Chief Executive’s Message – Friday 10 August
August 10, 2018
On Sunday 12 August, we once again, weather permitting, play local GP colleagues at cricket. The match starts at 1pm at Dartmouth Cricket Club in West Bromwich. I know the football season is back, but if you want to keep a sense of summer going, do join us for what should be a closely fought contest. There is food and face painting, and whilst neither is compulsory, it should be an enjoyable chance to meet colleagues and old friends. Before winter, I very much hope though that how we work with local GPs will take a few more leaps forward. Our emergency department teams have been working through changes to the process by which GPs contact our Trust, and the locations and process by which patients “dialled in” by GPs arrive on our hospital sites. Using iCares and many other resources within our Trust, including hot clinics, there is scope to get the right patient to the right place. This will reduce pressure on A&E, but more importantly offer the right care model and better care continuity for our patients. It should also help our hard pressed switchboard! Nuhu Usman and Liz Miller are leading this work, which we have agreed with the CCG Governing Body will start in October. Around 30-40 patients each day are brought to our sites after seeing their GP and there is more we could to help them get the right service.
This week I published a brief film in the communications bulletin outlining the latest news on Midland Met (also on twitter @TobyLewis_SWBH). There are three messages really. Firstly this week we issued a contract document inviting bidders to come back on site by November and undertake some important remedial and enabling work to help final construction. Secondly, our joint clinical group across hospital and primary care met again to review which services we will reconfigure in 2019 in order to sustain quality until Midland Met opens. Anything we do now needs to be consistent with Midland Met, in 2022, and of course with the replacement then of our A&E at Sandwell with an Urgent Care Centre run by the Trust with primary care input. Finally, thirdly, and most importantly perhaps, we have written to partners in Government asking them to support our revised plan to publicly fund and directly contract for a final construction partner to complete the building. This would end the PFI model for Midland Met, although next year we will decide how the facilities management for estates work would be provided – in-house or at arms’ length. I do not know when we will hear back from Whitehall partners, but I would expect that to be in coming weeks, no longer. There remains a strong and shared purpose to getting the new hospital completed and move to the model of care envisaged at the start of this century, and finally approved in 2014. When we hear from Government the countdown clocks can be updated.
You may have seen orange screensavers pop up on your computer (more about IT below as ever). There’s one at the top of this message. The screensavers have a simple message: Sepsis is this Trust’s top quality priority. Sepsis is our top priority because we can prevent avoidable deaths. It is in our hands to get best practice from within our Trust, everywhere in our Trust. David Carruthers is leading work alongside Paula Gardner to make sure that, as a first step, we assess at risk patients and act on those assessments, using the Sepsis Six bundle. It’s a tale of two halves (I said the football season had started). In our emergency departments we are seeing fantastic work to identify “red flag” sepsis patients. All but one had their bundle inside the golden hour last week. On our wards the position is not yet that good. Vital Pacs alerts are not always being responded to, and right now not every single patient gets the bundle in time. I know that awareness is rising, and that we have trainees and senior nurses working alongside each ward consultant lead to sort this out. There is absolutely no reason we cannot make this standard one we meet consistently. If we look at the now externally audited data we are seeing weekly from our Safety Plan and Consistency of Care it is unarguable that this Trust has made huge strides over the last twelve months in the care we provide on our wards. You, we, all of us should be proud of the changes we are making. But sepsis is a big challenge to any health system. Over the next three or four months we intend to meet that challenge. But we may all need to change and adapt to do that. Nicola Taylor in our community wards and teams is leading work to look at any re-admitted patients to see if we are missing opportunities where someone deteriorates, and you know from prior messages that every patient discharged now from our wards or AMU has the quality of that discharge assessed. Gradually, but determinedly, we are building a quality improvement culture and system. Look out next week for details of the first annual Quality Improvement SWB Poster Competition, taking place this November.
I do appreciate that the last couple of days have seen more significant IT failures associated with our N3 connections, and therefore some reversion to paper. Thank you to everyone involved in tackling this. The Board agreed today to establish a new formal sub committee of the Board solely focusing for the next six month on IT. This recognises the longstanding deterioration since 2016 in some IT reliability, at the same time as we have seen pockets of improvement. The new committee will include staff representatives as we look to make sure that your voice is heard.
Informatics Data – 10 August 2018
I once again am publishing our latest IT performance data (the figures in brackets were our first week’s information). This week Mark Reynolds and the team have been working through how to make the changes to our infrastructure we need to make in September and October to create resilience. They are part of a £3m package of measures agreed with the Board in recent weeks. That schedule will come out with TeamTalk in a fortnight’s time. Meanwhile the wifi installation work is taking place, aimed at improving coverage and speed during August. It is good news that we have almost completed the device linkage work for Unity in critical care and elsewhere. So, whilst I want to reiterate Rachel Barlow’s apology to all affected by this week’s internet and system slowdown, I want to also emphasise the need to book into Unity training. Our teams have been out and about this week providing support to our wards around readiness. But there is no substitute for booking in to have your training between 13 August and 26 October. Between October and January we will be going live. iCM has to be replaced and Unity gives us that replacement as well as the huge benefits of electronic prescribing. So if you are one of the just over 2,000 folk not yet booked in, please do: Paula Gardner has a video on Connect and in the communications bulletin explaining why and how. You will benefit, and we all will, because all of us will rely on the data that you collect and Unity shows us. If we get this right it will save many hours of paper entry and re-entry. And that data will then help our work on quality and give us research ready information to help us improve further.
If you read the last paragraph you will have noticed us committing £3million more to our IT. That is possible because we are continuing to balance our finances. That is tough but gives us scope to make choices and investments. Some of those investments are about innovation, like our new mediation service to tackle workplace conflict, some are routine expenditures to make sure services like rheumatology thrive, and others are big changes to try and improve care like the work in our A&Es which started this message. Thank you to everyone working through rotas and rosters to help drive down our temporary spend premium, and I hope that the new iProc/Oracle system is starting to bed down where you work. If not get in touch, because in the next three or four months we want to use that system to do more standardisation of goods and services. It will become pretty much impossible to buy anything without a purchase order here – we currently only have about 70 percent coverage – so that we can be confident that we are spending every penny to best effect.
Finally, today we said goodbye to Karen Wood, our Head of Complaints, whose replacement starts in a few weeks time. In the last three years we have transformed how complaints are managed in the Trust, with well over 90% of formal complaints responded to inside four weeks. This is a legacy to build upon, not least through innovative Purple Point service, and it is always important that from both compliments and complaints we find the learning to improve services for our patients.
#hellomynameis….Toby