Monthly archives: May 2019

Focus on Finance: 2018/19 and month one 2019/20

Good news! Despite the financial & activity pressures faced during winter across the Trust, the Medicine & Emergency Care Group has produced a healthy surplus of £599,142.00 for the 2018-19 financial year ending 31st March, a thank you for all your efforts in treating more patients than last year, keeping patient care at the forefront while still delivering a positive financial result.

The surplus has been mainly produced due to over performance on income relating to Emergency/ED activity, as well as reduced budgeted expenditure with pay underspends relating to vacancies across non ward areas which helped to offset recurrent cost improvement slippage on Medical Locums and Nursing Ward Efficiencies savings schemes.

Budgets have been set for the 2019-20 financial year and all within the Group need to work to deliver the same level of patient care while still keeping within the allocated budget provided.

The first month of the new 2019-20 financial year shows the Group with an initial financial performance of having produced a deficit of £133,297.00 – this figure is subjective to revision but underlines the fact there is more work to do to make sure the Group & Directorates continue to produce robust financial results in the new financial year.

Spotlight on Stats

Unity
We are at 92% for Unity Training. This is great, we just need to make sure we get that extra 8% over the next few weeks.

Sickness

Currently stands at 6.13% for the Group against the Trust target of 3%. If your average sickness % over a 3 month period is 4% or more your Manager should have developed an action plan with your Matron or Service Manager to address this. Ask them for a copy and if you do not know the sickness % for your area you can see it on Connect, along with other Workforce Information at
https://connect2.swbh.nhs.uk/esr/esr-workforce-information/

PDR’S
There are 133 staff who don’t have a PDR booked yet. They need to ensure they are booked and that their PDR’s are carried out by the end of June. Make sure your Manager has you booked on the Connect system by following this link:
https://connect2.swbh.nhs.uk/news/book-your-2019-pdr-review-dates-on-connect-by-31-march/

Mandatory Training
At 88.83% we are close to the target of 95% for the Group. Your ESR Record should tell you if you are up to date or your Manager should be able to tell you where you stand.

Chief Executive’s Message – Friday 31 May

A big week next week in the life of our Trust!  The Trust Board will be asked on Thursday to approve a recommendation to appoint Balfour Beatty as our preferred contractor to finish Midland Met.  And on Tuesday over 200 clinicians and senior colleagues will contribute to our annual leadership conference.  Meanwhile, as I tried to explain last week, over 400 job offers are out with candidates to join our Trust and another 600 jobs are recruiting.  We are promised new national guidance by Wednesday on the Pensions issue that the BMA have raised concerns about NHS-wide.  Then on Friday the national lead for learning disabilities visits our Trust to learn about the work we are doing and to compare us to best practice around the UK.  Mondays sees our latest in-house Green awards, building on the prizes we won nationally a few weeks ago.

With each passing week the need for the Midland Metropolitan Hospital becomes more obvious.  We are hugely expanding the surgical work of our Trust and so we need theatre space.  Heartbeat last month was all about imaging, and the new build lets us separate planned from unplanned scans.  And whilst bay nursing can be easier than single rooms and offer some companionship for patients, many prefer the dignity of a single room, especially with the en suites we will have by 2022.  Discussions continue to finalise not just our interim neonatal investment, but the changes of City paediatrics, Sandwell respiratory medicine, and our frailty model; all of which we want to get in place in 19-20.  We are trying to use the delay to ‘MMH’ to make sense of the clinical model with which we will operate the nine floors we will have in the future, alongside the BTC, our refurbished Sandwell, an expanded BMEC, as well as Leasowes and Rowley Regis.

The yearly Leadership Conferences we hold are always working days.  This time we will discuss what our digital future holds after Unity goes in.  Having an electronic record is just the start, and this week Sarah Yusuf, Bahadar Bhatia and myself were putting the finishing touches to a collaboration with Watson IBM around Artificial Intelligence in imaging analysis.  We would be the second place in the UK to do this.  We will joined by leaders from Walsall, from Dudley, key GPs and colleagues from the mental health Trust to discuss care integration.  Digitally integrating care has been much in the news this week with proposals elsewhere which we will watch with interest.  But to be unequivocal, better outcomes locally will come with ever more focus on the most vulnerable people in our communities, and the right care model will be grounded in list-based general practice.  Tomorrow we open our third GP practice, this time in Summerfield next to City – the Heath Street practice will work with Urban Health and is our latest collaboration as we work through how best to support families and individuals with self-care and home care.

The biggest topic in the leadership conference will be our welearn programme.  Almost every team has now submitted for QIHD accreditation (good luck to all, especially urology).  The race will open later this month for our 2019 QIHD poster competition.  But later in the year we will implement our own Learning From Excellence project, and before that all of us will get our own Policy Portfolio, pointing us very directly at new guidance or official documents that our jobs need us to be aware of.  Whilst we will open cyber cafes on our sites in the autumn, as far as we can we will make all of these endeavour mobile friendly, with over 1800 colleagues now using myconnect on their own, or a work, mobile.

Recruitment of course is only the start in creating the workforce model that we need to help our patients in the future.  Flexible working is part of our retention plan, as is our training investment.  Whilst we can all think of individuals who have or will retire, with our thanks for their service, our major retention issue remains people who join and leave us inside two years.  We have work to do to make sure that the friendliness and decency that we are known for as a Trust extends to new recruits, and that those people feel able to seek and get support and development.  Our Emergency Departments have led the way with a coloured dot on the badge to let people know how long someone has been on the staff – and maybe to prompt extra care and support for people just joining us. Bethan Downing is leading work to make sure that joining the Trust is simpler and smoother, and yes that includes having uniforms ordered before you start and ready to fit from day one.  It also includes your digital identity with access to key systems in place – as you would expect in a Trust where implementing Unity this year dwarfs all other projects but offers such massive benefits to safety and quality.

Attached are this week’s IT stats: IT Performance Stats 31 May 2019

#hellomynameisToby

West Midlands clinical academic careers programmes: 17 June closing date for applications

Are you a midwife, nurse, allied health professional, pharmacist or healthcare scientist considering a clinical academic career?

Would you like to increase your research knowledge and skills and work with an experienced researcher?

Birmingham Health Partners (BHP) is pleased to launch the 2019/20 West Midlands internship programme (formally CAIP), pre-doctoral bridging programme (formally MDBP) and post-doctoral bridging programme. These three programmes are aimed specifically at non-medical professionals for health professionals who aspire to combine research and clinical practice, and develop a clinical academic career.

Note: Closing date for applications is Monday 17 June, 12pm

Further details can be found on the website or by checking out the West Midlands clinical academic careers programmes launch poster.

If you have any further queries please contact clinicalacademics@uhb.nhs.uk

Heartbeat: Putting patients first for 30 years – Bernie’s journey

Bernadette Hickling, Midwifery Team Manager will be retiring from the Trust after putting patients first in our maternity wards for over 30 years.

Bernie started working with the Trust back in 1983 as a staff nurse for a year on the rehabilitation ward on sheldon block for 6 months. She then spent another 6 months on the Isolation ward on D12

Bernadette would leave the organisation in 1984 to train as a midwife at Birmingham Maternity Hospital. She would then return to the Trust in 1989 and has been here since.

For 24 years, Bernie worked as a community midwife and then a community midwife manager for the Trust covering area such as Great Barr, Kingstanding, Lozells and Aston.

From 2013, Bernie then moved to the antenatal clinic at City Hospital.

There are multiple obstacles a midwife faces whilst working at the Trust. With the region where our hospital site is based having such a diverse population with people from a variety of different backgrounds and ethnicities, this can be bring many challenges.

Bernie has faced many of these challenges and said: “We now see a lot more non-English speaking pregnant mothers who have just arrived in the UK. They’re full term and need urgent scans and management plans. In addition added challenges are now seeing maternity patients with much more complex co morbidities.”

“Also due to the current worldwide unstable political situation we see the impact of this in our maternity Trust. We now see more vulnerable pregnant women from war torn countries with horrific experiences of rape and torture as well as seeing more trafficked pregnant women who have had female genital mutilation.”

She added: “Fortunately for us, our maternity unit offers good practice as we now have more specialist midwives and clinics to meet the needs of our complex population.”

With those barriers come triumphs, where in 2013, Princess Ann visited the maternity unit and strongly praised all the colleagues on ward for their dedication, including Bernie.

Louise Thompson, Infant Feeding Coordinator has worked alongside Bernie for many years and is full of praise for her fellow colleague.

She said: “It has been brilliant working with Bernie because she genuinely cares for staff and patients as she is always kind and calm. She has done such a lot to support infant feeding our antenatal clinic and this has made a real difference to some of the most vulnerable infants.”

Bernie plans to wind down when she retires as she will have more time to go on holidays with her friends and family as well as her two Border Collie dogs, Kira and Alfie.

20 per cent discount for The Monster: 16-20 August

Trust colleagues can now get up to 20 per cent off The Monster which is returning to the NEC between 16 – 20 August.

Get your tickets now by visiting https://www.theticketfactory.com/the-monster/online/

To find out more information about this offer please see Monster poster.

Keeping the beat: Focus on Cardiology Diagnostics

Change brings improvement is a saying that is definitely true for the Cardiac Physiology department which has over the last few years undergone significant change transforming the service it offers patients and improving quality.

The department which has 52 members of staff has faced challenges in recruiting staff over the years due to a national shortage of cardiac physiologists but undeterred has engaged in a number of different approaches to attract skilled clinicians including offering flexible working arrangements alongside the opportunity to work in a BSE accredited department. Alongside attracting new talent, the department has also worked hard to open up opportunities to enticing staff in to Cardiac Physiology from neighbouring trusts with the offer of band 7 training positions.

We are a department that is investing in training for our staff and as part of this there are plenty of opportunities for our staff to get involved with regular echo, device, ambulatory, cardiographer and clerical meetings, where problems and improvements to the service are discussed.

Reducing waits

As you can imagine, in a diverse and deprived community where cardio vascular diseases are commonplace we are never short of a full workload, and recently a change in NICE guidelines has increased the demand for our services from stroke services. We have however managed to reduce the analysis waiting times from 12 weeks a few years ago to approx. 3 -4 weeks now.

Transforming services

We are the 4th largest centre in the UK with regards to remote monitoring of devices and the largest for monitoring bradycardia devices. Because of this we were selected by Medtronic to do research using iPhones as remote monitors instead of the larger bedside monitors. This is now being rolled out nationwide.

Leading the way

Two years ago we embedded a brand new Mediconnect database system in to our working, allowing us to centrally manage all pacemakers device followups and implant information, moving us away from multiple standalone systems. We are one of the few departments in the country to have this ability and it was our first step in to a paper light future.

Quality improvement and quality assurance

Quality improvement isn’t just a one-time deal, as a department we regularly carry out Quality Assurance for all of our tests, including peer reviews. We also regularly review assess staff competencies as well as producing standard operating procedures for all systems and tests, something we did not have at all 2 years ago.

Recognition in the right direction

Improving Quality In Physiological diagnostic Services accreditation is our gold standard and following a recent review, we have been awarded a recommendation. Not quite an award yet, but something we envisage becoming an award by May this year making us one of four hospitals in the country to have this accolade. A massive achievement demonstrating the level of team work and commitment that has transformed our services in the last few years.

CQC inspections – What are we doing to improve

Following the visit from the Care Quality Commission (CQC) in September 2018, the regulator published their report in April this year. Overall our Trust retains its rating of “requires improvement” however they rated our services as “outstanding” in the caring domain.
There is more to do, to ensure our acute children’s and adult services can achieve a “good” rating but also much to celebrate with removal of the “inadequate” ratings for safety and “outstanding” ratings for critical care.

In Medicine and Emergency Care, colleagues have begun drawing up plans in earnest, working hard to help the Trust move from ‘requires improvement’ up the ‘good’ rating we aspire to by highlighting key learning points from the inspection.

Emergency Care

• Staff up to date with all Mandatory Training
• Sufficient numbers of substantive staff are on each shift
• Staff receive up to date annual appraisals, supervision meetings, and appraisal of work performance
• Staffs understanding of mental capacity assessments, and lack of understanding of how to support MH patients.
• Review how staff competencies are delivered and assessed
• Four hour target to see, discharge, admit or transfer patients is fit for purpose.
• FFT lower than national average

Admitted Care

• Improve time to investigate complaints, to match trust policy
• Risk registers have all relevant risks, that are complete and reviewed within designated
  time scales
• Ensure mental capacity assessments, and best interest decisions are recorded in clinical notes. Actions needed to assess if patients had capacity to choose their level of support, or to give consent
• Policies are kept up to date
• Appropriate assessments for delirium, lying and standing BP and vision
• Confidentiality of records, computers left unlocked.
• Staff had limited understanding of Duty of Candor

David Carruthers, Medical Director added:,

“I think it’s important with any report like this that we do take on board the areas for improvement that have been identified for us to look at but we should also continue to keep working on the aspects of our services we already perform well at, many of which form part of our quality and safety plans.”

Chief Nurse, Paula Gardner, said:

“I was pleased to see the improvements in community inpatient ratings. The team have done some phenomenal work. Well done to everybody. The CQC also called out some outstanding practice that we need to be proud of such as the blue pillow initiative, domestic violence advisors in EDs, dedicated listening time for relatives in our stroke unit and the infant feeding conversation cards. We still have some more work to do, to get us to good and outstanding everywhere and that is making sure we get the basics right.”

We expect the CQC to return within 12 months to see how we have improved since last September.

Welcome to Medicine Matters

Dear All
I am delighted to introduce the first edition of ‘Medicine Matters’ – our long awaited monthly newsletter for the Group of Medicine and Emergency Care. Focusing on the good and the great we’ll be bringing you a roundup of what what’s been happening in the group and things to look out for in the future.
We are the largest Group within the Trust with 1347 staff in total, and we’re committed to making sure that each and every one of you has an opportunity to recognise your hard work, celebrate your successes and help us to develop our services to continue to provide high quality care.
First and foremost we’re here to advocate your priorities to improve our ability to provide excellent care for the patients we serve. With your support we oversee the delivery of a timely and quality service for patient care – both inpatients and outpatients, ensuring delivery of financial balance, staffing and recruitment and good governance.
In order to deliver these we are organised as Directorates – Admitted Care A (selected admission specialties), Admitted care B (unselected admission specialties) and Emergency Care (Emergency Dept and Acute Medicine). I hope this helps explain how we function within the Trust and look forward to ensuring this becomes a forum for 2 way communication within the Group.

Best Wishes
Chetan Varma,
Group Director

Latest edition of Heartbeat now online

The latest edition of Heartbeat is now available to view online.

This edition of Heartbeat features our recent Speak up Day, the work our homeless patient pathway do across the borough and how we work together to get the most out of Unity.