Chief Executive’s Message – Friday 20 March

March 20, 2020

Last weekend I walked many of our wards and departments listening to people’s feelings and fears about COVID-19.  This week amid the press conferences, we had a huge amount to do to keep getting ready for the marathon that is our response in Ladywood, Sandwell and Perry Barr to this pandemic. I met more than 150 colleagues in staff meetings on Wednesday and heard from dozens more, directly. I want to say both thank you to you all for your intense hard work and for your kindness, but also to reflect how important the feedback we have had this week on what’s working and what is not working in the planning of the response. I know that some colleagues in primary and community teams feels like the poor relation of this situation and next week myself and others are doing some time shadowing work with some of you to make absolutely sure we can see this situation through your lens. I know too how challenging this situation is for students and those in training, whose plans have been turned upside down. Whether you are an apprentice with us or enrolled through a university we will honour our commitment to you.

This week many of those same community teams were the folk who wholly relocated our Leasowes wards to Rowley Regis to create an end of life care centre in our Trust for patients unable to be in side rooms on our acute sites. Our Star of the Week this week is Neil Davies, Community Transport Driver who worked exceptionally hard to move the patients from Leasowes. Neil reassured anxious patients and kept the team positive, enabling the transfers to take place within the day.

PPE is the understandable focus for many in our teams. We have stores now on D18 at City, on Bryan Knight suite at Sandwell, and at Rowley, Leasowes and community bases for the community teams. It is clear we are not applying every outcome from a historic fit test. It is clear we are following national guidance that balances best case and supply. Having stopped day surgery today and with a big order delivered yesterday we are better placed than before. We have issued written guidance and hand delivered it to many ancillary teams. So now is the time to be careful about what is worn where and to challenge one another when someone’s use is outside our norms. To be very explicit, out of hours decisions on what PPE is released are solely the preserve of our CNP team. Please respect the difficult decisions that they may have to make – they have my full support in making those decisions. When we disagree on such decisions, let’s do so with civility and calmness. No matter your perceived seniority we will address inappropriate behaviour in this regard.

The focus next week will be on getting our temporary redeployment training ready. For many people we will be rolling out the respiratory care refresher training announced by NHS England midweek. Already ITU colleagues are putting in place extended training for others in surgery who will be supporting the expansion of our units, including into theatre recovery. Last week we ceased all less urgent elective inpatient surgery and today we did likewise with day case surgery. I do not underestimate the misery this will cause for patients, including colleagues on our own staff. We have only slightly pre-empted the national position and continue to look to see what can be done to expedite operations vis the private sector under the NHS. I want to reassure colleagues working in outpatient areas that, whilst we will, in all probability, ask you to work in the near future in some inpatient functions, you will be provided with training, mentorship and support. No one is to be asked to work beyond their credible competence. Some people will be asked to resuscitate skills they have set aside or develop, with our support, new skills. Thank you to many non clinical staff who have volunteered to do what they can, and even if earlier today we suggested you could work from home for a few weeks we will be working to understand and support you to come back to site later in April to help with the effort to surmount the first peak of the virus.

As that last sentence implies, we cannot be certain that flattening the curve means just one surge. We must approach this global issue on the basis that, for perhaps the first time in a hundred years, we may see multiple peaks over a period of time, between six and eighteen months, and we need to find a route to tackling this as best we can. No amount of upbeat camaraderie alters the fact that this is a crisis on an epic scale. On the other hand socialised medicine, our NHS, is uniquely well prepared to address this societal challenge, which is no respecter of wealth, place, or background.  And in an ageing society, perhaps this is the wake up call that we need to think through how best we support older adults in our community and find a properly integrated model that links supported housing, day care, nursing and care homes, and acute services.

Meeting the challenge also requires a different compact between employees and the organisation. Again let’s use that to best advantage. The model is one of trust. If you self isolate, certainly the first time you do, we will not require documentation or proof. We will work with each individual to help you, just as we hope that many of you move now to hotels at the public expense where being at home risks harming your loved ones, or impairing your ability to work. We are absolutely maintaining our wellbeing activities, yoga and beyond, and providing showers, food and other things. There is not an absolute annual leave ban. Of course some leave will be cancelled in April, May and June. You will not lose leave, or money, nor be compelled to take leave. But this is a long haul project, and so we have to balance staffing levels for now against having you fit to work this summer and autumn. There will not be ‘carte blanche’ on agency use. Not because money is a constraint, but because we need experienced teams. So we are investing in our bank rates in April, paying more for people who do a certain number of shifts. If that works (and let’s be clear increasing the bank pay rate this winter did not work) we will continue and expand it, as we seek continuity in teams and experience on the squad. Agency remains a premium of wasted money on workers who often are not able to do the full range of tasks our jobs require!

Attached to today’s message are some Questions and Answers from this Wednesday’s first COVID-19 CEO staff briefing meetings. More are planned for 8 April. It was good to see more than 150 colleagues attend, many on behalf of their teams. It was clear that our plans were still being made sense of locally and that some areas of the Trust, especially teams like porters, catering and PTS had been left in the dark about key details. That was not the intention. But it is a failure, and one I own completely. We will improve our model for communication beyond email. You can help by registering to use myConnect our mobile app (search SWBH myConnect on Google Play or the Apple App Store). In addition to content including videos, that app allows us to push guidance to you, prompting you to consider amends to that guidance as it evolves. I was asked in all sessions whether we would be compelling colleagues to act in certain ways. The answer is nuanced. Part time colleagues stay part time, but we’d love you to do overtime. Those leaving us cannot be made to stay, but please do. On the other hand, with PPE in line with our policy, and training, we can insist that you treat infected and query infected patients. There is no self isolation because of the state of public transport. We are trying to balance tackling individual anxiety with making sure we can rise to the challenge the country demands of us. I remember many years ago asking my Nana, what did you do in the war? No really, that is the scale of what we are facing: Your kids and grandkids, mine too, will ask. Let’s do what we can to live up to their belief in our basic decency, kindness, and bravery. Thanks again for facing this. I know it is not easy. I am proud of the teams that are the heartbeat our organisation, including our silver squad – led by Liam, Paula, and David, who are trying to manage COVID-19, and make sure in 2021 we are not still talking about this in the present tense.

Remember we share COVID-19 briefings now in two ways:  Our daily e–bulletin, and our clinical queries briefing from David Carruthers and Tarun Saluja. Both are visible to all on Connect or myConnect.