New Year’s message from Chief Executive Toby Lewis

January 2, 2018

Dear colleague,

A new year starts and I wanted to take the opportunity to share a few ideas with you about our future.  The NHS, and our social care partners, are under strain.  We are not immune from those pressures.  But we have a distinctive and a great chance to improve further what we do, and working ever more closely with general practice and community pharmacy partners, that is a chance that I hope that we take.  2018 is the year to make sense of our move into Midland Met in the middle of 2019, and everything we do now is intended to build our 2020 model of care now, in readiness to succeed.  We have a once in a generation opportunity.  We need to seize it.

We continue to need to work to make our IT work better.  It ought to be something we do not need to talk about at all.  It should just be assumed that we can print as we need, order and view and approve results easily, and see one patient record simply.  You know we are working with out of date infrastructure, though that is changing week by week.  In the spring we will put in our Cerner EPR, Unity, and rely far more on cloud based storage.  You may have seen small yellow stickers on walls on our acute sites – marking the spot where new computers will arrive in February.  Before we go live with the new systems, we have a lot of training to do.  Not just in how to use the system itself, but in how we are changing care pathways to map to the system – fewer bespoke care plans in nursing for example, or new results acknowledgement arrangements for tests to make sure no patient falls through gaps.  This work will dominate our lives in the next six months.  But the benefit should be obvious, and nowhere more so than in introducing electronic prescribing, replacing paper drug charts, which sometimes move between wards and pharmacy, and giving us a chance to cut medication errors for our patients.

The safety plan, and our consistency of care work, has been a great success in 2017, in my view.  The data shows that everyone’s hard work is paying off.  Missed checks have fallen.  Documentation has improved, with ward teams saying that SAP1 compliance is transformed since the summer.  Falls and pressure ulcers are down and antibiotic compliance and IV substitution rates have improved.  These are sometimes called the basics.  I think we should consider them the fundamentals of care, in our acute wards and community hospitals.  To offer the best quality we can our mission is to make those fundamentals our norm.  Consistency is what we want for our patients, and what we should expect of each other.  That reliability will be improved by the technology, as we reduce rework, collecting information once and relying upon it.  By 2020 our patients too, through the new patient portal, will be able to see the work we do, and their carers will too.  This February we put onto our wards the Purple Point system, to let relatives, carers, and patients, alert us and raise the alarm much more easily if they are worried we have missed something, often a ‘something’ around communication.

Speak Up Day last September was not a one off.  Thank you to the hundreds of staff who made a pledge to raise concerns and risks.  Every morning I see that commitment in our incident reporting.  I am sure that feedback from that reporting, on what has changed, could be better.  As a Trust I know we act on safety issues with real determination.  I see that in the work of orthopaedics and anaesthesia to deliver their improvement plan after two patients died.  I see it in our investment to improve non invasive ventilation with the specialist unit on priory 5, again learning from deaths. In 2018 David Carruthers, our incoming medical director, will lead our work with Group Directors and their teams on the Trust’s Quality Plan.  That aims to improve outcomes in areas like sight loss, cardiac and stroke mortality, and how we work to improve mental health.  An investment such as the creation of a specialist surgical enhanced care bay last December will help us to improve the care of patients after a laparotomy.  As important a step for a defined group of high risk patients, as our drive on better sepsis care is for all our inpatients.

None of these ambitions will work without individual excellence and a commitment to teamwork.  The Care Quality Commission were explicit with the Board that that was what impressed them most from their visit to us in 2017.  Quality Improvement Half Days provide the space for teams to talk and to drive improvement.  By the spring every one of those events will be accredited, as we look to make QIHDs the engine for change that we need.  We all know that a meeting can be ineffective or effective, and good structure and leadership usually makes all the difference.  In February and March every one of our 700 line managers will be themselves accredited for their leadership skills, as we get ready to introduce our Aspiring to Excellence PDR programme whereby every one of us will have an appraisal between April 2018 and July 2018 agreeing our individual objectives for the twelve months that follow.  Part of our workforce plan is to make the very most of our diversity, and the talent in our midst.  We know that for many colleagues, for example those with a disability, we have work to do.  We are investing heavily in mental health support among our staff.  And we need to constantly reinforce our values of mutual tolerance and respect.  The issues we all face are often a symptom of wider society.  2017 has seen a global movement to tackle sexual harassment, especially in the workplace.  #MeToo is something we must embrace at the Trust, and we have, with dismissals in 2017 for harassment and assault.  I would encourage anyone experiencing unacceptable comment or peculiar intrusion to raise it with your line manager, your HR business partner, trade union colleagues,  with Raffaela Goodby, or with me directly.  Ideally keep a diary of your experience and speak up, we will not ignore you.  I promise you, it is not ok round here.

You will appreciate that the investments I have mentioned, in safety, in technology and in relocating services, are not cost free.  Whilst we have increasingly strong and overt support from commissioners to manage local finances together, which is very welcome, we have to continue to manage and reduce our cost base.  2017 has seen us halve agency spend.  In 2018 we have to cut our costs significantly.  During January we will firm up proposals to reduce temporary pay spend and to rationalise non pay expenditure.  From April we need to be making a seven figure dent in our monthly spend.  Benchmark data shows us that that is possible and safe.  Please do not read this as a call not to put forward new costs or expenditures, and please do not tolerate being told we cannot afford good ideas or expenditure to keep patients safe.  With a yearly turnover of £450m we can certainly do that.  Our task is to spend what we have deliberately and better.  If we do that, we can continue our plan to invest more and more in staff wellbeing and training, improving our recruitment and retention, and supporting teams to improve their skills and our results.  Our Trust, and our care system, have every reason to be confident and proud about what we do, and what we can do better.  The CQC were very clear.  Within twelve months we should – and can – be rated as Good.  The first such rating for a hospital linked provider in the Black Country.

I hope you share my absolute determination to see through that drive: Going for Good.  It underlines our 2020 Vision, and is what our patients categorically deserve.  As our NHS celebrates its 70th birthday, it is our part in the bigger picture to sustain and improve the best health service in the world.

Every best wish for the year ahead,

Toby

Chief Executive

Sandwell and West Birmingham NHS Trust