is a good reference point for all of us in 2011.

Wishing you all the very best for the New Year.

Chris

Fashion Disaster

2010-12-21T07:52:00.001-08:00

I must confess that fashion and dress sense has never been my strong point. My partner (who some of you will know I sadly lost to cancer in March this year) sometimes used to say to me, “you didn’t wear that tie with that shirt!” – in fact some of you may think just that from time to time when you see me around our Trust! Well today’s fashion disaster is that I left a very snowy Brighouse this morning in green wellies. Half way to work, thought “oh dear, I have not brought any shoes”; this means that I will be wandering around in wellies all day, including meetings with colleagues at Leeds Teaching Hospitals. Heaven knows what they will think. Oh well!

Staying “mentally elfy”

The best thing that I did last week was to call by the marquee in Albion Street dedicated to the theme of staying mentally healthy this Christmas. Some of you will have seen the story book prepared by our Trust with the story of 'Sad Santa' (it does have a positive ending). The marquee spanned the street so that people had to walk through it. Alongside the information stands and the freebies there were lots of activities including a choir! I came away with a very useful elf hat which is great for this weather (oh dear, another fashion disaster!). The serious message is that Christmas is a stressful time for many people but there are things that can help. I want to say a sincere “thank you” to all those involved with designing and delivering the event – it was great. It was also another fantastic example of partnership working with our colleagues in the city and our social campaigning work regarding mental health and learning disability issues. It also ties in with our resolve to work in such a way which promotes “Improving health, improving lives” not only for service users and carers involved with our Trust but for the wider community.

Marching Orders

Every year the NHS receives 'The Operating Framework for the NHS in England' from the Government. This describes the priorities for the NHS for the forthcoming year. It also sets out how much money there will be. In common with other NHS chief executives I went to Birmingham for the launch of the document and to listen to the Secretary of State for Health.

I personally welcome a number of things that the Government considers to be important. These include the development of outcomes for the NHS (we are doing a lot of work in this area ourselves); services for people with autism; healthcare for people with learning disabilities; dementia services; the publication of a new mental health strategy early next year and increasing access to psychological therapies. On money issues, there is no change to what we were planning on over the next year. In other words, things will be tight for us but there were no surprises and we just need to deliver what we have assumed in the first place. If I am being honest documents like the Operating Framework are not exactly holiday reading, but it is reasonably easy to follow and is worth a look.

Kind of related to this, we should be told this week if our bid to be the provider of mental health and learning disability services in North Yorkshire and York has been successful. The last “Barometer: Your Views” asked “do you think this will help us improve people’s health and lives and strengthen our Trust”. 40% of you said that it would “a lot”; 43% of you said either “not really” or “not at all” with 17% in between. Interesting results.

Personally I was encouraged to see that a significant number of responders think that we have a positive contribution to make to a wider population. It will come as no surprise for you to read that I believe this to be true. As I mentioned in a previous blog, I also believe that there is much we can learn from the great work being done by our NHS and social care colleagues up the A1. Either way I will let you know what the commissioners decide just as soon as I know myself.

That's all for now. Thank you for taking the time to read this and please do comment in the box below, or email me at chris.butler@leedspft.nhs.uk with any feedback.

Chris

Behind the scenes

2010-12-13T06:44:00.000-08:00

Behind each and every doctor, nurse, psychologist, occupational therapist, pharmacist, in fact all clinical professionals, are others whose work enables them to get on with their job - administrative staff, different types of ancillary staff and, dare I say it, managers.

In response to an earlier entry, I was invited to spend some time with part of our in-house facilities team that specifically deals with transport, stores and the distribution of things that are ordered by teams, anything from clinical equipment to computers. It’s all located in an industrial unit not far from the centre of Leeds. The only clue to its connection with the NHS are the signs with our Trust’s name on it. It opens at 0700 hours and closes at 1600 hours Monday to Friday. During the recent weather is remained open for business. It provides a service not only for Leeds Partnerships but also for the Community services currently provided by NHS Leeds. Upstairs are colleagues who book transport to move people, including service users and carers, around the city; also colleagues who do the procurement of products. Downstairs is the warehouse that stores goods received from the huge NHS distribution centre in Normanton for onward distribution to team bases, health centres etc.

Why am I dwelling on this? Well, I hope that those of you with a clinical role will not mind me observing that it’s the clinicians who get a fair bit of time and attention in every NHS organisation (and managers too, though not always in a favourable way!). However there are thousands and thousands of people working in the NHS, either directly or indirectly - for example people who work in our Trust under contracts we have with others - whose tremendous contributions barely get a look-in. At the moment in our Trust we are looking at how in the future we may provide such services. There is a possibility that we may “contract out” some of them, though this needs much more work before anything becomes a certainty. Regardless of this, right now, I want to say a sincere “thank you” to all of those behind the scenes people without whose work what we do would simply be impossible. You are wonderful people who do a fantastic job.

Students

Yes, I was one once! In fact more than once – I was foolish enough to do it twice! I discovered this week that I have something in common with Ed Miliband, that is we were both involved in student politics. For me it was getting involved in the politics of the NHS. I was even involved in a few demos in my time (all peaceful I hasten to add)!

My first training involved working in a large psychiatric hospital wearing a white coat. Community services were non-existent apart from a day hospital and a few community psychiatric nurses. We have come a very long way in what we do today in mental health and learning disability; today’s services would be unrecognisable to people 30 plus years ago when I started out.

Many of you will be aware that our Trust is deeply involved in teaching, research and development. You may be interested to know that in this academic term alone we have provided placements for over 160 nursing students. Also I had an informal catch up with Professor Susan Price the Vice Chancellor of Leeds Metropolitan University.

Also, in between having to be in different places this week, I started to read the report of the Patient’s Association, “Listen to Patients, Speak up for change”. It’s a series of stories from relatives and carers concerning what can only be described as their horrific experiences at the hands of healthcare professionals. Though all of the stories are about physical healthcare, as a nurse, it made me hang my head in shame.

Why am I reflecting on this and what is the connection between these events and our work?

Well, my training, though wide of the mark in some areas, was very disciplined, particularly during my second stint as a student doing “general” nursing. I was trained to understand what the patient (now the service user) had a right to expect of expert professionals and my personal responsibility to ensure that I did my level best to ensure legitimate expectations were delivered. Hence the vital importance that we all have in our Trust of shaping the thinking and intentions of the hundreds of students that flow through our organisation. This is because how we are today will shape how they will be tomorrow, and how students are developed today, across all of the disciplines, will directly shape the future experience of service users and carers.

This also emphasises the need for all of us pausing from time to time to reflect on how we personally measure up to the values of our NHS and our Trust. We won’t get it right all of the time. We need to find more ways to celebrate what we do well but also be honest about those times when we have messed up or could have simply done something in a bit better way – me included!

And Finally!

It’s not too late to let me know about any colleagues who you think deserve some special recognition for getting into work during the snow but time is running out!

That's all for now. Thank you for taking the time to read this and please do comment in the box below, or email me at chris.butler@leedspft.nhs.uk with any feedback.

Chris

Snow days

2010-12-06T02:33:00.000-08:00

Well it’s Friday afternoon here at The Mount and I have spent the past couple of days visiting some of our sites in order to see how people, including service users and carers, have been coping with the weather conditions and, most importantly, to sincerely thank people for managing to come into work. Hundreds and hundreds of you have made a special effort to provide a service, and it has been both gratifying and humbling to see the lengths people have gone to in order to provide a service. All of you have, either directly or indirectly, have lived out our Trust’s value of “commitment to quality of care”.

Do you know anyone who deserves particular recognition? Do you think that we could do anything differently to enable us to be even more effective during adverse weather conditions? If so please let me know, chris.butler@leedspft.nhs.uk. Of course the cold spell is far from over and for the next few days there will be ice to contend with but I know that all of us will just keep going (and I know that we will).

Public Image

Over the past few months a lot of us have contributed to a rigorous process looking at our values, our ambition, our purpose, and our goals. This process, led by our Board of Governors, resulted in our Strategy, which was launched at our Annual Members’ Day back in September. We are now looking at how these themes can be measured in the context of making a positive difference to service users, carers, and ourselves in “improving health, improving lives”.

Our colleagues working in our Communications Department have developed the “improving health, improving lives” logo as part of our Trust’s identity. This draws together our new purpose and values into a straightforward visual design that promotes our strengths as individual professionals, regardless of our role, and our Trust as an organisation.

I am sure that you will agree with me in wanting to be the first choice for the people who use our services, as well as communicating a sense of our expertise and professionalism. In this context evidence shows that building and managing a “strong brand” can play a significant part in making that happen. The “improving health, improving lives” logo will be used to complement our NHS logo and will be applied to all of our corporate stationery, literature, and documents to help to remind people, not just of our purpose, but our values and goals.

How much will this cost you rightly ask? Not a lot. Which is just as well as some of you will know that I have a bit of an allergy to spending money on anything that does not improve things for service users, carers and staff! All of the design work has been done in house and for free through the creativity of our Communications colleagues. The things that have cost some money have been publishing such things as our Strategy, our Annual Report, and other information about our services which we routinely have to do anyway. The only difference is that this now features our new logo. Regarding name badges and the like, I have ordered a new magnetic lapel badge which will have the logo on it. I was going to do this anyway as the one that I have got has become faded and very discoloured over the past five-plus years. Regarding letter heads and stationary, my letter head is stored on my PC so I don’t have printed paper. You will find the new stationary templates and logos in the document library on Staffnet (which, for external readers, is our intranet).

Your opinions – our future

I hope that you do not mind me reminding those who have received them (not everybody has) that the deadline for returning your NHS Staff Surveys is Friday 10^th December.

At present, we have a low response rate (35%) compared to other Trusts who are averaging around 60%. This could be because that everybody who has received a survey is wonderfully happy and contented in their work. However even with the best of organisations this is unlikely! The annual NHS Staff Survey is a great opportunity, for those of you randomly selected, to provide open and honest feedback about your job and working for the Trust. The more replies that are received the more representative the results will be in helping us to improve your working life, and so provide better care for service users and carers.

Completed surveys need to be posted in the pre-paid envelopes provided with the survey, so please make sure you post them in time to arrive with the survey company, Quality Health, by Friday 10^th December.

That's all for now. Thank you for taking the time to read this and please do comment in the box below, or email me at chris.butler@leedspft.nhs.uk with any feedback.

Chris

Christmas comes (early) but once a year

2010-11-24T07:57:00.001-08:00

Well, Christmas must be coming! I have just had my seasonal flu jab in one of our Treatment Centres and the Christmas decs are going up here. Incidentally, one of the staff here has a beautiful singing voice with snatches of carols being in the air!

Change is also in the air, with my past two weeks being taken up with helping with the appointments process for new colleagues to join our Board of Directors, with other colleagues being reappointed. We have three new Non-Executive Directors appointed by our Governors: Keith Woodhouse, Aqila Choudhry, and Gillian Taylor; Allan Valks and Niccola Swan have been reappointed. All of these appointments were made following an external recruitment process.

Also following an external process, Jill Copeland has been formally appointed as our Director of Strategy and Partnerships, a post which Jill has been seconded into from NHS Leeds over the last few months. All of our colleagues, new and old, faced stiff competition and it is good to have them on board (no pun intended!). Non Executive Directors, and our Trust’s Chair, are all appointed by our Governors as the “lay members” of the Board of Directors. Their job, among other things, is to assure from an external and independent perspective that we are doing what we ought to as a Trust. Don’t be surprised if, in particular, you see our totally new colleagues around our Trust as they familiarise themselves with what we do.

You may recall that I mentioned in a previous blog the potential for us to work with colleagues providing mental health services in North Yorkshire and York in one bigger organisation. At the invitation of NHS North Yorkshire and York we have submitted a formal bid to do this. If our “job application” passes muster, as a Trust, our interview will take place on 6 December. It is a competitive process and will take the form of a presentation followed by a discussion concerning our plans for the future. Why are we interested in doing this with everything else that is going on? We have considered this carefully and involved our Governors (including our Staff Governors) in thinking it through. At a time of change in the NHS, with our Governors, we decided that we should seek the opportunity to deepen our work in mental health and learning disability by responding to the invitation to bid to provide services for our neighbouring North Yorkshire communities. Of course there is no guarantee that our bid will be successful. However, if it is I am confident that there is much we can learn from each as I have met fantastic people doing great work in North Yorkshire and York just like you do in Leeds. Working with these services would be entirely consistent with our purpose of “improving health, improving lives” and that “we aspire to provide excellent mental health and learning disability care”. I will keep you posted on developments.

On the topic of transforming services, on Friday I attended a meeting with other key stakeholders across health and social care in our City concerning how, as a whole system, we need to change key parts of it both to live within the money available, as well as improving the experience of service users/patients and carers. All of this is a big ask. Personally I feel that we are well positioned to help with this given our collective extensive experience of re-designing services. You can expect to see more about this in due course. Linked to this I had a conversation with a colleague working in social care to touch base on where we are at in improving older people’s mental health services, connected to our contribution to implementing the National Dementia Strategy. The progress that has been made in the area has been entirely due to your commitment to improving what we do, whilst using resources in a different way, which is what I mean about other NHS colleagues taking a leaf out of our book in this regard.

For the first time in ages I went to the pictures last week! As part of our Time to Change campaign, the Arts and Minds Network organised “Film to Change” as part of the International Leeds film Festival. This involved a series of short films concerning mental health issues, ranging from psychosis to dementia, followed by a panel discussion comprised of media professionals and academics. The event was sold out which was fantastic! The films were very different in style and content – from documentary to art house. Some were made by our partners in the Arts and Minds Network and it was great to see our colleagues working in the Time to Change campaign and the Arts and Minds Network getting such a wide exposure (oh dear, is that another unintended pun!). Joking apart is was a great as well as informative evening; well done to everyone involved!

Finally for now, thank you to those colleagues who have taken the time to comment on my ramblings! It’s great to get feedback and do keep them coming in. I will respond if I can. Some colleagues have taken the opportunity to extend to me an invitation to visit their service in addition to my routine of getting out and about. I have two “extra” visits booked as a result of this, one to colleagues working in Facilities, the other to Psychological Therapies.

That's all for now. Thank you for taking the time to read this and please do comment in the box below, or email me at chris.butler@leedspft.nhs.uk with any feedback.

Chris

Hero's week

2010-11-16T03:21:00.001-08:00

Last week seemed to me to be dedicated to remembering heroes. This culminated in Armistice Day on Thursday and Remembrance Sunday. My parents were Irish, they met in Leeds (Mum was a nurse at “Menston”) and, in common with thousands of other Irish people, my Dad’s father fought in the First World War in a cavalry regiment. Luckily Granddad made it back in one piece.

Also last week I attended the funeral of a cousin. He was a bit younger than me (that is the right side of fifty!) married with children, mainly grown up, apart from one teenager. He died following a short illness. During the funeral service the priest related how engaged he was with his local community, including his local church; this was borne out by the numbers of people there. He also spoke about how he dealt with his illness with good humour and forbearance. The other thing that struck me was the quiet dignity shown by all members of his family, including his mother who is last surviving member of my mother’s direct family.

Why am I reflecting on this? What is the connection between a family event; national acts of remembrance; also the work that we do in our Trust? On the way home from the funeral, and in the context of all of the remembrance activities of the week, it occurred to me that heroism is much more common than we may think it is. If you stop and think for a moment, I am sure that you know scores of heroes. The service user with a serious mental health problem or a learning disability who will not give in to their illness; the dedicated carer supporting their loved one day in day out; a colleague who despite a serious illness is determined to come back to the job they love and the colleagues they treasure; the colleague who goes that “extra mile” to provide the best possible service they can. These instances are examples of how our Trust’s values such as “respect and dignity”, “everyone counts” and “working together” are put into practice quietly and without fanfare.

Please do not misunderstand me; I am not underplaying the sacrifice of those killed in war as it is hard to envisage a person willingly dying for someone else, but the world really is full of people being quietly, often invisibly, heroic.

That's all for now. Thank you for taking the time to read this and please do comment in the box below, or email me at chris.butler@leedspft.nhs.uk with any feedback.

Lounging with leaders

2010-11-10T00:26:00.000-08:00

Last week got off to a great start for me. I participated in a “Leaders Lounge”. Some of you will be aware that our Trust is investing in a development programme for our colleagues at team manager level (Band 7 staff to use NHS jargon). The programme is called “Fit for the Future”. It has been designed by our own Development Team and contained within it are a series of Leaders Lounges. These are discussion sessions between course participants and senior colleagues about current issues and concerns pertinent to our Trust which often reflect what is happening in the NHS more generally.

In common with my Director colleagues, I attach a high priority to making space to have such conversations with my colleagues, also service users and carers. I am of the firm view that reading reports and looking at numbers only takes you so far in understanding what is going on in any organisation. It’s easy to kid yourself that everything is fine if what is on paper looks OK. It’s good therefore to get first hand views from a number of sources and last week’s Leaders Lounge was a chance for me to do this.

We spent a bit of time looking at the results of the second Trust Values Questionnaire. Our Values, which are contained within our Trust’s Strategy, encompass such things as compassion, commitment to quality of care, and working together. 87% of our colleagues see the Values as being important to our work. This is great news. More challenging, however, is that over 50% of people who responded don’t feel that we always behave in ways that reflect our values. This does not mean that we fail to deliver high quality care in a compassionate way, but it does mean that there is a gap between what all of us, me included, espouse and what we feel to be happening. Why is this?

In the Leaders Lounge we discussed some of the things that disconnect what people want to do from what they feel able to do. We discussed the nature of an NHS culture shaped by targets and how this has impacted on our work. As a nurse I know the importance of getting and recording important information about, for example, the personal circumstances of service users, also the need to record information about someone’s care. There is a wealth of evidence that shows that things are more likely to go wrong if there are gaps in the information available. Reflecting on this it seems to me that we need to look at if our Trust is asking for the right information to be collected in the easiest possible way. The consequences of getting this wrong include people spending more time on writing and typing stuff than spending time with service users with a risk of not colleting the right information anyway! However, this needs to be seen in the context that things do need to be recorded. Many years ago us nurses and doctors were taught that, “if it isn’t written down it doesn’t exist”, this is as true today as it was in 1978. So you see the difficulty!

There are no simple answers to such complex problems, but it has occurred to me that there could be value in mapping the process of information collection by clinicians in the same way in which we mapped our clinical services. What does this involve? In short, you map and write down, or illustrate, all of the steps in a process. When you do this you nearly always end up with what looks like plate of spaghetti in terms of complexity. The next stage is to remove bits of the process that have little or no value. The objective is to end up with something which is simpler and less complex. Such processes are commonly used in industry and we have redesigned some of our own services using this particular technique. What do you think?

On Wednesday afternoon I visited Ward 2 at The Mount which is now the inpatient unit for service users with dementia. I called in as I was aware that the ward is a recent amalgamation of two former services, including what was the Aire Court Community Unit, and I wanted to see how things were progressing. I am grateful to the staff for making me so welcome and for putting up with me disrupting the ward routine.

Later in the week, with some of my colleagues, I had an opportunity to visit mental health and learning disability services in York. It was good to see what others are doing with the same level of commitment and enthusiasm that I see in our Trust. With all of the changes going on in the NHS there may be opportunities to develop closer working relationships over time. This is because NHS North Yorkshire and York are in the process of finding a new ‘host’ for the mental health and learning disability services which are currently part of their Primary Care Trust’s provider service. We are currently exploring if we should formalise an expression of interest in this.

So, last week was good as it focussed pretty much on getting a sense of services both in our Trust and elsewhere. Every interaction illustrated to me the amazing contribution everybody makes to ensuring that service users and carers, not just clinicians but everyone involved in supporting clinicians in helping service users and carers do their work. Despite the complexity of our world we really are closer than we may think to putting our values into action.
That's all for now. Thank you for taking the time to read this and please do comment in the box below, or email me at chris.butler@leedspft.nhs.uk with any feedback.

Chris

Working together

2010-11-09T01:11:00.000-08:00

My last blog focussed on the Government’s expenditure plans along with some observations about what that means for our Trust.

Of course the Government’s Comprehensive Spending Review has significant implications for the whole of the health and social care system in Leeds. What happens in other partner organisations will have implications for what we can do for service users and carers.

“Working Together” is one of our Trust’s values, and it happens that last week I ended up spending a fair bit of time working with colleagues from NHS Leeds, Leeds Teaching Hospitals (LTHT), Adult Social Care (Leeds City Council) and the Yorkshire and Humber Strategic Health Authority (SHA) to better understand, and plan for, these wider implications.

Why do this? As I mentioned in my last blog entry, as long as we deliver our plans we are, clinically and financially, in a relatively strong position. However, we cannot totally separate ourselves from other things happening in our city. At best, we may be able to help other partners, and, at worst, unless we engage with the wider issues we may find ourselves the recipient of some unintended and risky consequences later on.

So what happened last week? First thing on Monday I had a regular meeting with Sandie Keene, the Director of Adult Social Care in Leeds. Michele Moran, our Director of Care Services and Chief Nurse, joined us along with John Lennon, who works with Sandie as Chief Officer for Access and Inclusion. The four of us had a conversation about our joint programme of work to further integrate into our Trust elements of Adult Social Care. This feels more pressing in the light of the financial challenges facing all of us. Sandie and I also agreed to keep in touch about wider developments in the NHS in Leeds.

First thing on Tuesday morning I met with colleagues from NHS Leeds and LTHT to discuss the work that flows into the acute hospital with regard to, for example, long term conditions, and also the options for handling more of this work closer to people’s homes for less cost, especially regarding services for people with dementia.

We also discussed how to keep up the momentum on the variety of new areas of work given that people are already busy with their ‘day jobs’. Being connected with other providers of health and social care in Leeds is as important as ever and we agreed to meet with a broader group of stakeholders in Leeds later that week to bring them up to speed.

Tuesday was a busy day as the same afternoon I was at the SHA with colleagues from the NHS in Leeds to brief the SHA board of directors about the work of NHS Leeds and other partners. This goes well and I took the opportunity to stress the need to ensure that social care, both for adults and children, participate in both shaping future plans and putting them into action.

On Thursday I attended our monthly board of directors meeting, which filled most of the day. Look out for the regular briefing from the Chairman to see what was discussed. After this Michele Moran and I attended the Leeds Acute Services Strategy Group at St James’ Hospital. It was another good opportunity to be a part of the wider conversation of healthcare in Leeds, particularly where services for older people are concerned.

Why is any or all of this significant? My experience suggests to me that “you have to be in it to win it”. Also you can’t complain later if you choose not to be part of what can, at times, feel like discussions where you only have a marginal interest. Of obvious significance for us is the future of dementia services alongside our local implementation of the National Dementia Strategy.

At our Annual Members’ Day in September, Alastair Campbell reminded us of the connection between physical and mental health. We know that people with serious mental health problems and learning disabilities are more likely to have undiagnosed conditions such as diabetes and heart disease. We know that if conditions such as these go untreated, they shorten the life expectancy of people with mental health problems and learning disabilities. Ensuring that this is taken account of when things could be fundamentally changed is very important.

More broadly, having an understanding of what is being played out between other partners and, in the spirit of partnership, doing our best to help people with complex health problems is the right thing to do.

On a totally different topic, I did most of my mandatory training last week. As well getting it done (fire prevention, hand hygiene, and basic life support) it was great to spend time with other colleagues. The 4pm Friday finish was good too! Sincere thanks to Ian, Holly, Sharon and Julie for making the day so interesting and informative.

That's all for now. Thank you for taking the time to read this and please do comment in the box below, or email me at chris.butler@leedspft.nhs.uk with any feedback.

Chris

Storm warning

2010-10-29T03:42:00.001-07:00

Some of you will be aware that we are trying out a new way of finding out your views about issues of the moment, the “Barometer”. Our very first Barometer question was

“To what extent are you concerned about the impact of the economic downturn on our ability to deliver front line services?”

The responses were:

Not at all concerned 17 3.50%

Not very concerned 14 2.88%

A little concerned 93 19.14%

Very concerned 362 74.49%

These results speak for themselves. Also no-one can have missed the publication of the Government’s spending plans for the next few years. There were no major surprises for the NHS. The “headline” position is that the NHS budget will grow 0.1% per annum above the rate of inflation over the next few years. This is welcome news, however inflation in the NHS always runs ahead of inflation generally. This also needs to be seen in the context of major reductions planned for the whole of the NHS in capital spending and administration costs, as well as a transfer of some resources from the NHS into local authorities to support the provision of social care.

Whilst costs are increasing for the NHS each year well above 0.1% above inflation, our Trust has been planning for some time to receive less income over the next few years. Balancing the 0.1% increase against the likely rate of inflation in the NHS, it is likely that overall inflation funding will amount to a reduction of 2% per annum over the next few years.

What does this mean for us in practical terms? In our Trust we have been making plans for the future for a good while using the numbers the Government has now published. Our plan is to manage costs out of our Trust over the next 4 years and this is already well underway. Because we are looking at things over a 4 year horizon we are doing nothing which is sudden or drastic. However it does mean that in some areas there will be fewer people. You will recall the reports about this in the Yorkshire Evening Post a while ago. I want to be absolutely clear that people will lose their jobs only as a last resort. I say this as I have a strong view that the NHS always needs people with the right skills and positive attitude; I also believe that redundancy payments amount to money that we can better use on providing services for service users and carers.

To manage the numbers of staff down to where we think they need to be we have already done a number of things. For example, we scrutinise each and every non clinical vacancy to see if the job is needed or if it can be done in another way; we have also taken on a number of people on short-term contracts. With regard to people on short term contracts I want to be clear that these colleagues have, and continue to make, a major contribution to the work of our Trust and I for one have not ruled out making the temporary appointments permanent whenever we can. In the future people will at times need to readily move across our Trust into different jobs. We continue to look at how we can do things more efficiently and effectively both in our Trust as well as leading on initiatives in Yorkshire and the Humber.

Concerning the former, clinical services are being re-designed to reflect clinical pathways rather than being solely age related as well as better integrating some of our work with adult social care. Such work will enable service users not only to receive a better service but enable is to reduce management costs across health and social care. On management costs, we are reducing the cost of our corporate functions more quickly than other changes taking place in clinical services in order to give clinical services more time to make their changes. On the broader work, we are leading on behalf of the NHS in our region work associated with reducing costs associated with how the NHS buys good and services from suppliers. We are well placed to do this though our colleagues working in our Trust’s Commercial Procurement Collaborative http://www.yhcpc.nhs.uk/

Getting this as right as we can is important in holding true to our ambition of “improving health, improving lives”. It is also a real test of how we adhere to our values such as “commitment to the quality of care” and “working together”. There is no doubt that things will be tough for the next few years, however with my colleagues we have been planning for this for some time. Though we will have to do some things that we would not readily do I am quietly optimistic that by keeping true to our purpose and working efficiently and effectively that we will see things through to, eventually, a more stable future.

It's more than treatment

2010-10-29T03:34:00.000-07:00

Some of you will have seen the advert for the World Mental Health Day event at the Becklin Centre this week. It proved to be a good opportunity for me to drop by and meet colleagues, as well as getting a sense of how creative you are being in working with service users beyond the traditional boundary of medicine, nursing, and the professions allied to medicine. It was particularly good to meet some colleagues who have come to work with us with diverse occupational backgrounds outside the NHS. It's great to have people working with us people with different life experiences who bring a different take to what many of us take for granted in terms of "how things are done". Thank you to everyone involved in arranging the World Mental Health Day event; it was great.

The rest of the week has been a mixture of seeing colleagues in the Trust as well as representing our Trust externally. As far as possible I always try to strike a balance between how much time I spend on external issues whilst making sure that I do not spend an excessive amount of time away from our organisation. My rule of thumb is that if I am away for more than a day at a time I start to get twitchy (other than when I am on annual leave)!

Earlier this week I met with Maggie Boyle, the Chief Executive of Leeds Teaching Hospitals; John Lawlor, the Chief Executive of NHS Leeds; and other colleagues in the city regarding the future shape of acute services in the city. What's that got to do with us you may ask? Well, one of the key programmes concerns building on our work on improving dementia services. My experience tells me that if you are not in on such discussions from the start you can sometimes have a nasty surprise later on! By contrast later in the week I met with our trade union colleagues.

We discussed a number of things going on in the Trust, such as how we are getting on as an organisation money-wise this year, through to the interesting, and for some people, controversial issue about staff uniforms versus people wearing their own clothes to work. On this, interestingly though, staff instinctively have reservations about uniforms, evaluations show that service users and carers like to see them in inpatient settings. Also when I have been out and about in our Trust difficulties in ensuring our dress code is adhered to comes up pretty regularly. This led me and my manager colleagues to think about whose views we should attach most importance to. For me service users and carers always win out and you can expect to hear more about how we will respond to this particular feedback from them over the coming weeks.

More generally I very much appreciate the work that our trade union representatives do in the Trust. Personally I have been a life long member of a trade union and the work that our trade unions do on your behalf, either as individuals or as a collective, in invaluable. As ‘management’ we have a good open dialogue with your representatives without which we would not be able to aspire to be the best employer that we can be. I will be discussing with my immediate colleagues how we can further improve our lines of communications with our trade unions given everything that is going on in our Trust and the NHS generally.

Well, that’s this week’s snapshot. As always I am happy to receive any feedback you may have, including anything you may want to know more about.

Chris

To blog or not to blog?

2010-10-29T03:28:00.000-07:00

Dairys

Do you remember those 5 year diarys? My sister had one and I used to sneak a look at it from time to time. It did have a lock on it but it was rubbish and easy to circumvent! Of course all what was in it was "good day at school" etc. As a kid I also used to like those diarys with lots of pages of what most people saw as useless information but I considered to be fascinating facts - I always was a bit of a strange child! I also recently discovered that some of my cousins still keep a diary. Perhaps you have your own "diary memories".

Well here is my first blog. It is very much an experiment for me, as is using Facebook at home. For now I don't intend to start Tweeting - many people in our Trust say I do quite enough of that already without using technology!

Our Purpose, Our Future

So what will I use this blog for? I am keen to strike the right balance between what is going on in our Trust from my perspective, and inviting your views on the things that are on my mind. I say this as the things that all of us face some major challenges over the coming months and the ability to exchange views will become increasingly important.

For me the most important thing to adhere to is the delivery of our new Strategy which was launched at our Member's Day. At the heart of this is "Working in partnerships, we aspire to provide excellent mental health and learning disability care that supports people to achieve their goals for improving health and improving lives". Despite the changes we can all expect to see in the NHS and social care system over coming years, for me this statement encapsulates an enduring purpose for all of us.

What Do I Do With My Time?

I thought that it may be useful to offer to you a sense of what I have been doing this week.

Each week is different, but, perhaps surprisingly, I have limited control over how I spend my week. Often how I use my time my time is committed to people or groups who want to spend some time with me for whatever reason.

This week has included activities related to developing our work as a Trust; the work and careers of our colleagues; also using opportunities to influence the work of the NHS in Yorkshire and the Humber. For example, I had a useful discussion with our colleagues working in the part of our Trust which is the Northern School for Child and Adolescent Psychotherapy www.nscap.org.uk, about possibilities for the future and how things are going with their management arrangements within our organisation. Externally I attended a meeting hosted by the Yorkshire and Humber Strategic Health Authority www.yorksandhumber.nhs.uk and the Department of Health www.dh.gov.uk to influence the development of how the commissioners of NHS services can better link what they pay NHS Trusts to the quality of the service provided and innovations in services. Last night (Thursday) with Frank Griffiths, our Chair, I attended the Yorkshire and Humber Health and Social Care Awards. One of our colleagues in Older People's services, Pat Larner, was nominated in the category of Yorkshire Post NHS Health and Social Care Hero; also our “Time to Change” team was nominated under the Success in Partnership Working award. Both were pipped at the post, but I am immensely proud to work with such wonderful colleagues. Well done to Pat and the “Time to Change” team!

That's all for now. Thank you for taking the time to read this.

Chris