Chief Executive’s Message – Friday 14 December

December 14, 2018

I very much hope you are ready for Christmas. In the coming week we judge the decorations contest, and as usual on the day itself we will have gifts for patients and free food in our restaurants for colleagues on shift. Part of being ready for the festive period is being prepared for the single weekdays between Bank Holidays and the pattern this year of weekends.

I cannot emphasise enough how important it will be to have robust rota planning and discharge planning in place. I know some team leaders may be frustrated to be asked, but it is vital that we are well prepared to ensure that we manage safe discharges this festive season. We have worked hard with GP and care home partners to be ready. I know this week we rolled out our successful Sandwell early discharge work on to the City site, and I know too, how hard teams are working to help patients who have been with us more than a fortnight to move to the right location for ongoing care needs. I remain, despite our pressures, convinced we can succeed but we will need everyone to work together. Knowing who is going home tomorrow, and having that patient ready before 10am will make all the difference to the care of someone else. For all the skills and compassion of our ED colleagues, whose advent calendar is above, the A&E is not intended to function as a night ward, and to avoid that we need discharge volume and velocity, safely, rather than more beds. It is both safe and ‘ok’ for a non-complex patient going home this lunchtime to be asked to self-care at the bedside or in the day room under supervision if need be.

This last week saw a well-publicised simulation of the future integrated care model that GPs, social care, the third sector and our teams are co-constructing for 2020. This is in line with our long term vision and the NHS Long Term Plan. It will be grounded in a major move from financial flows based on counting what we do to funding annually or multi-annually each resident on a capitation basis. The emerging provider alliances – essentially co-operation agreements between neighbours – will then adapt what we do to better meet the needs of children, families, those with long term conditions and the growing older population that we serve. From April, I would expect each primary care network locally to have established with us some priorities for immediate improvements, as well as a shared vision for the longer term. This is all groundwork for Midland Metropolitan, and must be based on the staff and skills that we have locally. Put more bluntly, we have to design models of care that people want to work in. Some of those will be ‘centralised’ but many will be distributed across our own locations and key centres in primary care, like Neptune, Tower Hill and Rowley Regis. Our exact relationship with general practice in the future will vary across our geography. In some places, as with Modality, we will see groups of GPs take on work we presently do. In other areas, we may take more direct responsibility for primary care, either in partnership or as the prime provider. We have bid recently for some GP services and are now awaiting the outcome of those tenders.

Any distributed model of working will rely, of course, on our IT. We continue to focus time and attention on that, and are expecting next week to confirm our place at the head of the queue to enlarge and replace our N3 connection. On current plan we would expect all of the IT technical dependencies for Unity to be resolved and in place by the time we have our February Dress Rehearsal. Doubling our Wifi capability and resolving all of the local printing issues are hurdles set by our Board before we can progress to go-live. I want to thank those colleagues in Martin Sadler’s team who are working to achieve those aims. Unity Roadshows have been drawing crowds this last week and continue next week. Over 2,000 people remain to be trained in January, and if you have not yet booked yourself into basic training, you need to do so. Whilst we continue to publish statistics about our IT and work towards to a more methodical quantified scorecard, we are also conscious that we need to understand how our IT feels where you work. Look out in staff comms for the opportunity to be one of our 100 mystery shoppers who will be asked each fortnight whether you are experiencing improvements. It is important to us all not only to deliver Trust level IT changes for the better, but to neither obscure nor leave unresolved local issues like that faced now by neurophysiology or midwifery.

I want to thank colleagues in maternity services, especially Clare Cushing for the work done to make progress since October on VTE assessments. The Trust re-achieved a 95% threshold this month.  You will remember though that our safety plan aim, and our quality plan aim, is 100% coverage. Efforts continue in acute medicine to do just that. I am sure that our leadership teams at local level can do this, and AMU A have been driving ahead. Whether it is overnight or at weekends, we need to make sure that assessments are not stayed to board rounds but completed live. Our mortality analysis continues to show avoidable harm and we should be unembarrassed, as with sepsis, ensuring that we deliver from ourselves as professionals the care we would wish as patients.  In 2019 for both VTE and sepsis we will take together decisive steps to meet that promise.

#hellomynameis…toby