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

paul.litchfield@bt.com

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

paul.litchfield@bt.com

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