How to blog, for health professionals

It’s still November and therefore, it’s still #NaBloPoMo (no, nothing to do with ridiculous facial hair; National Blog Posting Month – come on, keep up) and in my last post I wrote about ‘why’ health professionals should blog.

When discussing this post on Twitter, someone asked me if I would write a ‘how’ to blog post for health professionals.  I can’t for the life of me remember who asked me this, so if it was you, thanks for the inspiration J.

There’s a plethora of advice and guidance already on how to write a blog, so I won’t recreate it, but will throughout this post link to some helpful resources that will hopefully get you up and blogging.

How to write

I really like how short and simple this guide for 'Dummies' is for general advice, so I won’t repeat it.

This blog-post on how to write a blog is also a brilliant resource aimed at novice bloggers or existing bloggers who want to develop their style.  It’s written by a nurse, so she’s been there before you as a blogging health professional too.

Both of these resources will help you think about your style, content, size and frequency of blogging amongst other things.

What tools/sites/apps to use

If you want to create a new blog, you will need something/somewhere to ‘publish’ your wonderful work.  This can be done using a wide range of different tools, which come mainly in the form of websites or Apps for mobile devices.  There are many out there, some free and some that you can pay for.  If you’re starting out, my recommendation is to use the free ones.  I don’t pay for the tools or hosting for this blog.  The only financial cost to me is a couple of quid per year to own the www.foord.me.uk domain, which I use simply to as a redirection address to get people to this blog.

This Top Ten Review shows in list form the functionality of each of the ten highest-rated blogging tools available at the moment.  Many of these have both websites and Apps.

If you’re after a more narrative description of your options for what to use to create and publish your writing; this review of the 15 best blogging services may be more helpful to you.

If you intend on using your mobile device to blog, this guide is a very good review of the best Android apps.  For most, if not all, the apps reviewed, there’s likely to be a version for iPhone/iPad, and other operating systems too.

Being a health profession online

If you are a registered health professional with a regulatory body, what you do in public online needs the same consideration as to what you do off-line in the real world in terms of observing your professional code of conduct.  Therefore, it’s well worth being familiar with how your professional ‘code’ applies online as well as off-line.

Some health professional regulators have produced specific guidance on social media, such as the following (if your health professional regulator isn’t listed below, it’s not because they don’t have guidance, I just couldn’t easily find it!):

 

• Nursing & Midwifery Council
• General Medical Council
• Health & Care Professions Council
• Royal Pharmaceutical Society*
• General Dental Council

(*I know they aren’t the pharmacist’s regulator, but I couldn’t find any guidance from GPhC)

Finally my six blogging tips for health professionals

1. Confidentiality

Maintain patient and colleague confidentiality whenever posting a blog.  It’s probably a good idea to check with family members too when mentioning them.  Even if you don’t mention someone by name or use other identifiable information, remember that your narrative about the events you’re describing could still identify an individual or team.  If you have their permission to do this that’s fine, but still proceed with caution.  If in doubt, seek advice.

2. You can take the nurse out of the ward…

Remember, not everyone who reads your blog will be able cope with reading your graphic description of how the pressure ulcer looked/smelled whilst they eat their corn-flakes.  It is perfectly OK to give graphic descriptions (within the boundaries of Tip 1 above), but it may be helpful to give a warning up-front so your readers can choose an appropriate time for when they read it.

3. Share, share and share again

Great content is worth sharing.  You’ve written your masterpiece but no-one’s reading it!  Once you’ve published your blog share the link to it across social media in tweets and on The Facebook for example, as well as telling people in real life too.  If you do start to write a blog after reading this post, please let me know and I will share what you’ve written.  If you think there are people you’ve engaged with through social media who you think would be particularly interested then contact them to tell them about your post and they will most likely share it.  There are many websites and organisations who are looking for guest bloggers, so do search them out too, like the ‘WeBlog’ on @WeNurses WeCommunities site.  If you feel comfortable letting your employer know about your blog (remember it’s public, so they probably know anyway) they may be keen to post one or more of your posts on their website or Intranet.  If you don’t find your post being shared, this doesn’t mean it isn’t any good, it may just mean you’re not sharing it in the right circles.  It is entirely possible that what you’ve written is only of interest to a very small niche audience, which is absolutely fine.  If you’ve any concerns that what you’ve written isn’t any good, see tip ‘4’ below…

4. Seek feedback and continue the conversation

“We all need people who will give us feedback. That's how we improve” Bill Gates once said.  This is so important.  We aren’t all budding Charles Dickens, so if you do start to write a blog, listen to your readers’ feedback with the aim of learning and improving your blog.  When I shared my previous blog-post, I had some fantastic feedback from @ShelaghAHP which led me to update my blog to make it more broadly accessible to a wider group health professionals than just nurses who I’d originally written for.  I’ve had further feedback since then about how this has improved the post.  This goes to show that being open to and responding to feedback can improve what you write and how it’s received by others.  Most blogging sites/tools have the facility for people to post ‘comments’ about your blog-post. Don’t be afraid of this, welcome it, as it not only allows people to post feedback, it also allows what you’ve written to start a conversation that others can continue.

5. Reflection

Writing is an excellent ways to reflect on what is frequently a stressful, but rewarding, profession.  In fact our professional training teaches us to use reflection as a tool for learning; and keeping a blog is a great way to keep a reflective journal.  Once you’ve published a blog-post, you can edit and change things, but once it’s been made public, it’s public; therefore, I would highly recommend after you’ve finished writing, go and do something different for a short period, have a cup of tea, then come back to it; give it a thorough proof-read, check you’re still happy saying what you’ve written, and only then publish and share (see Tip 3 above).

6. Before you blog T H I N K   F I R S T

This mnemonic which was originally written for Twitter will also help you think about your writing for a blog. Don't feel intimidated by this, you don't have to achieve everything in there all the time, but it's helpful in considering what you're sharing with the world:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Good luck and please to let me know how you get on.

#NaBloPoMo (and why health professionals should blog)

November is National Blog Posting Month (follow the #NaBloPoMo hashtag on Twitter).

Many people are familiar with the age-old adage “everyone has a book in them…”.  Whilst I doubt that’s strictly true, I like the sentiment; I do believe that everyone has their own story to tell and their insight on how they understand the world.  Through seeing things through the eyes of others, or walking in their shoes, we can benefit from the diversity of experience that this gives us.  We also can’t do everything personally ourselves and there is great benefit to learning from others’ knowledge.

During this month, you are encouraged to try to write a blog, either for the first time or to take it up again if you’ve tried before, but not written for a while.

After a little furtle around t’Internet, I found many helpful sites and posts on how to write a blog and what it should include.  There are also many great examples of blogs you should read, including this: 101 blog-posts every nurse should read.  There are plenty of resources about why blogs are helpful and why people should write them, but there aren’t many aimed specifically at health professionals describing the benefits.

Some other examples of good blogs written by and aimed at health professionals can be found on the WeNurses community blog.

What’s a blog?

It might be helpful at this point to be clear about some of the basics: the word ‘blog’ is an abbreviation of ‘web-log’, which does what it says on the tin; it’s “a regularly updated website or web page, typically one run by an individual or small group, that is written in an informal or conversational style“ (Google, 2014). For a bit more of a detailed explanation, try here: What Is A Blog.

There are simple web-tools/apps to help you write and publish your blog, many of which are free, so you don’t need to spend any money ten-years training web-design to get up and running. It’s really straightforward to get started; here’s a guide to some of the ‘THE Best Places to Start a Blog’.

Why would anyone be interested in what I’ve got to say?

When I embarked on writing my first blog, I honestly thought that it would mainly be Mrs F and my Mum that would read my blog; however, in addition to these two devoted readers, I got an incredibly positive feedback and to date, my 100 words a day for 100 days blog has had almost 13,000 page views!  When I set out I intended on using this blog as a way of keeping a journal of some significant events and experiences from the first 100 days in a new job.  I was encouraged by friends to write this publicly in the form of a blog.  This obviously meant that I had to be a bit more disciplined in what I wrote for public consumption than I might be in a private reflective journal.

Pick a specific topic area that really interests you and that you will be motivated to write about.  There is a great chance that many others share this interest.  You will then get people interested to repeatedly return to read your future posts and use the tools available to allow people to sign-up to receive an e-mail update when you post new content.

What’s the benefit of health professionals blogging?

Health professionals are encouraged to get into the habit of using reflection as a tool for self-learning throughout pre-registration training and beyond into professional life.  Writing a blog is a natural extension of this, which allows, where appropriate*, for that reflection to be shared more widely and therefore for others to benefit from this learning.  Whilst guidance from the health professionals regulators', such as the NMC, on continued professional development doesn’t specifically cite blogging as a tool for reflective practise, I firmly believe it’s a helpful process for this.  The NMC’s PREP (Post-registration Education & Practice) Handbook says: “You should think about how you might like to record what you do, what you learn and how you apply it to your professional practice”.  Similarly, the HPC's guidance for registrants on Continued Professional Development states "registrants should: maintain a continuous, up-to-date and accurate record of their CPD activities seek.. and ensure that their CPD has contributed to the quality of their practice and service delivery". Writing a blog is both an excellent way to learn in itself and can be used as a way to evidence learning and how it can be applied into every-day practice.

This is simply a start of the benefits in terms of how blogging can support your maintenance of your professional registration.  There are many more, including inspiration for others and peer support.

Inspiration

If you choose to write a blog, you never know who may read it, as you will be publishing to the world*.  Albert Einstein said “A ship is safest in the harbour, but that is not what it was built for”.  Whilst we should be considerate in what we write publicly, don’t feel too restrained by this; take some risks with what you write in order to inspire others.

There is a wonderful 365-day blog currently being written by Rachel (@nursingrahs) a student nurse about every day of her final year of pre-registration training.  Rachel writes each day about the trials and triumphs of her third year of training before qualifying as a nurse.  I have huge respect for her honesty and perseverance in writing this.  It has certainly inspired me and helped me reflect on balancing personal, professional and other elements of my life.  There are countless others who get inspiration from this and other similar blogs.

Another great example is the University of Salford Occupational Therapy Education Blog.  This contains content created through the collaboration of different people with an interest in the education of OTs.  Through the blog current issues are discussed, pages shared for those who want to know more about the profession and external links to a range of relevant and useful places to find out more about occupational therapy.  Started in 2007 it's an inspirational resource for a range of people from those with little or no knowledge of the profession trough students, health professionals and to academics. These wonderful people can be found on Twitter at @otsalforduni and also on Facebook.

Peer Support

There are fantastic communities of health professionals across the UK and around the world.  This is demonstrated perfectly through social media in many ways.  None greater than through the amazing work of Teresa Chinn and the astounding success that she’s had with the WeCommunities that she has developed and inspired, originally through @WeNurses.  These communities now include midwives, many branches of nursing, paramedics, pharmacists, hospital chaplains, commissioners and a newly emerging @WeDocs.

A great feature of blogging is the ability for people to share and comment on what you’ve written and for this to be distributed far and wide through social media.  This really broadens the experience and the support for you and others that can be achieved.  What is really wonderful is when boundaries between the digital world and the real world blur and people personally talk about blogs and what they’ve learnt from them.

You may also try writing a blog with someone else or as a group, support each other, use it to learn.

 

What’s more important; quality or quantity?
Both!

Whilst it’s important that what you write is easily readable, relevant and that others can connect with it; it is equally constructive to blog often as well.  A really well-crafted single blog-post on a topic relevant to the masses may be read and re-read by many.  For you to really get the benefit from the connection with others that blogging will give you, write little and often.

Blogging isn’t about publishing your thesis and nor is it just about sharing brief thoughts; there are other tools like Twitter for this!  You can write as little as 100 words, or even less, but seek feedback and listen to what others tell you with an open mind and learn from this, but also trust your instincts; you’ll get to know whether you’re writing enough or too much.

What if I need help?

November is a great month to start to write a blog, as many others will be starting out at the same time and generally, established bloggers are only too willing to offer a helping hand.  Specifically, during NaBloPoMo there’s a Twitterchat at 5pm (UK time) every weekday throughout November 2014 using the #NaBloPoMo hashtag.  There should be a lot of encouragement and advice available through that route.

Personally, I am always happy to assist in any way I can too and finally, don’t be afraid to ask questions.  The chances are that if you’ve got a question, there are many others also wondering, but too afraid to ask, so don’t worry about how simple or complex the question is: The only ‘stupid’ question, is the one you don’t ask!

(*please do ensure that you never include any information in any blog-post that you write that could identify any individuals without their explicit consent to do so, unless information you’re sharing is already in the public domain.  Even if this is the case, it’s still a good idea to check with/inform them first.  Also, be aware of your professional code of conduct and ensure that what you publish is aligned to this, e.g. the NMC Code or HPC Standards)

Advice for new health & social care graduates

I've been privileged to be invited as the guest of honour and to give a short speech at two academic award ceremonies at a local University.  Those graduating will include midwives and nurses from child, adult, learning disability and mental  health fields. There will also be post-graduate awards including health visiting, school nursing, medical and dental education, operating department practitioners and assistant healthcare practitioners amongst many others.

I want to give a speech that is relevant to today's practitioners, so I turned to Twitter to seek the best advice that current nurses and students have either received or would like to hear. On a Saturday afternoon, the following two simple tweets started a conversation:

"What's the single most helpful/inspirational piece of advice you've ever had in your nurse training/career?"

and

"Student/newly qualified nurses/midwives; if you qualified tomorrow, what's the one piece of advice you'd want to hear?"


The conversation that ensued went on for two days and continues as I write this blog.  This Storify documents a selection of some of the best advice from wonderful people who took time to join the conversation, which included over 25 unique pieces of advice and many common themes:

My task now is to find a way of turning this into a meaningful speech, which I will share in a future blog.

What does it take to be a leader?

I’ve spent a lot of time this week thinking about leadership.

This was prompted by two significant things: firstly I was Acting Chief Officer while my boss took a well-earned break; and secondly I attended a feedback session for survey results as part of my participation in the NHS Leadership Academy  Top Leaders’ Programme.

Prior to the feedback I had to undertake a series of ‘diagnostic’ tests. It wasn’t as scary as that sounds, but included me seeking 360 degree feedback through an online survey from a range of colleagues; completing my own version of this survey and also taking tests on the following:

• Verbal Reasoning
• Numerical Reasoning
• Organisational Climate
• Leadership Styles
• Career History & Mobility
• Personal Dimensions

This was the first time I’ve had proper 360 degree feedback through a formal anonymised process, so was really looking forward to some insightful and honest views. I wasn’t disappointed, as my colleagues were generous with their praise for my strengths and clear and genuine in identifying areas for my development.

The purpose of the ‘diagnostic’ feedback session was to work through the 360 degree feedback alongside the results of the other tests/surveys I had undertaken to look for key messages and themes for me to work on throughout the Programme. Whilst it was tempting to try to read too much into individual elements of the results or single comments, I was helpfully steered through the themes and have much to work on for my development and to support the development of those around me.

 

You have to leave your ego at the door to really hear the messages of the feedback and to be open to change to become a better leader.  One key thing I took away from the feedback session was confirmation of the amount of work and effort I need to put in to be the leader that I want to be. It has really helped me to focus on the areas of change that I can make in myself, my attitudes and behaviours to have the best impact whilst remaining true to myself, my values and beliefs.

 

I have some work to do to make some changes now, but will have more opportunity to explore the themes from the diagnostic tests further with my mentor and at the first proper sessions of the Programme in late November. I am looking forward to meeting my fellow 'cohort 18' participants from around the NHS and to learning from their different perspectives and experiences, as well as offering my support to them.

I'll keep you posted on my progress...

 

#TANTT – Teach A Nurse to Tweet Tuesday

Today is Tuesday. Today, @WeNurses, I and others supported nurses to learn to use Twitter.  This was Teach A Nurse To Tweet Tuesday, which is a weekly campaign.

The benefits of nurses using Twitter are many and broad. This greatblog by @Gray3Gray explains her journey in discovering the value of Twitter to health professionals.

To support and encourage more nurse leaders working in commissioning to engage with each other, other nurses and the public through social media, I recently ran a webinar for Commissioning NurseLeaders’ Network on The Basics of Twitter.  A recording of this webinar is available online here.

If you don’t have an hour to watch the recording of the webinar, my top 10 tips for getting started with Twitter are:

1.    Sign-up and in your ‘Profile’; say who you are, what you do & what you tweet about.  This helps others find you, see what you’re about & decide whether to connect with you.

2.    No ‘disclaimer’ is needed in your profile, people will assume you’re tweeting your own opinion, unless you state otherwise.  Adding a disclaimer is not really necessary and wastes some of the valuable character limit within which you should describe yourself (see tip 1 above).

3.    When you first sign-up to Twitter, you will be represented by an image of an egg, which you can replace with any image you want.  Hatch from your egg & add a picture of yourself to your profile.  People want to connect with people, not eggs.

4.    If you’ve newly signed-up to a Twitter account, don’t immediately follow hundreds of people without tweeting, as people may think you’re a spam-bot and could block you, especially if you’re still an egg (see tip 3 above).

5.    Retweet things you find interesting, they don’t have to reflect your views, but be of interest to you & your followers.  People will not assume that you always agree with everything you retweet.

6.    Follow a range of people with differing views, not just those you share.  The power of Twitter is the diversity of opinion.  This helps avoid you limiting your view of the world to a small group of people who think exactly like you.

7.    Do you know your RT from your MT or your DM from your HT? Learn the lingo, at least some the common stuff, so you know what others area talking about! Here’s a link to Twitter’sGlossary, which is a good reference point if you don’t understand any jargon or abbreviation you see.  If it’s not in this glossary, it may not be Twitter jargon and thisblog-post may be of assistance:

8.  Use the many free resources available to get the most from Twitter, such as Twitterversity from @WeNurses

9.    Create, use & follow lists to find & connect with groups of people; here are my lists.

10. When you Tweet: THINK FIRST:

 

Once you've started using Twitter you may want to consider joining a Tweetchat, which is a pre-organised facilitated discussion on a set topic. Here's a Simple Guide to Tweetchats.

Finally a brief plug for an NHS Employers blog-post of mine, this time with Teresa Chinn, about the myths of Twitter, which may help to encourage the more sceptical of you to give it a try.  An Infographic of the post is here on the @WeNurses Pinterest Board.

 

 

Incidents, Seriously?

When something goes wrong, the NHS has a responsibility to learn from it and to prevent it from happening again. When this results in serious harm to anyone, the weight of responsibility to learn and improve is even greater. Within the NHS we call these Serious Incidents and each NHS organisation has a policy through which these are identified, investigated, lessons learnt and improvement made to reduce the risk of recurrence.

All local NHS organisations’ approach to managing Serious Incidents stems from the national Serious Incident Framework. This is ‘owned’ by NHS England and was originally established in March 2013 for a relatively new organisation to lead the process throughout the NHS in England. It is currently under review and it is recognised that a much greater focus is needed on the learning from serious incidents whilst also ensuring a consistent and proportionate approach to investigation and incident management. Key to this is to put the patient and/or family at the centre of the process and to ensure that they are involved as much or as little as they want to be in this.

This week I attended a meeting as part of the NHS England Patient Safety Team’s consultation with staff from commissioners and providers in our local area. This was to talk to us about the current review of the framework and get our feedback on the latest draft. It was a great opportunity for us locally to influence how this evolves nationally and for the national team to get a feel for how things work at the front-line and to ensure that the framework reflects practical realities. This was only one of a series of meetings that the national team were running to engage with staff who have good practical experience of managing serious incidents and the background evidence of what works and what doesn’t to improve outcomes for people.

Inevitably, the discussion about the proposed new framework got into some of the detail of what will change and what won’t, such as: Will or won’t commissioners require providers to submit update reports 72 hours after the incident is discovered? Will all Grade 3 pressure ulcers continue to be deemed as serious incidents? What will change on the list of Never Events, and will this form part of the framework or be kept separate? How will disputes be resolved where a commissioner and a provider don’t agree as to whether an incident is ‘Serious’ or not…

Personally, the most valuable part of the conversation was when we discussed the overarching values and principles that should form part of the Framework. If we try to legislate for every single minute detail or circumstance that may occur; firstly we’ll never see the revised Framework, as it will take a decade to write and secondly, it will be the size of several volumes of the Yellow Pages! However, if those principles and values that over-arch and underpin the framework are clearly stated and agreed by those operating within it, any issues not specifically detailed in an appendix or flow-chart should be easily resolvable.

Ultimately, I believe that the following two things are most important in this:

1. Ensuring that the person involved in the incident and/or family is at the forefront of the minds of anyone involved in investigating it to ensure they are treated with dignity and compassion throughout. The needs of the individual should come above protecting the reputation of any organisation; and

2. A rigorous focus on learning at all levels must be applied, to include those directly involved, local services, units, organisations, wider local stakeholders and feeding into a system to genuinely contribute to learning across the NHS to reduce risk in the future.

[EDIT]

SInce writing this post, I have become aware of a consultation by the Care Quality Commission on draft guidance on implementing the new regulations on 'Fundamental Standards'.  This includes a Fit & Proper Person Test for people sitting on providers' Boards.  The following is a section from the guidance that describes the requirements for a fit and proper person:

"In addition to the usual requirements of good character, health, qualifications, skills and experience, the regulation goes further by barring individuals who are prevented from holding the office (for example, under a directors' disqualification order) and significantly, excluding from office people who:

  "have been responsible for, been privy to, contributed to or facilitated any serious misconduct or mismanagement (whether unlawful or not) in the course of carrying on a regulated activity, or discharging any functions relating to any office or employment with a service provider".

This is a significant restriction. It will enable CQC to decide that a person is not fit to be a director on the basis of any previous misconduct or incompetence in a previous role for a service provider. This would be the case even if the individual was working in a more junior capacity at that time, or working outside England."

The full consultation details are here.  The relevance of this to my blog-post is that any person who has a history of covering up NHS failings may (should) find themselves barred from holding senior posts in the NHS in the future.  Interesting article in Telegraph online here.

They Came, They Saw, They Inspected

On Thursday last week I received notification that on Monday (this week) the Care Quality Commission were coming for a week to inspect Child Safeguarding and Looked After Children’s Health Services.  The CQC are the regulators for all health and adult social care services in England.  They have previously done these inspections jointly with Ofsted and therefore have included Local Authorities and Children’s’ Social Services in their scope; however, this inspection was just the CQC.  Therefore, whilst they did include health services that are commissioned by the Local Authority, their scope to make recommendations for these is limited.

The notification last week initiated a flurry of activity from my CCG colleagues and our providers to prepare for the inspection this week.  We needed to provide a range of documents as evidence in advance.  We also needed to identify a group of ‘cases’ that met certain criteria to enable the inspectors to see records of and speak to children and families who had used a specific range of services.

This week started with the inspectors meeting with me as the Executive Lead for Safeguarding within the CCG and with our Designated Nurses and Designated Doctor.  We agreed the programme for the week with the inspectors aiming to visit as many relevant services as possible to speak to staff, patients, families and to look at records.

The following are the services that they visited:

• Midwifery
• Health Visiting
• A&E
• School Nursing
• Child & Adolescent Mental Health
• Adult Mental Health
• Contraception & Sexual Health
• Drugs & Alcohol

Throughout the week our Designated Nurse for Safeguarding Children and I had regular briefings from the inspectors on what they have seen and heard.   As a normal part of the inspection process any major issues requiring immediate action are highlighted to commissioners.  Throughout the week there have been no major issues that have required immediate action.

Today we got some verbal feedback at the end of the inspection.  We will receive a draft report to correct any factual inaccuracies within a couple of weeks.  The final report, including any recommendations will then be publicly published.  The feedback today was generally positive and in particular, the inspectors were complimentary of the committed and passionate staff who they had met throughout the week.

There were a number of areas highlighted by the inspectors that they will make recommendations on in their report.  None of these are issues that we weren’t previously aware of and already taking action of one sort or another on.  To follow-up the findings of the report we will ensure that there are robust plans in place to address all of the issues that were raised.

It is fair to say that the process of the inspection was challenging and hard work for a wide range of people across the NHS, the Local Authority and other services involved.  The result of this process will be for us to refocus our efforts in the areas identified by the findings of this inspection and to provide the public with assurance of how children are safeguarded and Looked After Children’s health is supported in Luton.

Competitive Dialogue

The technical detail of NHS procurement is not going to make the most inspiring blog for the majority, so it’s with trepidation that I write this post about what we’re doing in Luton at the moment.  Due to the specific procurement process I’m writing about still not being complete, I have to be careful about some of the detail, but I will either update this post in the future, or write again on the subject (unless there’s a significant ground-swell of opinion that I don’t!).  If you do want to read about some of the more technical details, the Procurement, Patient Choice and Competition Regulations are what you’re after.  These regulations implement Section 75 of the Health and Social Care Act 2012 and are updated by more recent European Regulations.

Clinical Commissioning Groups (CCGs) are clinically led local organisations that know the area in which they are working, and so are able to commission services that are specifically required by the population that they serve.  CCGs are responsible for commissioning the following services in their 'patch':

• Urgent and emergency care (for example, A&E);
• Elective hospital care (for example, outpatient services and elective surgery);
• Community health services (services that go beyond GP);
• Maternity and newborn; and
• Mental health and learning disabilities.

CCGs can commission services from a range of providers, including from the voluntary and private sectors.  Anybody that provides these services must be registered with a regulating body, such as the Care Quality Commission.  That’s a terribly brief description of CCGs adapted from NHS England’s Understanding the New NHS; more detail on the full commissioning cycle here.

When a CCG is ready to ‘procure’ (buy) services as part of its commissioning of services, there are a four possible procurement procedures used to award contracts under the legislation and regulations cited above, which are:

• ·     OPEN – The open procedure is suitable for simple procurements where the requirement is straightforward and the provider market is not very large. It is most commonly used in practice for the purchase of goods where the requirement can be clearly defined. As there is no "pre-qualification" of bidders, anyone can submit a tender and it is possible that a large number of provider will bid. The open procedure is more suited to a small provider market.
• ·     RESTRICTED – Consider the restricted procedure where you want to "prequalify" providers based on their financial standing and technical or professional capability so as to narrow the number of providers permitted to submit bids. Where the restricted procedure is appropriate, you should be able to specify your entire requirement now such that, based on your invitation to tender, bidders will be able to deliver a fully priced bid without the need for any negotiations following receipt of the bid.
• ·     NEGOTIATED – Following the Public Contracts Regulations 2006, the negotiated procedure can only be used in extremely limited circumstances, for example, where the contract is for a genuinely unique type of solution and there is only one capable provider in the market;
• ·         COMPETITIVE DIALOGUE – The competitive dialogue procedure can only be used in limited circumstances. It may be appropriate where: (1) the contracting authority is unable to produce a complete specification of requirements without discussing its needs in detail with providers (but iterative discussions with bidders should allow a detailed solution to be specified); and (2) where the solution is likely to be particularly complex and will require dialogue with bidders to conclude. The competitive dialogue procedure is generally used for very complex procurements.

If you’re still awake, congratulations, thank you and now keep reading...

The Luton CCG Board took a decision that in reprocuring our mental health and community services we would use the Competitive Dialogue process.  This decision was based on both the complexity of the services and our desire to work with potential providers to develop specifications for the services based on their expertise of what was innovative, possible and personalised to the needs of local people.  The way that this works is that rounds of dialogue are held with bidders, clarifying and honing ideas, until the best fit to achieve our required outcomes is arrived at.  This iterative approach represents best practice in procurement, as there is flexibility to shape services throughout the process, through patient and public engagement and through ideas from potential providers and commissioners, before finalising service specifications.

There are a range of ways in which you can approach this, but for us in practice this has meant that once the initial prequalification* stage was passed by potential providers we met with them one at a time to discuss what we wanted for our population and what they could potentially provide; formal written bids were then submitted, which were scored and any providers who didn’t meet a necessary minimum score dropped out.  The next round of ‘dialogue’ is currently in progress, but to a more detailed level, including providers sharing proposed service specifications.  Further formal written ‘bid’ documents will then be submitted and scored. Following a final executive-level panel meeting between bidders and commissioners, a proposal will be made to the Board to agree a preferred bidder and then contract negotiation starts.  We report regularly to our Board to update on progress with this procurement.  The latest Board paper summarising progress to date is here.

This whole process may all sound a bit complicated, and it is!  There is a lot at stake, with many tens of millions of pounds of public money involved in the potential contracts for these services and more importantly the potential benefit to the people of Luton and their health.  One significant thing that we have learned so far from the process is that it is definitely worth all the complexity and hard work.  We intend on getting really high quality services as a result, which are focussed on meeting the needs and achieving positive outcomes for our local population.  We have particularly valued the involvement of members of the public throughout the whole process and the contribution they are making to this being successful.  An element of the public involvement we have run was our ‘Big Conversation’.  The whole approach we’ve taken to involving the public in this procurement may be a subject I blog about in the future.

The procurement continues and I’ll provide an update in a future blog.

(*Preliminary stage in a bidding process where it is determined if a provider has the requisite resources and experience to provide the service as required.)

Week 11: Celebrate the 6Cs on International Nurses/Midwife Day

For 2014’s International Day of the Midwife and International Nurses’ Day on 5 and 12 May I would like to propose that we add some celebration to the 6Cs.

In our very busy personal and professional lives there is often little boundary between the two!  We seldom take time to appreciate what we have, where we’ve come from and the wonderful profession that we share.

I am proud to be a nurse and have been extremely fortunate in my nursing career so far to have worked with some amazing nurses and midwives from whom I have learned so much.  I have also been given fantastic opportunities to experience and do things I never would have achieved on my own or in many other professions.

It is important that we celebrate nurses, midwives and all those who choose to care for others for a living.  As a profession we are often negatively stereotyped and very quick to be self-critical and don’t always do as much as we can to promote the many positives of what we contribute to society.  Sandy Summers’ series in The Nursing Times challenges some of these negative stereotypes and proposes further ways to break these down.  The RCN’s ‘This is NursingCampaign’ also goes some way to better describe our role to the public.

We must eliminate the use of negative language to describe our profession and our place within it.  A particular pet hate of mine is the use of the word “just”, as in the phrase “...just a nurse...” or “...just a student...” and certainly never both together!  This devalues what we do, the role we play individually and as part of a team wherever we work. So let’s commit to never using these terms ourselves and challenging them when we hear others say them.

These, along with further efforts, are needed to ensure that there is more celebration of nurses and midwives.  In the UK, the final (61^st) requirement of the Nursing & Midwifery Council Code for nurses and midwives is:

“61. You must uphold the reputation of your profession at all times”

This requirement of all registered nurses and midwives is usually viewed as “don’t do things that will bring the profession into disrepute”; however, whilst this is an important interpretation, I think it should be seen as an active requirement to positively celebrate and promote the profession... and perhaps this should become the first requirement of the Code, not the last!

So, let’s take these two days on  5 and 12 May 2014 as an opportunity to celebrate nurses and midwives, to celebrate all that we do for people and to celebrate what wonderful people nurses and midwives are!

This doesn’t have to be sycophantic or arrogant; we should never be embarrassed to say who we are and what we do.  Whenever I meet someone new and am asked what I do for a living, I always say first “I’m a nurse”.

So nurses and midwives everywhere, celebrate your values that make you who you are, be sure to be true to them and positively uphold the reputation of the profession.

David Foord, Nurse & Director of Quality for NHS Luton Clinical Commissioning Group

You can follow David on Twitter: @DGFoord  connect with him via Linked In and read his weekly blog here.