Chief Executive’s Message – Friday 5 January 2018

January 5, 2018

This message is a thank you message.  Thank you to everyone who has done the right thing and had a flu vaccination.  Thank you to everyone who has gone the extra mile or far more in recent days to safely look after a patient at home, or taken the difficult decision to not admit, or to arrange an alternative to admission.  Thank you too to people staying beyond their shift or returning to site overnight.  To anyone taking on a bank shift to cover sickness or help support winter pressure beds.  Because of your efforts we are coping, and our patients are getting the best care possible.  This is not a spin operation:  Quality will not be everywhere right now what we all aim for.  Safety is the focus.  Apology letters have gone to the patients whose last acute night of their stay was in a recovery area earlier this week, so that a newly admitted patient could have an acute bed.  A risk based decision.

But I also want to thank leaders who are trying to introduce new ways of working now, and last month, and next month, which will give us a better chance of coping less frenetically in the weeks ahead and next winter too.  We simply have to begin to manage to our expected dates of discharge.  Although ambulance surges were problematic over the last weekend with other hospitals struggling, the underlying issue here is discharge volume and discharge certainty.  Delays behind ED in our wards drive vast effort to manage our sites, but those efforts typically amount to discharge decisions affecting ten to fifteen patients on each hospital site.  If we knew sooner and collectively who those folk to move to the next stage of their care were, our system would work.  Put like that, and that is the maths, the challenge we face seems like one we ought to be able to work together to address.  Across hundreds of beds, two dozen patients.

Next month, given the recruitment completed, and those leaving us, we will achieve our promise of having no more than thirty nursing vacancies in medicine.  Down from over 150 this time last year.  That is a massive change in our Trust, and a huge opportunity.  In the early weeks and months of 2018 we have to support, mentor and inspire those new joiners, which is why we have invested in practice development nurses and maintained supervisory time for our ward managers.  Get those new joiners ready, with the rest of us, for our new computer system, Unity, this spring.  And make them feel welcomed.  Thank you to everyone involved in our Bringing Your Ambition to Life campaign, and to putting our best faces forward to persuade people to join us.  As I explained in my new year email message, our strategy is to make our money work, to support continued investment in staff wellbeing, training and development.  That demands we drive agency costs down further, and with our recruitment success that feels possible.

The Trust Board yesterday met at Rowley.  That gave us chance to spend time with teams on the site still reflecting on the CQC report from October.  We gave ourselves until March to implement all the recommendations from that report.  On the evidence of yesterday’s visits, and our Board discussion, I suspect we are a month behind our plan.  But we are seeing progress on issues as diverse as water fountains in BMEC ED, mandatory training approaches, and safeguarding policies.  If you have not yet taken a look at the CQC report and our plans, please do.  The big message remains – if we can achieve consistency of care in medicine and emergency care, our organisation (your hard work and skill) will receive a Good rating.  Welcome therefore to Claire Hubbard, as our new group director of nursing in medicine, working alongside Michelle Harris as operations director, and Chetan Varma, who leads the group.  My thanks and admiration go to April Hawkins who has led much of our improvement effort in medicine in the last six months.

Finally, in Hot Topics on Monday, we will begin to talk about the results of our national staff survey.  Though our response rate remains low, the messages are clear, and when cross referenced to bigger surveys like Your Voice, I think pretty consistent.  There is lots of improvement this year compared to last, but it is still the case that the majority of colleagues feel that communication could be better.  This certainly includes two way communication from and with ‘senior management’ and that engagement and involvement could be better, especially in big decisions.  So we have work to do to meet that challenge, starting with using this time’s Hot Topics to get your ideas on how to improve and on what would show we have.  We face tough decisions daily, and certainly over the medium term.  But that difficulty and complexity makes it all the more important that people know what is on the agenda and how to influence and adapt it.  We will work, through Hot Topics, Heartbeat, QIHDs, and other mechanisms to help everyone to understand how you can make your voice heard in choosing how to address issues of quality, efficiency, and strategy in our organisation.  We cannot be Good, nor sustain that, without everyone in the Trust believing, from day to day experience, that you matter.  The Chairman wrote in Heartbeat about courtesy and politeness to each other being part of that, I recognise that engagement and involvement with local managers and corporate leaders is part of that 2018 journey too:  Happy new year!

#hellomynameis….Toby