calling all clinicians – dare to lead?/media/confederation/files... · 2020-02-27 · calling all...
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Calling all clinicians – dare to lead?
Professor Keith Gardiner - Chief Executive, NIMDTADr Richard Wright - Medical Director, SHSCT
Dr Paul Litchfield - CMO, BTNicki Patterson - Director of Nursing, Older People and
Primary Care SEHSCT
Dr Paul LitchfieldOBE OStJ FRCP FFOM
Dare to Lead – getting health on the business agenda
• Know what you want to achieve
• Understand where power lies
• Think from a business perspective
• Argue rationally & emotionally
• Use business language
• Focus on outcomes that matter
• Aim for a “win – win” outcome
• Be pragmatic and play the long game
• Never compromise integrity
Succeeding in the Boardroom
Cultural Evolution –Is the future in our
own hands?Dr Paul Litchfield - Chief Medical Officer, BT GroupLaura Collins - Carer and East Belfast ICP member
Colette Goldrick - NI Director, APBIDr Anne Kilgallen - Deputy Chief Medical Officer, DoH NI
Dr Paul LitchfieldOBE OStJ FRCP FFOM
Cultural Evolution – a view from industry
MarketsTechnologyCompetitorsCustomer expectations
SkillsAttitudes
DemographicsEmployee expectationsLeadership is
Critical
Leadership Styles
Appropriate:• For a crisis or time sensitive• Delivery the priority• Well understood processes• Low skills and/or trust
Creates:• Strong sense of hierarchy• Clarity of expectation• Discipline & compliance
Appropriate:• For complex problems• Development the priority• Behavioural change needed• High skills and/or trust
Creates:• Achievement above expectation• Accountability & empowerment• Ownership of outcomes
Organisational Health
Programme for Government: New
Thinking – NewOpportunities
Dr Colin Sullivan - Director of Strategic Policy andReform, Department of Finance
Programme for Government: New Thinking – New Opportunities
NI Confederation 2016
Colin SullivanDirector of Strategic Policy and Reform
Department of Finance
Why the need for a new approach?
•Significant pressure on public finances
•Rising and Changing demands for existing services
•Societal Change
•Many ongoing “wicked” issues that havenot progressed over a lengthy period –several of these in the “health” space
Life Expectancy Metro Bus Map: DHSSPS
8 – Number of the bus Life Expectancy Metro
8 – years difference in life expectancy
People in more deprived areas live much shorter lives than those from less deprived areas
This pattern far from unique to here but is a major problem
Those living in the most deprived areas have worse outcomes than those from the least deprived areas
76% higher rate of emergency admission to hospital (2013/14)
150% higher rate of deaths due to preventable causes (2009‐13)
216% higher rate of deaths due to respiratory disease (<75s, 2009‐13)
421% higher rate admissions due to alcohol‐related causes (2011/12‐2013/14)
Source: DHSSPS. All rates standardisedNote: Most/least deprived – 20% most and least deprived Super Output Areas in Northern Ireland calculated using NIMDM
Suicide rate higher in deprived areas...Crud
e Suicide Ra
teDeaths pe
r 100,000
pop
ulation
Source: DHSSPS.Note: Most/least deprived – 20% most and least deprived Super Output Areas in Northern Ireland calculated using NIMDM
Most deprived 3x rate in least deprived areas
...as are prescriptions for anti‐depressants
Source: DHSSPS. Data relate to 2013Note: Most/least deprived – 20% most and least deprived Super Output Areas in Northern Ireland calculated using NIMDM
Life Expectancy Metro Bus Map: DHSSPSHealthy life expectancy much less in
deprived areas
So, people in more deprived areas do not only live much shorter lives than those from less deprived areas...
...but the time they spend in good health lags even more
Source: DHSSPS.Note: Most/least deprived – 20% most and least deprived Super Output Areas in Northern Ireland calculated using NIMDM
68.4
64.4
63.2
59.6
54.3
0 10 20 30 40 50 60 70 80
Least deprived areas
Second least deprived areas
Middle areas
Second most deprived areas
Most deprived areas
Female Healthy Life Expectancy (Years)
Gap – 14.2 years
Underemployment in Northern IrelandUnderemployment rate in Northern Ireland (2005‐2015) • During Jan ‐March 2015, it
was estimated that 53,000 workers were underemployed (6.5% of workforce)
• Younger workers more likely to be underemployed
• In comparison with the UK, Northern Ireland had a lower rate of underemployment than the UK average (9.6%).
• NI has had a lower rate of underemployment than the UK over the last decade.
Source: NISRA, Underemployment Bulletin, June 2015
Poverty rates in NI are higher than the UK and the gap has widened since the downturn
0%
5%
10%
15%
20%
25%
2002/03
2003/04
2004/05
2005/06
2006/07
2007/08
2008/09
2009/10
2010/11
2011/12
2012/13
2013/14
Poverty rate (w
hole pop
ulation)
NI UK
Source: (DSD HBAI)Notes: Before Housing Costs (BHC) measure
Relative Poverty is a measure of contemporary household income inequality, in other words, whether the poorest are keeping pace with the growth of incomes in the population as a whole. All individuals in a household are considered to be in relative income poverty if their equivalised household income is less than 60% of the median UK income. Households reporting the lowest incomes may not have the lowest living standards. The bottom 10 per cent of the income distribution should not, therefore, be interpreted as having the bottom 10 per cent of living standards
Need for changed approach
• Danger of becoming locked in a vicious circle unable to progress the thorny / wicked issues
• Creating a virtuous circle: output focussed – seeking real positive change that is measurable
• Joined up approach needed to deliver on economic/social priorities:– Working on a cross cutting basis to develop the value added opportunities in Northern Ireland
• Look outside of government –• Recognise the importance of engaging and working with the
private and the community/ voluntary sectors to deliver programmes.
ONS "Life in the UK" report gives snapshot of the nation's well‐being.
Measuring National Well‐being includes indicators on:‐ health, ‐ relationships, ‐ education & skills, ‐ what we do & where we live, ‐ our finances, ‐ the economy, ‐ governance, ‐ the environment and ‐measures of “personal well‐being” (self assessments of well‐being).
Programme started a national debate on what really matters.
3 reasons for moving to wellbeing approach:
1. Other measures needed alongside GDP ‐ which is an inadequate measure of social progress.
2. Using wellbeing as a guiding narrative helps governments to focus on medium and long‐term outcomes, rather than just inputs and processes
3. Public services are focusing increasingly on prevention and require joined‐up approach.
Outcomes Based Accountability
• Focuses on impacts on our people rather than actions in Government
• Use of Indicators to show change required coupled with Measures to highlight success levels
• Opportunity for the NI Executive to work with other sectors about how to tackle the big challenges facing our society
A New Approach
• NI Executive has produced a draft framework for an Outcomes Based Programme for Government (PfG)
• Consistent with recommendations in the ‘Towards a Wellbeing Framework’ report produced by the Carnegie Roundtable on Measuring Wellbeing in Northern Ireland
• Lessons Learned from previous PfGs in 2008‐11 & 2011‐15o more joined upo focused more on outcomes than inputs
• Builds on the methodology currently deployed in Scotland
The Scottish Way
7 PURPOSE TARGETSGrowth, Productivity, Participation, Population, Solidarity, Cohesion, Sustainability
5 STRATEGIC OBJECTIVESWealthier, Smarter, Healthier, Safer and Stronger, Greener
16 NATIONAL OUTCOMES – for next 10 years
50 NATIONAL INDICATORS
The NI Way
HIGH LEVEL OUTCOMES ‐ 14 succinct statements describing what we are trying to achieve.
KEY INDICATORS ‐ Approx 3 per outcome, in key areas indicating progress towards the outcome. Taken in the round, show direction of travel.
KEY ACTIONS ‐ Actions that will shift key indicators. Collaborative programme – subject to review in light of progress.
PROGRESS MEASURES ‐ Providing information on how the actions are being delivered.
PfG Framework Structure
Outcomes
14 succinct, high‐level statements describing what we are trying to achieve
Indicators
42 specific changes we want to bring aboutTaken in the round, show direction of travel
Measures
Providing information on whether we are succeeding
Our Purpose Improve wellbeing for all – by tackling disadvantage and driving economic growth
Draft PfG Framework – 14 Outcomes
Outcome – supported by indicators
Reduce health inequality Improve support for adults with care needsIncrease healthy life expectancy Reduce PovertyReduce preventable deaths Improve supply of suitable housingImprove the quality of the Increase the use of public transport and healthcare experience active travelImprove mental health Increase the competence and capability of Improve health in pregnancy people and communitiesImprove child development Increase reconciliation
Improve air quality
We enjoy long,
healthy, active lives
We enjoy long,
healthy, active lives
Outcomes “Pyramid”
PfG Purpose: improving wellbeing for all – by tackling disadvantage, and driving economic growth
Outcomes, Indicators, and Measures already developed in PfG Framework
Action Plans linked to outcomes – and associated performance measures
POPULATION ACCOUNTABILITY
PERFORMANCE ACCOUNTABILITY
Outcomes “Pyramid”
Draft PfGFramework 2016‐21
Next Steps
Outcomes Based Approach
Two levels of Accountability –Population & Performance
OutcomeCondition of well‐being for a population/sub‐population (adults, children, families, communities)
e.g.We live longer, healthier, more active lives
Population IndicatorMeasurable data which helps quantify achievement of the Outcome
e.g.
Percentage of adults who smoke?Level s of Obesity?Number of avoidable deaths?
Performance MeasuresMeasurable data which helps quantify the impact of a project/service
e.g.How much did we do?How well did we do it?Is anyone better off?
Popu
latio
n Accoun
tability
Performance
Accoun
tability
So where are we?
What have we done?• Population based Outcomes • Population based Indicators & measures • Getting from ends to means ? – pathfinder learning (Poverty, Citizen Safety from Crime, Economy)
And what’s left to be done?• Connecting outcomes to actions (ends to means)• Performance measures • Getting from ends to means (performance level)
Timeline
Stage Date
Consultation on PfG Framework 27 May – 22 July
Development of PfG Action Plans By Sept 2016
Development of:• Economic Strategy;• Social Strategy;• Investment Strategy;• Budget
For public consultation by Oct 2016
Executive and Assembly Approval Processes December 2016
Different Mind Set
This requires significant changes to traditional ways of working.
Many of these changes are captured in the ‘enabling state’ concept which can be summarised as the move:
• From setting targets to outcomes• From top‐down to bottom‐up• From representation to participation• From silos to working together• From crisis management to prevention• From doing‐to to doing‐with• From state provision to the third sector
Opportunities for OBA1. take a whole of government approach
2. for more innovation ‐ to think creatively about solutions to longstandingproblems.
3. to engage stakeholders in building shared vision of what is important andwhat strategies are required– this increases confidence that goals are theright ones and that they will be sustained.
4. to systematically collect data, monitor progress and critically assessoperations, services, and outcomes.
5. shift from provider interest to user interest.
6. to build confidence in public institutions.
7. shift culture
Challenges
1. Alignment of budgets
2. Moving beyond fine words to action
3. Shifting the culture – political and administrative
4. Systems may become indicator driven rather than outcomedriven.
5. Need to choose the right measures thataddress challenging problems ratherthan being easy to collect or affect.
Challenges1. System must have the capacity to develop outcomes, identifyindicators, and collect and utilize data.
2. Training required to assist people with new thinking aroundOutcomes‐Based Approaches
3. Changing governance relationships amongst agenciesrequires new spirit of cooperation and trust.
4. Temptation to judge progress too early.
5. Implications:(a) for the Executive(b) For the NICS(c) For stakeholders
Enablers ‐ Public Sector Reform role
We have high quality
public services
One of 14 outcomes
Support Activities Shared Services Digitalisation Procurement Cross‐cutting Reforms
OUTCOMES
INDICATORS
MEASURES
ACTIONS
PfG needs to permeate all parts of government
Public Sector Reform Agenda Supporting, Influencing, Leading and Enabling Reform in partnership with others.
An Approach to Public Sector Reform & Innovation under 3 key categories:
STRATEGIC
OPERATIONAL
ENGAGEMENT
OECD ReviewTransformation FundCross Cutting Reform ProgrammeShared Services and Digitalisation
Innovation LabsBehavioural Insights
Ideas EngineNICS AwardsNICS Live
OECD Public Governance Review
Strategic
Recommendations chime with PfG – launched on 6th July 2016
Strategic
Voluntary Exit Schemes across NI Public Sector:• Challenging project – unprecedented in history
of NICS• Supported by Public Sector Transformation Fund
(£700m over 4 years)• Over 4,000 public servants exited in 2015/16
Greater Emphasis on Shared Services and Digitalisation• Increased mandate for ESS and BSO to provide
shared services across Public Sector• Rolling Programme of Digitalisation e.g. ‘16x16
Transformation Fund
Strategic
Cross Cutting Reform Programme
• Executive agreement to areview to identify and assessNICS cross cutting reformopportunities
• 30 cross cutting projectsacross six thematic themes
• Executive agreement wasreached in November 2015 totake these ideas forward forfull feasibility with the NICSBoard providing overarchinggovernance.
Operational
A regional Lab offering a fresh approach to developing both strategic and tactical solutions to complex problems using a human centred approach and behavioural insights
Engagement
• Celebrating the excellence of individuals and teams working to improve Public Services.
• Inaugural awards held in March 2015 with over 118 nominations
• NICS Awards 2016 in progress with award ceremony scheduled for Parliament Buildings.
• Successful event held in March 2015 bringing together around 1,500 delegates
• Event themes -Enabling Our People, Improving Services for People, People Working Better Together, Inspirational Leadership for Our People
• Currently planning NICS Live 2017
• Staff Innovation Scheme promoting collective responsibility for service design & improvement
• Open to all staff – adaptive trial commenced June 2014 – over 300 ideas received
• Considering staff and external challenge prizes
New era of Reform needs to support the PfG
‐ Equipping colleagues to maximise the impact of the OBA approach
‐ Cross‐cutting and departmental specific reforms need to be aligned with the PfG ambitions
Reasons to be cheerful
* Executive commitment
* Start of a new mandate
* Recognition of need to take a new approach
* Logical methodology
* Appetite to succeed
Thank You
Closing remarksColum Conway - Vice Chair, NICON and Chief Executive,
Northern Ireland Social Care Council