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Chief Executive’s Message – Friday 10 November

November 10, 2023

When you are a Chief Executive, you are accountable officer for the Trust you lead. You may not be responsible for a great deal directly, but you are ACCOUNTABLE for everything. Patient safety, staff satisfaction, delivery against access standards and delivery of financial expectations. That accountability is to my Trust Board.

One feels the accountability very keenly when an aspect of your Trust’s services is not delivering, particularly when patient safety and experience is negatively affected, along with that negative trend impacting on colleague’s morale and pride.  At the moment, that one issue which weighs heavily on me, is that of patient and staff experience in urgent and emergency care (UEC, for short).  Allow me to explain why, and more critically, what I feel we are and need to do about it:

Boiling it down, we have unacceptable waiting times for patients in our emergency departments (EDs) and our urgent treatment centres (UTCs).  The inability to assess, treat and where necessary admit patients in a timely way, leads to cubicles being filled and overcrowding in our EDs. In the last few weeks, that overcrowding has deteriorated, meaning critical safety standards like ambulance handover, wait to be seen by a doctor/practitioner and wait for admission, are being severely compromised.

It is not enough for us to either a) slip into the trap of saying “well, everyone’s UEC standards are slipping, we are in line with them” or worse still b) effectively lose our sense of moral outrage about this.  Be under no illusion, our Trust is slipping faster than others in this area, and it is not only increasing the risk of harm to patients, but also starting to cause moral injury to our staff.

To respond, the Trust Board yesterday agreed a significant investment for the rest of the year to improve patient safety and experience at our front door(s).  This includes:

  • More senior medical decision makers in ED and acute medicine/SDEC for longer in the day
  • Transfer team investment to move patients who need admission, to their inpatient bed more quickly
  • Extending our UTC hours well into the night
  • Improved food and drink provision for patients awaiting admission in our two Eds.

This investment is significant.  It totals well over £1 million, and it must deliver results.  Lest we forget, patient access standards (4four hours, ambulance handover times etc.) are not performance measures.  They are proxy indicators of safety.  We must improve. The quid pro quo for this investment, which I need from everyone in the Trust who contributes to the patient journey in UEC, is adherence to professional standards of responsiveness, adherence to clinical triage and assessment standards and a focus from inpatient ward staff on timely discharge and assertive patient journey coordination.  Most importantly, however, I want you all NOT to lose your sense of moral outrage about this and to remain positive that we can do better. Because we can do better.

Thank you for your help.

Have a good week.

Richard