Chief Executive’s Message – Friday 28 February
February 28, 2020
Covid-19 as we are coming to know it is still at the forefront of some people’s daily work. A handful of assessments each day are coming our way, and there is every reason to think in the weeks ahead that that will grow. On Connect, and if you cannot find it, say so, there is guidance not just on treating people who present, but also on your own symptoms and what to do is you need to self-quarantine. There is a balance to be struck between awareness raising and undue concern, and I think that our infection leaders, like Taran and Julie, are finding that balance. I want to thank them, teams in ED, and our emergency planning squad, for the hours of effort and time going in. We want to work together with the ambulance service, GPs and local pharmacies to support our community, with very many of us travelling, or having plans to do so in the coming weeks.
Monday next sees the launch of our first pilot in Body Worn Cameras. This is a direct result of your incident reporting and the focus this year on 21-day reports into those incidents. That produced a working group focused on violence and aggression, which reports direct to our Risk Management Committee. We are investing to use this technology, as other NHS bodies have successfully, both as deterrent and as an aid. That will help with tackling racism, discrimination and violence as we want to make sure that you can work safely here. I well appreciate that this launch brings its own challenges, and we have learnt from others about some of those, including issues of data privacy and patient confidentiality. Thank you to our security team for going first, and ED and some of our more complex wards, as well as teams working alone in community settings will come next.
Almost a month ago I wrote here about our emergency care team presenting to the Board about their plans for the future, both short term and long term, as staffing in the departments had sharply improved. As a Board we have moved slightly away from utter focus on the Four Hour quality standard. That is because we want to make sure that we meet other parallel goals around initial triage in 15 minutes, ambulance handover inside 30 minutes, and senior assessment in an hour. About two thirds of the patients over one hour are waiting in our wait rooms, and a third are inside the department. So the plan is simple, but fiendishly difficult to do. We need to make sure assessments are made, rounds if you like, for everyone inside the department with our senior clinicians, and that we do use ambulatory majors, to use our cubicles even if we then return lower risk patients back into the wait room. Of course when we move to Midland Met we will have cubicle numbers sized to meet demand. Until then the balance of risk lies in this model of care, recommended by medical and nursing leaders and used effectively in other Trusts.
Thank you to the ward teams who hit 100% for sepsis screening this week. We are back well into the 90s now as a Trust. However, around half of our screened indicated patients then waited over an hour for treatment including medication. You know by now that sepsis is our Number 1 Quality Priority, and over the next few weeks we will be working to find the right mix of staffing, structure, persuasion and insistence to drive that Golden Hour Treatment figure upwards. This is our chance to save lives and prevent harm and we need to seize it.
Most weekends, and every week, we see huge effort to address staffing shortfalls. You know that in 2017 and again in 2019 we set an ambition to try and be fully staffed. The data changes all the time, but it looks like we will go into April having HALVED vacancies in our Trust this last year. I cannot recall using capitals in a Friday message before in nearly 7 years’ service, but I do so to tackle the typical urban myth that everything is getting worse and all is managed decline. We have had success hiring nursing associates, ward nurses, specialty doctors in ED, theatre staff, and midwives.
There are just over 150 “hard to fill roles” which we are focusing on in April, May and June, which are perennially difficult to recruit to, here or indeed anywhere. At the same time, we are promoting from within. There are lots of examples of individual progressing in their careers at the Trust, and I am delighted that after external advertisement, and interview, Liam Kennedy has now been confirmed as our long term Chief Operating Officer, with Mel Roberts moving across to become a deputy chief operating officer. There are plenty of other moves and opportunities, and it is important to restate that we are on track to achieve our band 8 and above BME leadership ambitions, growing significantly the diversity of our senior leadership cadre. It is against this broad context that we will go into April absolutely bearing down hard on the £16m a year we still spend on agency costs, at least 40% of which disappears from staff pockets. The Trust has always invested to have better staffing ratios where we can than minimum, and that continues, which is why we need to recycle funds and try and get value for money from each hire.
Heartbeat is out next week! Now separate from payslips – you can look up what you got paid via ESR. Of course our monthly magazine focuses on our University Hospital announcement, as well as Year of the Midwife and Nurse. But it also includes some fantastic information about our work on weight, on wellbeing and on physical exercise. This weekend’s weather may not be conducive to taking a mindful walk, or time out for yoga. We do use the pages of Heartbeat to begin to talk through the real health consequences of weight, the impact on any of us psychologically, but also on our long term mortality and links to other conditions. From our work on smoking I do appreciate that there is real sensitivity to the Trust as our employer getting too close to someone’s personal health. However, in our view as a Board, we have a duty of care to make sure that our workplace and our working patterns support sleep, rest, wellbeing and fitness. Of course that helps effective work too, but our motive is about each of us thriving in our lives as well as in the NHS. Do get back to me, or to Ruth Wilkin, if you have ideas about weight management, great eating, more exercise, and wellbeing generally. We have teams in critical care, among our junior doctors, and across the Trust picking up the mantle of taking forward ideas which help us all to meet our own health goals. Work can make that harder. This workplace wants to help make it easier, although the rumour that we are getting a Trust dog, and a rota for walking it is, just a rumour….
To end this week with our latest Star of the Week, Advanced Physiotherapist, Fran D’Souza who was nominated for going above and beyond the call of the duty in supporting a frail and elderly patient to be discharged. Read Fran’s story on Connect https://connect2.swbh.nhs.uk/news/star-of-the-week-fran-dsouza-advanced-physiotherapist/
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