Chief Executive’s Message – Friday 16 March
March 16, 2018
Another busy week draws to a close as I write this message. This week I have not been able to issue a note on Midland Met, as I pledged last week. This is because negotiations to bring in our interim construction contractor have gone more slowly than we hoped. It is not Brexit but it is a five way negotiation, so has its challenges. However, we do now have an agreement and very much hope to have mobilisation on the site in the next ten days. This secured key jobs and gives us some momentum to move forward, and a platform to try and resolve the funding issues. I suspect it will be April before that work is concluded given that we are discussed over £100m. I must reiterate that no money will be taken from local NHS funds to address this. Of course we need to continue to meet our financial duties, and we will end 2018/19 with a small surplus – almost uniquely among local NHS organisations. I do not underestimate the sacrifices involved in that. Having to let go long term bank or agency colleagues, as we reduce those pay rates, is undoubtedly difficult. Our bank staff are part of the team here.
Our best case model now sees us open Midland Met in 2019/20. It is too early to confirm that date but we will do so by this summer. Against our hope to open in October 2018 this is frustratingly delayed. Yet given the challenges the project has faced, each one outside our making, it remains our best timetable. Though Midland Met is not the strategy for our Trust, it is an essential part of our 2020 Vision, and in particular the quality improvements in our quality plan, whereby we look to reorganise how we work to get better outcomes. The Board is clear, and has been clear across Whitehall, that a single acute site is the sole route to seven day services and to truly team based care. So, I guess, I can be confident that we will get there. More slowly than we hoped or need, but with certainty. Thank you for bearing with us.
I want to congratulate teams delivering exceptional results, through this message. Of course our Shout Out system gives you chance to do just that, so please think about who you want to celebrate. Our Compassion in Care award is given monthly. I am thrilled that, so far, through Purple Point we have had more compliments for staff than complaints or causes for concern. A great tribute to you – and in particular to Caroline Dawes, Lisa Beddows, Ravinder Kaur, Lisa McFarlen and Sarah Burrows, who have been picked out by patients and relatives for their work. Individual improvements are worth a mention but team success is even more important as it drives sustainability. Well done to our facilities team for being the first to book every single person in to have your appraisal under our new Aspiring To Excellence PDR system. Now let’s use those conversations to thank team members and to set objectives for the year ahead!
Congratulations too to the Mesty Croft district nursing team. They are the first of our six community district nurse teams to “go green” on all of their performance KPIs. At a time when the NHS is once again looking at and talking about emergency care and acute systems, perhaps to the exclusion of other things, I want to acknowledge the achievement of many community teams faced with big caseloads and the challenges of working independently in people’s homes. This month we have a huge focus on sepsis care. In that context thank you to our ED teams whose improved sepsis screening results offer real hope for better outcomes and care. Please take the opportunity of Hot Topics to talk about sepsis and whether you know enough to enact our policies and procedures. If you have not read the orange screensaver on sepsis, go look for it. It tells you all you need to know.
In the last few days I have been involved in a few discussions though about poor care. The Coroner has again written to me, on your behalf, about the unacceptable care pathway for head injuries, which led to a patient’s avoidable death. And local councillors alerted me to an elderly patient discharged after 1 a.m from one of our sites, in his nightgown and still with a cannula in situ. We all know that that is not our norm. Usually we achieve better than that. But our quality and our safety focus has to be maintained and we have to work to reduce pathway errors. Discharge in a nightgown is not a resourcing question. It is us wanting to go a little further to do what is right. We should never be discharging someone in this manner, and will support any employee who prevents someone being discharged in such a state, regardless of their profession or discipline. I know our transport teams for example have stepped forward to stop this in the past. We will always find the resources for dignity. But need the eyes and voices of all of us to stop mistakes like this. It is truly difficult to explain to a patient or relative how our attention to their needs missed a retained cannula. I have asked directors of nursing to advise me what should be our response, in conduct terms, when this happens.
I want to assure you that Midland Met, Unity, finance and other huge programmes will not distract your Board from a continued focus on basic safety. Every working day for me still starts with incident reports and safety plan data. I can see us reducing week by week the number of missed checks. I am proud that our community teams are rating every discharge, and feeding back to acute teams how we can make each one safe and therefore green. This month’s campaign on Measles, Mumps and Rubella (MMR) is testimony to a determination to improve community resilience and staff wellbeing. Last year we invested in NIV care on priory 5 and in acute surgical care too. It is a month or two too early to confirm this year’s funding priorities but I know we will find funds to spend on quality improvements, like the HIT team, which we substantiated budget for a few weeks ago. If you have ideas about safety and about quality do speak up. Better still at your next QIHD put your idea forward. Across the Trust those ideas amount to our real improvement plan.
In-house inspections are out in our organisation again this week, as we were last week. I visited City ED and was impressed with the cleanliness of our space, and the resilience of colleagues. Almost every patient observation check was passed. We have spent the last two years trying to ensure that, in our community, GP and hospital ways of working we support A&E. That effort needs to continue, and we need to challenge ourselves to not create processes or pathways which simply result in a patient defaulting back there. I am grateful to individuals who spoke up about protocol which appeared to suggest failed discharge patients via transport should return to ED, which is not and should not be our approach. The inspection regime, our incident reporting, ok to ask, and Speak Up are all ways to create a culture determined to improve. Thank you to everyone who is playing their part in just that – as we aim for Good. Where we are not already great.
#hellomynameis….Toby