Enclosure: G Agenda item: 10 GOVERNING BODY Title of paper: and Action Plan 2018-19 Date of meeting: 28 March 2018 Presented by: Yvonne Leese Prepared by: Yvonne Leese Title: Director of Quality and Integrated Governance & email contact: yvonne.leese@nhs.net Title: Director of Quality and Integrated Governance & email contact: yvonne.leese@nhs.net Corporate Objective addressed by this paper (please select one or more with an X): 1. To commission safe, sustainable, efficient and affordable services to meet the health and wellbeing needs of the population of Greenwich and reduce health inequalities with an additional focus on the urgent and emergency care system x improvement along the pathway 2. To ensure the CCG s position recovers to meet its financial duties and performance standards x 3. To nurture and support primary care to be resilient and thrive x 4. To strengthen productive relationships with partners and the public to work as a health and care system x 5. To actively engage with our communities to improve their experience of healthcare x 6. To play an active and influential role in shaping SE London and London wide commissioning x Purpose of the report: The CCG had a very challenging year in 2016-17 and was placed in Directions by NHSE following an inadequate rating under the new NHSE retrospective assurance process in September 2017. This Organisational Development (OD) strategy supports the development of the organisation as it moves from its current inadequate rating to achieving its ambition of being an outstanding organisation by 2020. The strategy has been informed by Away-days and workshops with the Governing Body, senior leaders and CCG staff as well as surveys and feedback from our key stakeholders during 2017-18. The OD strategy sets out how we will meet the development needs of the Governing Body, our member practices, wider workforce and the organisation as a whole, so that we are better equipped to deliver the ambitious reforms set out in the Health and Social Care Act 2012, the 5 Year Forward View and our emerging Clinical Commissioning Strategy. To deliver the level of radical system-wide transformation reflected in our vision, emerging strategy and strategic goals we will need to develop our leaders, our wider workforce and an organisational culture that drives the delivery of continuous high performance. Our structure, systems and management practices will also need to be aligned to deliver these results. The plan considers this complex range of inter-related factors and identifies goals that will enable us to improve CCG performance to meet the changing needs of our population as we move forward to much more collaborative and partnership working with our colleagues across South East London. The OD Strategy encapsulates our approach to the development of our CCG by setting out:
National and local strategic context for Greenwich CCG Our vision, values and corporate objectives Key areas of strategic transformational change The principles underpinning the Our commitment to the NHS Leadership Academy s Leadership Model and approach to transformational leadership development at all levels across the wider organisation Our CCG s organisation development goals and detailed action plan for 2018-19 Summary of actions, if any, following this meeting: The implementation of the 2018-19 organisational development action plan will be monitored closely by the Greenwich Executive Group (GEG). The action plan will be reviewed and RAG rated each month as implementation progresses enabling the GEG to consider any risks to delivery and how they are effectively being managed. Previous committee involvement: Greenwich Executive Committee and Senior Management Team Recommendations to the Governing Body: 1. Governing Body is asked to approve the strategy and accompanying action plan (Please provide details below where Yes is indicated) Impact on Governing Body Assurance Framework (x) Yes x No N/A Impact on Environment (x) Yes No N/A Legal Implications (x) Yes No N/A Resource and or financial implications (x) Yes x No N/A Equality impact assessment (x) Yes No N/A Privacy impact assessment (x) Yes No N/A Impact on current NHS Outcomes Framework areas (x) Yes x No N/A Patient and Public Involvement (x) Yes x No N/A Communications and Engagement (x) Yes x No N/A Impact on CCG Constitution (x) Yes x No N/A Attachments: (i) OD Strategy 2
Organisational Development Strategy 2018-2021 Version 1.0
Contents Introduction...3 Where we are now...3 National Strategic Context...4 Local Strategic Context...4 Collaboration and Partnership Working with the Local Authority...6 Primary Care Transformation...6 Collaborative Working with other SEL Commissioners...6 Sustainability and Transformation Partnership (STP)...6 Our Mission, Values and Objectives:...7 Organisational Development Definition and Model...8 Definition...8 Organisational Development Model...8 NHS Leadership Model and Approach to Leadership Development...8 Key Drivers and Themes...10 System-wide:...10 Organisational/Individual...10 Strategic Themes...10 System and Transformational Leadership...11 Who is this OD plan for and why?...11 Governing Body...11 CCG Staff...13 Member Practices...14 Wider Partners...15 Engagement...15 Annual 360 Degree Stakeholder Survey...15 NHS Staff Survey 2017...16 Feedback from Awaydays...16 Actions agreed as a result of Awaydays held in 2017-18...17 Workforce Planning...17 Current Position...17 Talent & Succession Planning - Proposed Approach...18 New Roles and Working across Boundaries...18 NHS Greenwich CCG...20 Monitoring and Review...21 Appendix A: Detailed Organisational Development Plan 2018-2019...22 Appendix B: References...27 2
Introduction NHS Greenwich Clinical Commissioning Group (CCG) is now approaching its sixth year of operation following authorisation on 1 April 2013. Made up of representatives from each of the 35 practices in Greenwich, the CCG is responsible for planning NHS services for the population of the borough of Greenwich, working with other clinicians and healthcare providers to meet the needs of the local people. This includes: Acute Hospital Care Urgent Care Rehabilitation Care Adults and Children s Community Services Mental Health and Learning Disability Services General Practice Services The CCG is committed to working with patients and healthcare professionals, as well as in partnership with local communities and the Royal Borough of Greenwich (RBG), to make sure that health and social care is linked together for people whenever possible. In addition to GPs the Governing Body membership includes other clinical specialists from nursing and secondary health care. Where we are now The CCG had a very difficult year in 2016-17 and was placed in Directions by NHS England (NHSE) following an inadequate rating under the new NHSE assurance process in September 2017. This strategy supports the development of the organisation as it moves from its inadequate rating to its ambition of being an outstanding organisation by April 2020. The strategy is linked with our Organisational Recovery Plan and addressing the conditions and directions placed upon the CCG by NHSE. The strategy has been informed by Awaydays and workshops with the Governing Body, senior leaders and CCG staff. This has helped us shape our vision and how this is shared with our Greenwich partners. The OD strategy also sets out how we will meet the development needs of the CCG and our workforce, so that we are better equipped to deliver the reforms set out in the Health and Social Care Act 2012, the 5 Year Forward View and our South East London (SEL) Sustainability and Transformation Plan (STP). To deliver the level of system-wide transformation reflected in our vision, emerging clinical commissioning strategy and goals we will need to develop our leaders, our wider workforce and an organisational culture that drives the delivery of continuous high performance. Our structure, systems and management practices will also need to be aligned to deliver these results. The plan considers this complex range of inter-related factors and identifies goals that will enable us to improve CCG performance to meet the changing needs of our population as we move forward to much more collaborative and partnership working with our colleagues across South East London. The OD Strategy encapsulates our approach to the development of our CCG by setting out: 3
National and local strategic context for Greenwich CCG Our vision, values and corporate objectives Key areas of strategic transformational change The principles underpinning the Organisational Development Strategy Our commitment to the NHS Leadership Academy s Leadership Model and approach to leadership development Our CCG s organisation development goals and action plan National Strategic Context We know there are many challenges facing the NHS. Some of these can be addressed by making continuous quality improvements, by raising performance across the board, concentrating on improving primary care and ensuring we always deliver a safe, high quality, value-for-money service. However, improving the existing system on its own will not be enough. The NHS faces increasing challenges with the demand for health and social care rising and the need for a health and social care system that delivers quality and a positive experience for those requiring services. The NHS Five Year Forward View published in October 2014 sets out a new shared vision for the future of the NHS based around new models of care. In delivering this vision, the guidance introduces a triple aim framework that describes an approach to optimising health system performance through the simultaneous pursuit of three dimensions: 1. Improving the quality of healthcare 2. Improving the health of the population 3. Achieving value and financial sustainability In 2016 Developing People - Improving Care, a national framework for action on improvement and leadership development in NHS funded services was launched. This framework identifies the five conditions common to high quality, high performing health and care systems in every local health and care system in England. Evidence shows that these five conditions shape cultures that enable people to continuously improve care, population health and value. The five conditions are: 1. Leaders equipped to develop high quality local health and care systems in partnership 2. Compassionate, inclusive and effective leaders at all levels 3. Knowledge of improvement methods and how to use them at all levels 4. Support systems for learning at local, regional and national levels 5. Enabling, supportive and aligned regulation and oversight The OD Plan will reflect any gaps identified in the CCG that may prevent these conditions from flourishing. Local Strategic Context Following a challenging 2 years Greenwich CCG s overarching priority and aim is to be Outstanding by April 2020 by delivery of better care and achieving financial balance and we will do this incrementally and at pace by: 4
Improving the whole system performance around the Emergency Care pathway by better prevention services, keeping people well at home with more anticipatory care, effective acute in-patient care when required with no-one staying in hospital for any longer than they clinically need to and timely discharge home from hospital after an acute episode with appropriate support Delivering on the CCG Financial Recovery Plan (FRP) and the targets and outcomes set out within the 2017-19 Operational Plan which encapsulates the national requirements set out within the 5 Year Forward View and related planning guidance. Delivering on the CCG Organisational Recovery Plan which was developed between December 2017 and January 2018. This overarching plan outlines the wide-ranging short and medium-term actions the CCG is taking to address the weaknesses identified during the remaining part of 2017-18 and during 2018-19. The plan is to achieve Requires Improvement in our annual retrospective Improvement and Assessment by NHSE for 2017-18 which will be announced in July 2018; and to achieve a good rating for 2018-19 and then Outstanding for 2019-20. Support member practices to transform primary care over the next two years through the development at pace of the four Local Care Networks established in 2016. This will support our overarching vision of more integrated and sustainable General Practice Services that are at the heart of community based care in the borough thereby ensuring that we are able to treat and care for people at the right time, in the right place by the right people. Contribute in a positive and demonstrable way to the development of the South East London (SEL) Sustainability and Transformation Partnership (STP) and the local delivery system ensuring that all stakeholders, including wider CCG practice membership, are involved and informed. Support the development of an Integrated Care System (ICS) locally Ensure strong alignment and engagement with our key stakeholders including our membership, Local Authority, providers and public. The OD Strategy seeks to support the CCG as it continues to rise to the challenges described, ensuring the workforce is equipped with the necessary skills and behaviours to accelerate performance in order to ensure the strategic aims of the organisation are delivered in conjunction with key stakeholders and within the challenging financial framework. The inability of the CCG to meet its statutory obligations in terms of acute commissioning and the emergency care pathway standards resulted in the CCG being put in legal directions by NHSE in September 2017. This difficult performance environment has inevitably intensified regulatory intervention and exposure, which can contribute to stresses felt by staff and cultural strains. 5
The actions contained therefore within the strategy underpin the successful delivery of the Organisational Recovery Plan and strategic priorities outlined below, whilst recognising the changing environment in which the CCG is operating. Collaboration and Partnership Working with the Local Authority NHS Greenwich CCG is committed to pursuing further collaboration with the Royal Borough of Greenwich, believing that through real partnership working with the local authority and other organisations across all areas of their work every opportunity can be maximised to make a real difference to improve health and wellbeing in the borough. The NHS 5 Year Forward View makes this case strongly and compels NHS Greenwich CCG, its partner organisations and the local community to embark upon radical transformation of all aspects of the care commissioned and delivered. This is clearly set out in the Greenwich Health and Well-being Strategy (Healthy Greenwich, Healthy People 2015-18). Primary Care Transformation The CCG has been working closely with its 35 member practices following publication of the General Practice Forward View (2016), which sets out a vision to deliver sustainable general practice services that are at the heart of community based care in the borough. To treat and care for people in the right time, in the right place by the right people. The CCG also took on level 3 delegated primary care commissioning from NHS England on 1 April 2017. Key to this work is ensuring that we have both the capacity and capability within the primary care workforce to lead and deliver the required transformation. Collaborative Working with other SEL Commissioners We are committed to working with 5 other CCGs in South East London and the wider London region, sharing resources effectively to commission coherent clinical pathways and services for our community. We work closely with staff from the Commissioning Support Unit that provide a range of managerial support and since September 2017, with the Integrated Contracting Delivery Team (ICDT) based at Southwark CCG, who support acute contracting. We have developed key relationships with other stakeholders, the Royal Borough of Greenwich, the Greenwich Health and Wellbeing Board and with NHS England. The CCG s Operational Plan (2017-19) sets out a framework to ensure that the CCG is able to meet its key strategic priorities. Through this the vision is to deliver a place-based approach to: Local redesign and co-ordination of services to improve outcomes and reduce costs across the whole system Improved social outcomes and better health and wellbeing of local residents Sustainability and Transformation Partnership (STP) The CCGs and Provider Trusts in SEL agreed in 2016 the geographical footprint for the Sustainability and Transformation Plan. The plan has recently evolved into a partnership that will work to deliver the high level strategic transformational change areas, rationalising wider service provision and driving major network programmes. 6
The six CCGs in SE London (SEL) commissioned a review of commissioning functions in early 2017 which led to a consultation to develop a SEL executive leadership team working across the six CCGs. This will support the strategic development of Integrated Care Systems (ICS) across the patch and the implementation of the Sustainability and Transformation Programme. We have worked collaboratively to develop our plan for South East London, and where there is a benefit to the system and to our residents we will deliver collaboratively, whilst much will be continued to be delivered locally. Our STP does not capture everything that we are doing as a health and care economy. Instead it focuses on five priority areas and related areas of focus that we believe will have the greatest impact on our challenges and pressures to collectively address the three gaps of health, quality and finance while increasing value. The delivery of these plans will be supported by a cross-organisational governance arrangement that will allow us to overcome difficulties and collectively manage the transformation required. Our Mission, Values and Objectives: NHS Greenwich CCG has set a clear direction for its work over the coming years and as a key local NHS partner has also communicated its vision, values and strategic objectives. These agreed statements underpin the organisational development strategy and the actions recommended for the next three years. Mission Statement Our mission is to secure the best possible health and care service for the population that we serve, specifically in primary care settings and in hospitals as necessary. Our Key Values Putting People First Being respectful of others Having a shared Vision and Ownership (individual and collective accountability) Maintaining Organisational Integrity Always aspiring to be the best we can Corporate Objectives 2018-19 1. To commission safe, sustainable, efficient and affordable services to meet the health and wellbeing needs of the population of Greenwich and reduce health inequalities with an additional focus on the urgent and emergency care system improvement along the pathway 2. To ensure the CCG s position recovers to meet its financial and governance duties and performance standards 3. To nurture and support primary care to be resilient and thrive 4. To strengthen productive relationships with partners and the public to work as a health and care system 5. To actively engage with our communities to improve their experience of healthcare 6. To play an active and influential role in shaping SE London and London wide commissioning 7
Strategic themes for systematic transformational change Community-based Care the provision of patient-centred care outside of a hospital setting either in a patient s home or based around a primary care team Care of the Frail/Elderly the provision of high quality coordinated care in support of an ageing population in Greenwich with increased life expectancy where patients can experience multiple health conditions and an increase in clinical complexity Co-ordinated Care the provision of joined up care across a whole system that is responsive to a person s needs, uses the latest technology to support service delivery and develops enhanced access to data and information across partner organisations Organisational Development Definition and Model Definition There are many definitions of organisational development but for the purposes of this strategy and accompanying plan the following definition is used: A deliberately planned, organisation-wide effort to increase the organisation s effectiveness and efficiency. It is a long-range, long-term, holistic and multi-faceted approach to achieving transformational change and is underpinned by the ability of individuals, teams and the organisation to grow. The key feature here is the reference to long-term and multi-faceted which reflects the organisational complexity of the CCG but also the long-term nature of our health improvement ambitions. It also recognises that success in a CCG is linked to both effectiveness the quality of interventions, decision-making and strategy, and also to efficiency the deployment of resources to achieve the most cost-effective health outcomes for local people. Organisational Development Model There are many different approaches to organisational development (OD) and several different models from which a programme of support may be drawn. The requirements of primary health care led organisations like CCGs, reflect the need to consider the different facets that impact on organisational effectiveness, both internal and external. NHS Leadership Model and Approach to Leadership Development In order to consider the varying factors which impact on a CCG and its capability to deliver in this continually changing environment, the NHS Leadership model is a helpful framework for exploring the OD needs of the organisation. This model considers the themes and dimensions that contribute to effective CCG leadership at all levels in the organisation. The model explores the areas of system, team and individual effectiveness. 8
Based on research and created through extensive consultation, the Leadership Framework has been tailored to the specific needs and environment of health and care, and is applicable to all staff at any stage of their career. It sets out the expectations of leadership at every level of the system and provides guidance to those who commission leadership development. By utilising an adaptation of the model to prepare the organisational development strategy, the approach has enabled a recognition and assessment of the requirements of the CCG s future plans. This supports a refreshed forward strategy to enable organisational, team and individual growth. The action plan attached to this strategy suggests interventions for 2018-19 which will begin to address the developmental areas identified (Appendix A). In addition, reflection on the 6 domains identified by NHS England in their Framework for Excellence in Commissioning, sets out the expectations for CCGs in the delivery of their commissioning duties. The six domains are as follows: A strong clinical and multi-professional focus with significant member engagement Meaningful involvement of patients, carers and the public Clear and credible plans Robust governance arrangements Collaborative commissioning Clinical leadership The OD Plan therefore supports the development of leadership at all levels across the CCG in line with the Healthcare Leadership Model. It is clear the future requires leaders who are inclusive, resilient and delivery-focused while also remaining caring and patient-centred. 9
Key Drivers and Themes The current environment in which the CCG is operating is extremely challenging and multi-dimensional. CCGs are attempting to enact the local actions required to deliver on the Five Year Forward View and other national priorities, whilst at the same time support local place-based planning and adopt new transformational models of care to support Sustainability and Transformational Partnership (STP) level plans. The following key drivers have been identified for consideration by the CCG Governing Body in determining their future OD strategy and plan: System-wide: National policy direction (e.g. Five Year Forward View) Demographics and changes in need/expectations New models of care and system transformation (doing different things, not just doing things differently) Financial context and efficiency requirements (e.g. Capped Expenditure Process (CEP) and Quality, Innovation, Productivity and Prevention (QIPP)). Organisational/Individual Changing role and responsibilities of CCGs Workforce skills and development of capability in the CCG team Leadership task for the Governing Body system and organisation-wide Balancing priorities STP versus place-based care plans Strategic Themes Six key strategic themes underpin the CCG s forward OD strategy and accompanying action plan: Leadership Workforce Skills & Development Systems & Processes Clinical Focus Engagement Collaboration Dimension Theme Desired Outcome Leading as Individuals Leading the Organisation Leading the System Leadership Workforce Skills & Development Systems and Processes Clinical Focus Effective leadership and empowerment at all levels and in all aspects of work Team members ably supported to carry out their roles and realise their potential All working in the most efficient and effective way to deliver the best we can Decisions and plans are clinically led and informed 10
Engagement Collaboration Engage in a meaningful way with staff, partners and our local people Collaborate to deliver objectives that improve health outcomes The OD Plan supports these six strategic themes and delivery of the desired outcomes. System and Transformational Leadership A key feature of recent public service work has been the blurring of organisational, professional and geographical boundaries as services are integrated and transformed, resources pooled or shared and staff deployed more flexibly. Such collaboration is evidenced in the Better Care Fund, Care Bill and Health and Wellbeing Board. Few, if any leaders, will have experienced this environment and the combination of system opportunities and challenges such large scale change brings. System leadership helps address complex and complicated issues not easily solvable by one organisation or person. There is now a need for transformational leadership at many different levels locally as our whole system, organisations, teams and individuals need to rapidly develop the skills and resilience to manage working in a changing environment with such uncertainty and confusion. There is a need to combine strong, directive organisational leadership with collaborative system-level leadership. Ideally both of these should be modelled in the system (The Kings Fund, 2014). Successful health care systems to date have made widespread and systematic use of improvement methods. Experience suggests that developing transformational leadership capacity is best approached by focusing on real work (not hypothetical scenarios or case studies, although they can be helpful in illuminating options and alternatives), learning by doing, using small tests of change to observe, reflect and explore what works for a particular context. Studies suggest though that a new style of leadership only begins to develop where there is widespread readiness for change. There is also a need for impact measures to be an integral part of the development of system-wide leadership. Who is this OD plan for and why? The 4 following groups are affected by the actions in our detailed accompanying OD plan: Governing Body As the leadership entity in the CCG the Governing Body Members need to lead by example, set clear goals for the organisation and hold one another to account for delivery. A Governing Body Development Programme ran throughout 2017-18 with regular structured sessions every 2-3 months which included: Specific development sessions 11
Specialist training, e.g. patient participation and engagement and new Conflict of Interest guidance Master Classes, e.g. commissioning and QIPP Mandatory training where appropriate The CCG commissioned the Good Governance Institute (GGI) to undertake between January and March 2018 an objective review of its governance effectiveness and undertake specific governance developmental work. This programme was designed to support the CCG as part of its journey to improve organisational effectiveness through provision of an in-depth assessment and targeted strengthening of governance with a particular focus on roles and responsibilities of governing body members, and ensuring that governance systems and structures are optimally used to achieve the strategic objectives of the organisation. The agreed outputs include: Governance review report Action plan for developing governance effectiveness at the CCG Bespoke governing body induction pack based on good governance practice Board Assurance Framework for the CCG If relevant, briefing notes on particular issues for management or the Chair of the Governing Body. The review will also directly inform the Governing Body Developmental Programme for 2018-19. These sessions have an increasing focus on strengthening the capability of the GB to deliver the CCG s strategic priorities. They will also incorporate an element of respectful challenge. The OD plan focuses on ensuring that the Governing Body members understand their roles, have trust in one another s contributions and are able to function as a corporate leadership team in respect of making, and taking, decisions for the benefit of the Greenwich population. There is also a programme of personal development for each GB member resulting from annual appraisals and 1:1s with line managers and again reflecting personal objectives aligned to the CCG s corporate objectives. Similarly there will be robust induction plans in place for any new Governing Body members so that they understand their role and responsibilities and in addition a developmental programme specifically for the first year in this leadership role so that they are able to discharge their duties effectively. There was a review in Quarter 3 of 2017-18 of both the Syndicate Lead and the Clinical Project Lead (CPL) GP roles that support the Lead GPs on the Governing Body to ensure our structures are fit for purpose going forward to support delivery of the CCG priorities. Consequently there has been a shift to a more clinically focused portfolio for the Governing Body Lead GPs thereby strengthening clinical leadership and capacity. Directors are focused on effective delivery of their executive functions and for the Lay Members harnessing their specialist skills in overseeing key areas such as conflict of interest, patient participation and primary care commissioning. 12
Several GP members of the Governing Body are due to stand down in 2018. As such the CCG needs to strengthen its systems for identifying and developing aspiring GPs who may wish to take up roles in the future either supporting or on the Governing Body and be the clinical leaders of the future. This pipeline development is also closely linked with our member engagement strategy which is discussed later. NHS England has commissioned a 12 week intensive Commissioning Capability Programme for CCGs. This is a leadership development programme for senior commissioning leaders in commissioning systems. The programme equips leaders with the skills and insights they will need to manage financial challenges, systemwide transformation and change over the following 12 months. The overall aim is to support commissioners to drive improvement in performance. The senior management team at Greenwich CCG commenced this programme in February 2018 and will complete it in May 2018. CCG Staff The core CCG organisational team will be responsible for enacting the CCG clinical commissioning strategy and working with partners and the public to bring about transformational change. The plan focuses on their skills and leadership development, personal support and environmental factors necessary to deliver their best and build a capable, innovative and stable workforce. Team development sessions and awaydays will continue to be a key commitment for the CCG during 2018-20 to enable wider engagement of all staff in the vision, values and objectives of the CCG and to support two-way communication. Staff ideas and voices will shape our vision, values, organisation development priorities and how we do business. Staff have access to a wide range of in-house and external learning and development opportunities which are key to supporting recruitment and retention. The CCG will undertake an audit of what skills and competencies are required to deliver system transformation through its commissioning functions. We will undertake an audit in early 2018-19 of what skills and competencies we already have and identify any gaps. This will enable us to steadily over the next two years build a workforce that is fit for purpose with the capacity, capability and resilience to meet the future requirements of a commissioning organisation and a changing provider/commissioning landscape. We will review and adopt best practice from outstanding CCGs. Greenwich CCG is represented on a SEL Organisational Development Group which is leading a piece of work to identify what support is required for staff across the six SEL CCGs to develop the skills to work effectively both within their own organisation at a borough level and at scale across the CCGs and as part of the STP. From work undertaken to date the additional skills required of our workforce going forward may include: Delivering transformation through evidence-based approaches to commissioning Outcomes-based commissioning Knowledge and understanding of new contractual mechanisms 13
Working collaboratively and in partnership Managing performance Effective community engagement skills and activities The CCG commits to provide all staff with a positive working environment and to promote a supportive, open culture that helps staff to do their job to the best of their ability. In addition it will provide all staff with personal development, access to appropriate education and training for their jobs and line management support to enable them to fulfil their potential. All staff will have a monthly 1:1 with their line manager, attend a monthly team meeting and have an annual appraisal from which their individual objectives will be developed which align with team objectives and an accompanying personal development plan. The CCG will ensure that all teams and individuals have a set of objectives that map onto the CCG s overarching objectives and priorities. Performance will be monitored at team and individual level and appraisal and review meetings will be used to identify those individuals who are highly performing as well as those who need interventions to perform at the appropriate level. The aim is to help everyone to see how their role contributes to the delivery of the CCG s aims and objectives. This will support the achievement of organisational effectiveness. Member Practices As a member organisation it is vital that the CCG proactively engages with our 35 GP practices and supports them to develop sustainable General Practice services. The CCG has a signed constitution which outlines the relationship between the CCG and member practices. Although this is not a Workforce Strategy there is clearly a link with the OD strategy. Much work has taken place in SEL and Greenwich to develop the recruitment and retention proposals for the area. Greenwich is a borough where GP recruitment has been a significant issue in recent years and therefore how the CCG can support primary care to attract GPs and practice nurses to work in the borough is vital. The CCG is also supporting the development of a robust infrastructure to underpin the on-going professional development of general practice nurses in Greenwich which recently has been lacking. This is also currently supported by a national initiative whose implementation across SEL is currently led by Southwark CCG. This is very positive and is proactively supported locally by our Governing Body Registered Nurse. As mentioned previously another important part of our plan relates to ensuring we establish an on-going process for engaging and cultivating GPs who may have an interest in undertaking a role on or directly supporting the Governing Body. This succession planning involves developing a pipeline of GPs and proactively supporting their skills development to be able to effectively engage with the CCG and lead or support the delivery of clinical system-wide transformation working in partnership with commissioning managers, providers, key stakeholders and patient public representatives. 14
Wider Partners Many of the CCG s goals and objectives require change amongst partner organisations. The CCG cannot deliver transformation on its own. A golden thread that runs throughout our plan focuses for this audience on how the CCG can embrace and engage with partners in a collaborative way to support delivery in the future as outlined in the following section on engagement. Engagement The CCG acknowledges that engagement is an area where it did not perform as well as it could have in 2016-17. Consequently there was a loss of confidence and trust in the organisation that has needed to be rebuilt as a priority. Some good progress has been made in 2017-18 however there is much more to do to achieve our ambition of demonstrating that our engagement has led to tangible strategic and operational benefits for our communities and health outcomes. As such our ambition going forward is to ensure that robust engagement is an integral part of how we do business strategically and how we operate at a day to day level. The Engagement Strategy 2017-20 was developed with the involvement of our membership, patients and the public, our key stakeholders, as well as our staff. The CCG has 6 corporate objectives for 2018-19 one of which it to actively engage with our communities to improve their experience of healthcare. All staff were asked to ensure that in 2017-18 one of their personal objectives was focused on engagement so that it is core to what we do. This will be repeated again in 2018-19. The activities we undertake as part of our engagement work aim to be both inward and outward looking and inclusive. Part of the OD Strategy needs to be focused on how we proactively develop our engagement skills and activities across all levels of the organisation to deliver effective and meaningful enduring engagement with our patients and public, our members and our staff. The CCG has a sound infrastructure for engagement with a Lay Member with responsibility for patient and public engagement. A dedicated session at each Governing Body meeting gives local people an on-going opportunity to engage with the CCG leadership and raise their concerns first hand. We were delighted to receive in November 2017 an improved NHS England rating for patient and public engagement from requires improvement to good, and are committed to building on this to further extend our networks through Greenwich in 2018-19. Our patient and public engagement strategy 2017-2020 provides the framework by which we will develop our Engagement Programme going forward, and monitor patient and public engagement. This strategy aligns with other CCG plans and priorities and is underpinned by Greenwich CCG s statutory obligations, including the NHS Constitution. Annual 360 Degree Stakeholder Survey A key component of our engagement work each year is the annual 360 degree Stakeholder Survey. The uptake rate of the 2016-17 annual survey was disappointing at 41% and the feedback from those stakeholders who did respond was often critical. The CCG has proactively managed the process this year with a 15
robust project plan and senior leadership. This has resulted in a much improved stakeholder response rate of over 83%. We will use the 2018 survey feedback we receive from our stakeholders to inform our OD Plan for 2018-19 in relation to the Governing Body, our members and our staff and develop and deliver an ambitious Engagement Programme for 2018-19. NHS Staff Survey 2017 The national annual NHS Staff Survey is a useful barometer check for the CCG providing baseline information to continually assess the culture and working environment for staff. The 2017 Staff Survey identified some improvements, particularly knowledge of senior managers and communication. It also highlighted a number of key areas that required further significant improvement. The action plan for implementation in 2018-19 focuses on improving internal communications; appraisal systems and objective setting; recruitment and retention strategies. The response rate for the 2016 survey was 63% and in 2017 through proactive management of the process and good communication the response rate increased significantly to 85.3%. The staff survey will continue to play an important role in supporting the on-going development of the organisation, in assessing how successfully the culture is shifting and measuring staff satisfaction with the work environment. A key aspiration is to consistently achieve a high uptake rate of the survey each year so that as a small organisation the findings are as meaningful as possible. Staff involvement is an essential building block in the development of the OD strategy. The CCG is committed to ensuring staff that work for the CCG feel involved and engaged. Following analysis of each staff survey staff will be invited to be further involved in the development of actions for priority areas identified. The Staff, Health and Wellbeing Group will also monitor the implementation of the action plan and report regularly to SMT and the Governing Body on progress. Feedback from Awaydays Staff awaydays held in early 2017-18 provided staff feedback which echoed some of the above themes and included additional feedback including: confidence in organisational direction continuation of the Staff Health and Wellbeing Group regular team meetings within all directorates wanting closer, integrated working between teams/directorates wanting more permanent staff in post and fewer interims valuing the weekly staff briefing with senior management team to aid 2-way communication valuing a patient-focused approach respectful and inclusive culture investment in staff enabling leadership at all levels the contribution of staff to be valued zero tolerance of bullying and harassment availability of flexible working celebrating our successes a place to go when you need quiet concentration 16
Actions agreed as a result of Awaydays held in 2017-18 the implementation of new monthly Lunch and Learn sessions the continuation of the Staff Health and Well-being Group co-location of all staff on the 2 nd floor to support more integrated working between the directorates consideration of flexible working for those who would like it where this fits with business needs creation of a Quiet Zone on upper ground floor where a work station can be booked development of an OD Strategy undertake a skills audit and skills gap analysis (to be implemented in Q1 of 2018-19) Workforce Planning Current Position *The green boxes is our self-assessment of our current position in March 2018 Dimension Developing Progressing Advanced Market led Attraction We consistently face challenges in attracting the talent we need to achieve our goals; we don t always have sight of/understand of the talent requirements we will need to meet our goals We are able to attract some of the talent we need, some of the time, to achieve our goals. There has been a heavy reliance on interim staff We are able to attract most of the talent we need, most of the time, to achieve our business strategy We are always able to attract the talent we need, when we need it, and in the quantities require to achieve all our business goals Development We continue to evaluate/design structures to decide which talent pathways we should invest in We have a number of significant talent leadership development programme requirements to coordinate across the CCG Our talent and leadership development programme is highly inter-connected and have beneficial effects on our talent/leaders Our talent and leadership programme deliver all the benefits that both the CCG and our talent demands Retention We typically struggle to retain our talent/clinical strengths We can retain selected talent We can retain most of our talent, most of the time We are able to retain our talent all of the time and proactively manage turnover Work environment There are ways we can improve our working environment to support our business needs, increase performance potential and meets the needs of our staff Our working environment is flexible and adjusts to meet the evolving needs and desires of staff/talent while continuing to support our services The way that we are structured and organised enables us to maximise the contributions that our staff/talent makes to our mutual success We put our staff/talent at the heart of the organisation; staff/talent drives how we are structured and organised Innovation Our OD talent initiatives are rudimentary but we expect to implement innovative ideas We continue to evolve and improve our OD talent management approaches often we build on what has worked in other organisations We regularly compare our approach to OD strategy and talent development with other organisations and we typically compare well against others We are originators of healthcare sector leading OD, leadership and talent development and best practice Employer brand We are beginning to develop our employer brand and We are an employer of choice and have a clearly We are the leading employer of choice for We are able to adjust our employer brand 17
define our employee value proposition articulated and supported employee value proposition the talent we need now and employee value proposition to meet evolving business and talent requirements Talent & Succession Planning - Proposed Approach How do we know talent when we see it and what do we do with it when we ve identified it? Historically, what most NHS organisations do is take someone who is excelling in their current role and put them into a more challenging role based on past performance. The reward for good performance is then generally more work. We often assume high performing individuals have the inner resilience and intellectual potential to make the transition and figure it out for themselves along the way. Going forward Greenwich CCG would like to develop a structured, equitable approach, using consistent criteria to identify talent through the appraisal and development plan mechanism and then support the development of high performing individuals within a well-defined, talent management framework. New Roles and Working across Boundaries Recent years have seen new health and care roles emerge to support the delivery of integrated care systems. These roles seek to enable more holistic care and facilitate continuity and co-ordination of care across organisational boundaries. Some of these new roles (such as care co-ordinators and case managers) have integration at their core, while others (such as extended support worker roles or personal assistants) build on established roles to facilitate integration. New roles to support integrated care are only effective when they are part of a system-wide process of integration (Kings Fund, June 2016). The support of senior leaders is crucial for establishing a framework for integration, legitimising new ways of working, and ensuring a climate and processes are established that enable practice to develop in the desired direction. The CCG plays an important role in supporting the development of boundary spanning care through commissioning for transformation. Organisations need to develop shared agendas, visions, narratives and systems of leadership and also to engage staff and service users in identifying solutions, while aligning resources, contracting mechanisms and outcomes to reflect aims of integration (Ham and Walsh, 2013). It is now recognised that without sustained investment and support to facilitate change and tackle systemic barriers at local and national levels, progress in delivering integrated care will be limited. The commissioning skills needed to deliver integrated care often exist within parts of the workforce; the issue is how these skills are shared and distributed. Skills in communication, management and creating relationships are vital, and may be required by professional and non-professional groups more broadly. Interdisciplinary training, training of commissioning managers and clinical leaders, and cross-organisational placements can help develop and spread the necessary skills and competencies. 18
The skills we need to develop as a commissioning organisation to enable the delivery of integrated care systems include: Engagement skills and activities (Patients, public, communities, members, staff) to deliver an ambitious annual Engagement Programme Excellent communication skills Nurturing trust and building relationships between providers Establishing and sustaining high functioning local relationships Establishing structures and terms of reference for decision-making and risk management System leadership and transformation skills Holding provider organisations to account for outcomes delivery 19
NHS Greenwich CCG Work with others to invest in quality healthcare for Greenwich patients A high quality and accountable CCG, encouraging responsible partnership engagement in a transparent climate of on-going learning to create a patient-centred, financially astute & corporate approach to commissioning Care out of Hospital Care of the Frail Co-ordinated Care Our Organisational Development Priorities Leading as Individuals Leading the Organisation Leading the System Leadership Workforce Skills & Development Continuous Personal Development Strengthen Clinical Leadership Support individual/team development opportunities Annual appraisal, PDP and clear personal objectives Assess staff capacity and capability Clinical Commissioning Strategy in place Clarity of vision, mission and values Implement Organisation Recovery Plan Effective utilisation of skills across CCG and support increased autonomy Model behaviours to support a more empowered culture Team structures fit for purpose Develop a talent management policy Explore models to support a coaching culture Governing Body Induction Programme Development Programme Improve GB visibility SMT Leadership Development Programme Transformational skills Create and sustain effective clinical and managerial collaborative partnerships Systems & Processes Ensure support for individual operational business processes Adopt a learning organisation approach Strengthen decision-making Implement Governance review recommendations Support provider colleagues to enable transformation Clinical Focus Engagement Raise profile of GP Clinical Leads Support Clinical Leaders to fulfil roles Review approach to staff engagement Develop capability in teams to support commissioning for Integrated Care Systems Facilitate network of support for member practices Improve membership engagement in CCG Clarify objectives for STP and Place-based care Contribute to SEL or pan- London networks Implement Engagement Strategy & Programme Further develop Practice Patient Groups (PPGs) Support wider clinical and patient/public engagement Collaboration Proactively engage at a senior level in wider system leadership activities Support development of Joint Commissioning Broaden CCG leadership impact Lead work on local system architecture 20