Chief Executive’s Message – Friday 11 January

January 12, 2019

Earlier this week the NHS “ten year” Long Term Plan https://www.longtermplan.nhs.uk/ was published.  In due course the financial and workforce implication documents will also be issued. In truth local projects and ambition always matter more than national directives, but if you have had a chance to look through the plan you cannot fail to be struck by how our 2020 vision, and the work we have done on public health, on integrating care, and on long term conditions is reflected now in national strategy. We are working ever more closely with the primary care networks that local GPs have developed, and looking to build on strong partnerships with both local mental health Trusts. With our award winning integration projects in respiratory disease and diabetes, and community rooted teams like iCares and our heart failure team, we should be ambitious about what we can do next or more of. This February in Sandwell we will see a huge emphasis on tackling obesity in children and young people, and of course come July, our own smoke-free policy will be live in a place near your window.

Winter in the NHS is not all about bed crisis or pressure – many thousands of our colleagues are working fantastically hard in other areas of need. But I do want to pay tribute to site nurse practitioners, duty managers, nurses in charge in ED, and on call teams for the work being done to keep patients safe. Next week we are trying some new and different ideas in our EDs to try and reduce waiting times because we all want the experience of our patients to be good. The NHS Constitution which sets out our rights as citizens does matter, and it is, as it happens also explicit in our contracts as NHS workers. So for the right reasons, and because it is what we promised, we must face up to the work we have to do to reduce waiting times. In the last three months we have had three external reviews of our emergency care services. All three have reached the same conclusions. We have got great energy and ideas from ‘frontline’ to Board. We have got plenty of staff, and by comparison to national norms and standards are well resourced in emergency care. But our combined efforts are not yet translating into acceptable wait times, despite everyone’s hard work, going above and beyond. We do not have rising numbers of patients coming. We are not organising ourselves to meet expected demands. Yet if we have the right ideas and enthusiasm, and we do, then we need to be optimistic that we can turnaround a position where urgent care wait times here are now among the longest in the country for a minority of patients.

I chaired this week a Table Top Review (TTR) of the care of a patient, whose long term outcome and outlook is good. She was not overtly harmed by the many hours she spent with us. I was struck during the TTR by a few things that I wanted to share with you. Firstly, we ought to be pleased to work in the kind of organisation that does not wait for harm to come to someone to learn from our mistakes. Secondly, that communication is both the most important and toughest thing in healthcare. As I listened to clinicians and managers talk in the review, it was clear that everyone was telling the truth. And believed that their own view was the one heard and shared by others. Yet it was also clear that we had not taken or documented collective decisions on which we acted. For some hours of our patient’s stay, part of her care team was acting on one plan, but another part was working with, perhaps, a different plan. Thirdly, and under my accountability, our management processes to manage the safety of our sites, and make decisions in time of crisis, did not make or enact decisions. The nature of management is that it should anticipate tonight or next week’s problems and act to prevent, or mitigate them. That is what we need to learn to do. Of course that has implications for everyone in our Trust. For example, it means that the data we collect or use needs to be real and to be right. It is still the case that around a third of our Expected Dates of Patient Discharge are nothing of the sort. They are a holding date, or a date to be moved from one place to another, or an estimated date. Not one we are working towards. So all of us can contribute to helping to have the data to cause decisions to be made, and we will develop systems to make difficult decisions that keep patients, and colleagues, safe. Finally, we will, from this case, and others review some of our departmental procedures. Because whilst each unit will have its own way of working safely, when we add those ways together they cannot, fairly, mean either that there is nowhere for a patient to go, or our A&E department becomes a place of last resort on behalf of the hospital.

Whether it is annual winter pressures or another national plan for the NHS, it is always good to see something that has always been an issue coming to fruition with major improvements. So I wanted to call out the work that Bethan Downing and many others are doing to ensure that among our many amazing projects in our workplace, we have some focus on employing local people with learning disabilities. We have now a series of programmes, in part, linked to Sandwell College, and some pilot initiatives in theatres and elsewhere. Of course, becoming an employer able to work with all potential employees, demands change, and one is that we make sure that many of our jobs, are able to be undertaken part time or in a job share basis. That is anyway part of the flexible working package that we will confirm in February as part of our weConnect programme, because flexible working was one of the top 3 issues you voted to say we need to do better at the Trust. At the same time, I understand we have persuaded the national ESR data centre to change their data collection to allow us to report on how many employees we have with learning disabilities, so that we can be open with ourselves and local partners about whether we are succeeding in offering equal opportunities.  In this organisation, how we treat the most excluded and vulnerable people we share our community with, is, and always should be, a measure of our values, and I hope that you share a commitment to make that a reality for local residents, whether we are thinking about healthcare for homeless people, or employment rights for care leavers.

I know we did not make it to the Top 40 with our Christmas Charity single. But among the latest news from Your Trust Charity is funding for our reading scheme for children in our paediatric wards, undertaken jointly with the Sandwell Library Service. In the spring, anyone using our libraries will be able to order and collect books from the wider borough library collection on site. Why not try it?  It’s just behind the Amazon locker at Sandwell (the amazon locker at City is outside BMEC).

I did promise last week to write about IT. I will, although I do not want to jinx the improvement seen since October in our resilience. I will return to the topic over the next fortnight once we have firmed up certain plans for further improvement, including confirming when our N3 connection will be upgraded, which is the single biggest source of downtime over the last 12 months. Attached are this week’s IT statistics: IT Performance Stats 11 January 2019

More quick quiz “number” news, if you read my message last week:  852 people who had not done Basic Life Support training is now down to less than 350! And with your payslip in January you will get your very own mandatory training record, so that you know what you need to finish by 31 March. Remember, across the NHS from April you will not be eligible for your pay increment if you are not mandatory training compliant under Agenda for Change…

#hellomynameis…Toby