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Chief Executive’s Message – Friday 19 March

March 19, 2021

Congratulations to the four schemes who were finalists in the Health Service Journal awards this week, in particular to Fran Silcocks and all those involved in the winning entry for the sustainability award. Also to the alcohol service and Dr Sarb Clare who were both highly commended in their categories. I will also add my thanks and sincere congratulations to this week’s Star of the Week. Michael Reay is a volunteer who has been instrumental in supporting the Trust throughout the pandemic. He has been the linchpin of the volunteer support at City Hospital, attending almost every afternoon, coordinating distribution of snacks, posters, patient belongings and basically being on hand for whatever help has been required. Our volunteers are a truly valued part of our SWB family and as such it is right to acknowledge them in our workforce recognition schemes.

Our vaccine programme continues with the Sandwell hospital hub re-opening on Tuesday for second doses. Make sure you know when your appointment is or call the booking team if you need to check. First doses for any staff member can be arranged through the alternative vaccine hubs nearby including City Hospital. Check the COVID-19 bulletin to find out how to book your appointment.

Even if you have had your vaccine (first and second dose) we still need you to continue with the regular testing which has switched from lateral flow to LAMP. It remains really important that we pick up on asymptomatic cases so that we can best protect ourselves, our colleagues and our families. Details of how to collect your kit and where to deposit samples can be found by clicking here.

It is great to see the activities that the LGBTQ+ staff network are progressing. Please do your best to take part in the survey by clicking here to help the network further develop, and get involved in the regional LGBTQ+ History Month conference on Thursday 12pm – 3pm. The event is aimed at all colleagues and will help improve your understanding of how to better support colleagues and patients. Click here to find out more and reserve your place.

In this month’s Heartbeat column and in today’s message I talk unapologetically about dying, addressing some key and shocking facts about death and dying in the Black Country and in the west of Birmingham. These facts should jolt all of us into changing our attitudes to this, one of the two certainties of life.

I first became interested in the subject professionally, quite late in my managerial career.  Prior to this, I was an unthinking slave to the notion that modern medicine could and should, seek to cure all and that we should stop at nothing to attempt it. Yet, I was influenced significantly by a palliative care consultant in my second Chief Executive role.  She changed my thinking completely about the subject, by convincing me of the following things. An introductory conversation with our brilliant palliative care team leadership at SWB, reaffirmed this view:

  • Death was a certainty.
  • Too many people did not die with dignity and the evidence was there to prove it.
  • We are avoiding the discussion about what constitutes a good death, more and more as a society.
  • We are, as senior healthcare professionals, too squeamish about the subject
  • We investigate and seek to treat people too much, who are palpably in their last few weeks or even days, of life.
  • We pass the buck to the specialist palliative care teams too much, when end of life care is everyone’s responsibility. It is, to quote one of our Deputy Directors of Nursing, a “privilege” to nurse someone in their final hours.

Firstly, what are those facts? The Strategy Unit at NHS England did a study of death and dying in the Black Country and West Birmingham. They found:

  • Nationally, an average of 66% of people say they want to die at home.  In the Black Country, only 25% of people do so. People from deprived areas, and let’s face it, we serve that population, are more likely to die in hospital than people from more affluent areas.
  • The median length of stay for people dying in hospital is less than 2 days and most were admitted to hospital as emergencies. So this begs the question, why do we admit people who are probably not going to benefit from that admission?
  • In the last two years of life, over £172 million is spent on hospital services in the Black Country for decedents. Urgent care services in an unplanned way, accounts for two-thirds of this spend. This places us very high up a league table we would not want to lead, when compared to other systems/regions in the NHS.
  • The number of deaths per annum, having reduced for decades, is now on the rise again. If our approach to hospital dominated death continues without change to practice, Black Country hospitals will need a further 100 beds by 2040 just to deal with that trend alone.
  • There are numerous national and international research studies which show that much of the investigations and interventions in the last few weeks of life do not just add no value or quality to the care received, but may actually hasten death.

So what conclusions can we draw from this? At best, one could describe our approach to death and dying in our part of the world as uncoordinated and reactive. When 66% of people state they want to die at home and only 25% do so, we have a mountain to climb locally in meeting people’s expectations. Given our demographics and the socio-economic challenges we face locally, we must work even harder to turn that tide. To achieve that, we must change our own attitude to death as healthcare professionals in our Trust.

We are already quite well advanced in our thinking about how we are going to affect change in attitude and practice in this field. We have a competent, resilient and highly specialised palliative care team that straddles both acute and community care in both the “places” that we serve. That team have pulled together a quality improvement initiative which aims to achieve a better quality death for all our patients and residents. This will include better training, awareness and understanding of a subject matter we don’t tend to embrace well.  It includes better symptom control, pain relief and clearer care plans, initiated earlier and in consultation with family members or carers.

All the above intent and planning is great stuff and, as the facts I set out here show, are long overdue. But they won’t achieve any element of it, unless all of us, every single one of us, embrace the change. To do so, we must throw out the outmoded and wasteful models of paternalistic medicine which can robotically seek to test, diagnose and treat without thought. We need to take responsibility for managing the care of people who are clearly nearing the end of their lives and not just rely on our specialist team to do that for us.  Finally, we need to accept that we have an uphill challenge in this part of the world and we start from a low base in terms of good practice.  That is our starting point – let’s accept the need to change.