Chief Executive’s Message – Friday 27 July
July 27, 2018
Thank you to everyone who nominated someone in our Star Awards 2018. The biggest roll call of nominations ever, as we topped 500. The shortlists come out next week with Heartbeat. As you know four awards are voted for by you, and one by our patients, so get ready to consider who will get your vote for our three teams of the year – non-clinical, clinical (adult), and clinical (children), along with our coveted employee of the year award. Payslips come with Heartbeat (although later this year pay slips will go electronic only) and with pay slips come stage one of the national pay award. Stage two (back pay for April-June) comes in August. This phasing is national policy. The Trust intends to maintain our commitment to the Living Wage, and will continue to pay a premium to our lowest paid employees. This is not national policy and is a reflection of our values and beliefs.
This week a new “house” joined us, with FY1s (PRHOs in old money) coming on site. Next week we see new joiners at other training grades among junior doctors. We are immensely lucky in our Trust, though by design not accident, to have a fine tradition of medical education, learning and simulation. David Carruthers’ appointment as our medical director owed much to his impressive drive to help deliver that success over many years. It is no surprise therefore that our approach to the quality plan for the Trust will aim to use the passion, time, ideas and intelligence of doctors in training to initiate, audit and drive quality projects which can improve care – starting with VTE and with sepsis. And if by now you do not know that sepsis is this organisation’s number one quality priority this year, then maybe the heat is getting to you.
This week also sees the legal case between Hadiza Bawa Garba and the general medical council. David Nichol, our neurology lead, who has been active, alongside many others, is raising awareness of the issues from this sad situation. And the national news media will rightly cover an important decision about organisational vs. individual responsibility, and about how professionals are best regulated. As a Trust leadership we are clear that learning and developmental reflection, in any profession, must be protected in order to encourage any of us to be open about our mistakes, fears and understandings. We have made one step recently which reflects on the case. Any incoming temporary trainee doctor undertaking a shift now has a very clear induction model which necessitates them talking to those they are working with, and contacting their supervising senior staff member (usually a consultant) to agree expectations. This is an intentional act to make sure that colleagues unfamiliar with our Trust feel welcome and understand how we do things round here. Every consultant with whom I have spoken is clear that they want to hear from those working for them, and there must be no bars, real or imagined, to asking for help or advice. That is why the upcoming A&E trainee rota will put more junior doctors onto our sites at night, because we have heard the anxieties voiced by trainees about risk and isolation.
Over the term that the incoming trainee doctors are with us, they, and everyone, will see much change. Paper will largely disappear from clinical practice. Not only will Unity replace handwriting, and EPMA replace paper medicines’ scripts, but introducing Unity will reduce duplication of processes. Over the last fortnight I have spent much time with clinicians in ED and medicine, and it is clear there, and elsewhere, that we have clerking and assessment processes where we have not relied on each other, but instead restarted information gathering. In services where time is precious, we need to begin to change and to trust, and introducing electronic data collection will help us to operate as one team. Of course, that means that the legal framework of responsibility for clinicians must reflect team work as well as individual roles. I know only too well, and I again attach our performance data, that we have a way to go with IT resilience (this week has been our best in six for downtime). Nonetheless, Unity training is now open for bookings and runs from August 13th to October 26th. Please book in! You cannot use the “play domain” until you have done your training.
The dispute between the last Secretary of State and doctors in training gave rise to some gains. One of those was much clearer arrangements to support whistleblowing and hours monitoring among trainees. We have taken these very seriously in the Trust, and our Guardians have worked to hear the voice of trainees and advocate and problem solve with them. At the same time the Trust was a first adopter in having a Chief Resident as a representative and management leader for trainees working here. Whilst recognising those special differences, we want to make sure that trainees use Trust-wide systems, especially our IR1 system to raise concerns. My message to FY1s on Wednesday was this: Speak up, you will be heard and listened to. You bring a new pair of eyes so be sceptical when told that we have always done it this way and nothing can change. It can and does and must and will. Just because something was “like that in my day” does not mean it is the right way now and we should always hear the voices of those bringing fresh ideas and insights about how we can improve.
Finally, whilst no part of our Trust has a veto over change, increasingly as we adopt changes in practice, there will be a ‘hard stop test’ to confirm that FY1s, FY2s and registrars have been involved in designing any changes which alter how they work. Right now we are finalising altered arrangements for how specialties work alongside ED. In September we will make some pretty major changes to where and who sees patients. We have tried this several times in the past five years. This time needs to be different and part of that will be how we involve those whose working practices are altered as we look to improve care, and improve the experience of working here. Nuhu Usman, David Carruthers and Rachel Barlow are leading this particular project.
The cricket team is announced early next week, so last bids today direct to me, for the coveted chance to play on Sunday August 12th. We work alongside, and rely on, primary care. But this is a chance to express some healthy competition as we look to win the Midland Met Cup for the fourth time in five years, assuming the rain stays away.
#hellomynameis….Toby