Day 50: Half-time Team Talk

If you haven't read my blog from Day 1 here's a brief introduction (if you've been reading from the start, skip to the next paragraph, or carry on reading for a reminder):  On 1 September 2013 I left NHS Direct after seven and a half enjoyable years to take up a new post as Director of Quality & Clinical Governance with NHS Luton Clinical Commissioning Group (CCG).  With some encouragement from friends on Twitter, I set myself the challenge to write a blog of 100 words per day for the first 100 days of my experience of working in this new role.

I have given myself permission to write more than 100 words today as this is the day 50 milestone of my 100 day blog.  A bit like giving myself a half-time team talk!

In the last 50 working days I have probably learned more than I have in any other 50 day period of my adult life.  I learned an enormous amount at NHS Direct;  I also learned much in the year I was an independent Nurse Board Member with NHS Milton Keynes CCG; however, moving both into the world of commissioning and into my first full-time director role has been a steep learning curve and a great challenge (this is a challenge that I am up to meeting and thoroughly enjoying).

Moving from a provider to a commissioning organisation requires a change of mind-set.  You find yourself changing from being more closely in control of systems and processes for ensuring the safety and quality of services to working with providers through relationships and processes to gain assurance of this.  Many of the same skills required, but a different perspective.

One of the biggest challenges I have found in this role has not been getting to know the technical side of commissioning and what CCGs do, which I had a year's introduction to with Milton Keynes CCG; but getting to know Luton, including the local population's needs, the people who work in the health and social care system and the history of what has gone before in terms of services and people.

Before I officially taking up the role on 1 September I started to get to know key people and it is confirmed every day that the most important thing about being a director and in particular working in commissioning is interpersonal relationships.  I realise this sounds a bit clichéd and applies in many roles and businesses, but working in commissioning we don't have direct 'control' of the services our patients use.  We don't make decisions about individual patients' care on a daily basis.  The power of our role as commissioners is in bringing people together to develop, communicate and deliver a shared purpose to achieve better services for our patients and public.

This can be achieved to a limited extent by individual organisations on their own, but the real impact of CCGs will be integration between organisational boundaries, overseeing the 'system' and achieving outcomes in a genuinely person-centred way. I reflected in a previous blog post that I feel CCGs are a bit like yeast in dough; you can make bread without it, but it needs to be added at the start along with other elements to 'activate' the process of dough rising (I was helpfully reminded in feedback on this blog post that in order for dough to prove properly, it needs to be left alone and not interfered with - another helpful metaphor!).

With people and how I relate to them being so important, and at this half-way stage in my first 100 days, I have been reflecting on the key relationships I need to continue to work on in the next 50 days and beyond. In summary, these are: my own direct team, the Exec team, wider Board and other CCG colleagues; Directors of Nursing and other senior leaders in our main providers; key partners in the local authority with whom we are seeking to more closely integrate through our Better Together programme; fellow CCG Quality & Nursing Directors, senior nursing and quality leaders in NHS England, particularly within the Area Team; and probably most importantly with my wife, Sam, without whose support and direction I never would have achieved what I have in my career so far (she is very patient and tolerant of the time I devote to my professional life, but I will never take this for granted or neglect her).

I am looking forward to the next 50 days and beyond.

Thank you for taking the time to read this; feedback is welcome including ideas for what I should do with my blog after day 100!

PS the 'Word Cloud' is made up from the text of the first 50 days of this blog.