Robert Harrison
Chief operating officer
Harrogate and District NHS Foundation Trust
As chief operating officer, Robert is responsible for the daily operational management of the Hospital and the achievement of performance targets. Duties also include responsibility for IT, information, estates and facilities. Mr Harrison is the chief operating officer lead for urgent and emergency care and stroke on behalf of the West Yorkshire Association of Acute Trusts.
The long term plan supports the direction we’ve been heading in ourselves – working together across primary, social and community care in developing an ethos of prevention being better than cure, and developing services that promote independence and support people throughout their life, including end of life.
The Harrogate and Rural Alliance is made up of the local CCG, the county council, the district council, ourselves as the acute and community provider, the mental health provider and the federation of GPs. It’s a coalition across the whole of health and social care but also includes housing and other teams within the two tiers of council services. Our focus is on beginning to align our services to make them as efficient as possible and to ensure we’re able to provide the best possible services within the resources we’ve got as a coalition.
We are working to create a set of core services that will be jointly managed. They will predominantly be the community adult social care teams and community health teams. Then there’s a group of aligned services that sit alongside them, including community mental health provision, primary care, GP out-of-hours services and services from the hospital, including consultant geriatricians. These essentially come together to provide a service that works around the concept of the primary care home model. Four localities will have virtual hubs within which those teams will come together and undertake their multi-disciplinary teamwork.
The long term plan supports the direction we’ve been heading in ourselves – working together across primary, social and community care in developing an ethos of prevention being better than cure, and developing services that promote independence and support people throughout their life, including end of life.
Chief Operating Officer, Harrogate and District NHS Foundation Trust
Getting the basics right
We’re into the soft launch period at the moment. We’ve been redesigning our services for the last eight to nine months – the initial changes were around management structures and governance of the teams. We’re in the process of appointing an alliance director who will take over joint management of the community teams. The alliance director will be employed either by the foundation trust or the council. To encourage people to apply, we’ve left it so they can pick either employer, but whichever they choose, they will be managing people who are employed by a different employer.
This programme has required us to work through what localities look like and how we align with GP practices when they’ve got populations spread across boundaries where different community and social care teams have historically worked. We’ve had to look at how to align those and make them function differently. We’ve been working with our teams on how to make sure they’ve got the IT kit they need to be able to do mobile working. Some of this is just getting the basics right – for instance how can we make sure that staff can enter any of the buildings any of us owns, and hot-desk so they’re not restricted to going back to their own base?
We are sharing the case load, understanding who the best individuals are to have the most impact on the patient or service user, and trying to avoid the ping pong scenarios that have happened in the past where a GP on a home visit wants to refer and isn’t really sure where to refer to. How can we support keeping people out of hospital, keeping them well in the long term and building on the work the local council had been putting in place around living well practitioners?
We are sharing the case load, understanding who the best individuals are to have the most impact on the patient or service user, and trying to avoid the ping pong scenarios that have happened in the past where a GP on a home visit wants to refer and isn’t really sure where to refer to.
Chief Operating Officer, Harrogate and District NHS Foundation Trust
The real change has come in the last eight to nine months, when we agreed we’d all put the whole caseload into the work programme. As a result, people don’t feel that they have to manage another risk somewhere else. It says "actually, we’re all in this together, we recognise we’ve got a whole case load from every partner that’s involved in this, we’ve also got to do our day job and manage that case load, but now we can start to have a conversation about whether there is a way in which by sharing those resources and sharing the way in which we manage those caseloads we can become more effective".
Some of the bigger challenges are about, when somebody does need acute care, how quickly we can get them back home again. In the last 12 months, we’ve developed a supportive discharge service which also has a consultant geriatrician as part of the team, whose focus is on getting people back home as soon as possible. If someone’s got a package of care in place but can’t start it until the Monday, we will bridge that care in the community over the weekend until the package starts, so we can get people out of hospital – that’s enabled us to get our long length of stay down. Working with the local authority and the CCG, we’ve also got delayed transfers of care down to under 3% recurrently at the moment.
Relationships over structures
There is a whole heap of arguments either way as to whether to put community services in with acute care or not. If you’ve got the relationships right, I don’t think it matters much whether you’re a combined trust or not. The work we’ve been doing with the CCG, the local authority and the GP federation in particular demonstrates you can start to align services, integrate the way in which teams work together, regardless of what the corporate body is.
Some of the bigger challenges are about, when somebody does need acute care, how quickly we can get them back home again.
Chief Operating Officer, Harrogate and District NHS Foundation Trust
There are up-sides and down-sides to the trust being the provider of acute and community services. In some ways, the community has a different type of focus from acute management. Even so, we’ve put acute medicine, A&E, out-of-hours GPs and community district nursing teams into the same directorate management team. That gives them an overview and understanding of those services and how they can impact on each other, but actually the biggest impact on hospital services doesn’t come directly from health community teams – it comes from the ways those health community teams work with primary care, with mental health services and particularly with social care.
I don’t think you can solve all of this just as an acute and community provider on your own – it gives you a level of understanding of how to manage some of those movements across acute and community, but the broader benefits of working with system partners actually mean that its not critical that community services are managed as part of a combined organisation. We’ve achieved a lot under our approach, but with the right relationships in acute and community, we could have achieved exactly the same result without being a combined trust.
This is about leadership – about trust between organisations, relationships and doing the right thing. If you’ve got a focus on the individual who’s receiving care or can be prevented from needing care, you can build a coalition of the willing around that. You’ve just got to make sure you’ve got the right governance structure in place. This is about leadership not organisation. We’re not necessarily saying we’ve got it all right, we’ve been on a long journey to get to this place – we’ve had our ups and downs, as every partnership does. You build the trust - we’ve got to a place where our senior management teams and middle management teams are now starting to work in a really different way.
If you’ve got a focus on the individual who’s receiving care or can be prevented from needing care, you can build a coalition of the willing around that. You’ve just got to make sure you’ve got the right governance structure in place.
Chief Operating Officer, Harrogate and District NHS Foundation Trust
Ensuring the right governance
There are some basics you’ve got to get in place – how do you manage your complaints between you and how do you make sure you’ve got good consents in place for sharing data? That’s about being upfront with people about creating an alliance, and being clear about who’s in that alliance. One of the things we’re really focused on at the moment is getting the pace right for staff so they feel confident that they are still providing services in a really safe way through the transition, while giving them the opportunity to innovate and experience new ways of working, and backing that up with the right governance structure so that they continue to feel safe in what they do. While we’d all like to just come in on Monday and start doing things completely differently, it’s important to recognise that this is a transition and to have a really clear, phased mobilisation.