Chief Executive’s Message – Friday 8 April

April 8, 2022

This week I have been reflecting on prioritisation, on multiple service pressures, on the multiple “asks” made of us as a Trust.  Other, more well-known health commentators than me, have been making it clear that the 2022/23 planning guidance is a contradiction in terms to have 13 “priorities” to deliver as an NHS whilst also seeing a reduction in the income awarded to hospitals and community services to deliver them.

No more than in urgent and emergency care, does this difficult balance of the “asks” of us by national government, play itself out.  This week has been dominated by urgent and emergency care challenges on an unprecedented scale, with the ambulance service having a record number of call-outs waiting that they couldn’t get to because of crews being already busy responding to patients and transferring teams waiting to offload at hospital.  To try to do our bit to mitigate that risk, our own ED and acute medical teams have been put under huge strain and have broken with normal protocols at times, leading to busier than usual emergency departments at all hours of the day and night.

As part of their escalation plans in times of extreme demand, the ambulance service were required to enact their “immediate handover” policy at hospital sites meaning that paramedics, who would normally remain with the patients until the emergency departments are ready to clinically accept them, were bringing patients into the department and immediately returning to the road to respond to more calls. This is a change in practice, but one that was deemed necessary as the risk of not attending to category 1 and category 2 999 calls is deemed greater than the risk of overcrowded emergency departments.  I recognise how much additional pressure this has meant within our already stretched services. Thank you to all our clinical and managerial teams at the front door who have responded with professionalism, speed and flexibility to ensure that our patients are safe. I am so proud of your resilience and determination to do the right thing and put our patients first.

These additional pressures look likely to continue for some time, exacerbated by the increasing numbers of patients with COVID-19 in our hospitals, now that national social distancing measures have ended.  We have seen a 300% increase in our inpatients with COVID-19 in the last 10 days.

What happens at the front door of our acute hospitals, is everyone’s business – not just the teams in ED and our assessment units.  At times like this it is everyone’s responsibility to find out about the risk being managed at the front door and determine whether there is more that you can do to share that risk.  A problem shared is a problem halved, no more so than in the world of urgent care.  Our health services only work well when there is effective flow into the hospital (with only the patients who need hospital care being brought to us) and out. Community teams are doing a fantastic job working in partnership with primary care and social care to wrap care plans in place to move patients out of acute beds at the right times and increasingly, through frailty services and urgent community response, prevent admission in the first place. What we need continually is great decision making on next steps for patient treatment with a willingness to get patients in the right place at pace. Where there are blockers to doing this, or you think we could do things differently, please make the changes yourselves.  Don’t seek permission, seek forgiveness and support.

Urgent and emergency care is one part of what we do but it is where we have a greatest patient safety challenges at present and for the foreseeable future.  It is of course, a reflection of the whole health and care system and often our front door colleagues are those picking up the pieces when other services fall down or when there is not enough “pull” through the hospital or the wider system. Heartfelt thanks and admiration for all of you who are continuing to manage in these difficult circumstances.  We are determined to do all we can to support you as you prioritise every day.  National government may have 13 priorities for the NHS.  When you boil it down, our first priority is and always will be, patient safety.

Have a good week.