Chief Executive’s Message – Friday 8 November
November 8, 2019
Next week is Living Wage Week across the country. You will remember that in 2017 the Trust decided to pay the Living Wage, thereby in effect abolishing Agenda for Change bands 1 and much of 2. We then sought accreditation for this wider work with our supply chain and became the only local NHS body to achieve Living Wage accreditation. Both within our Black Country and West Birmingham STP, and now through the city-wide publicity next week, we are hoping to get many, many others involved. 88,000 people in Birmingham are in work but paid below a living wage. Many others are out of work. Because the public sector is a huge employer, and a huge buyer of goods, we have a real reach to change this position. In an NHS with a long term plan focused on inequalities and on the broader causes of ill health, it must be right to focus on the impact for individuals and families of poverty. Look out for details next week in staff communications of resources to help you to choose Living Wage businesses and outlets to use, and to help us to make it clear that our economy must not depend on a low wage model if we are to thrive as a city and a region.
I want to thank everyone involved this last week in work to safely discharge patients. Phlebotomists, patient transport staff, many doctors and nurses, site practitioners, on-call managers, social workers and care home staff. To make winter work well we need to discharge over 370 adult medical patients each week from our acute beds. And that assumes we can hold admissions below 50 a day. That can create a sense of undue pressure to make poor decisions, and it can create tension between individuals and teams. I very much hope we are finding the right balance where you work. However, the question cannot now be ‘who can be discharged today?’ it must include consideration of ‘if we need to safely discharge x patients today, who can we support beyond our wards?’ That is where we are fortunate to have an integrated Trust, to have good relationships with partner agencies, and to have reach into the homes and communities we work within. This is a balance of risk between the patient we know and can wrap a package around, and the patient just being collected into an ambulance and brought our way. To maintain winter safety we will continue to prioritise getting ambulances back on the road, and continue to focus on timely discharge and moves between wards to achieve that.
From Monday anyone needing to understand or access the adult community wrap around services (our Integrated Hub) we offer, can simply call 0121 507 2664 – 7 days a week 08.00-18.00 Our Sandwell based adult community teams will then not only connect you to our services, but to those of Birmingham Community Trust too. When we analyse the use of our community teams by our own hospital based services it is really clear there are scope to do much, much more to support people back in their own home, with their family, in a social setting. When we discuss frailty, or the degradation of someone’s independence through being in a bed for days and nights on end, it is vital we make best use of both admission avoiding and discharge enabling resources. Think too about which tests are truly needed prior to discharge, and which results could be reviewed after someone has gone home. The risks of corridor care for a newly arrived patient are highly likely to be greater than the risks of home follow up of a last, final day blood test for someone we have looked after for four days.
I am conscious that our conversation, and the national discussions, tends very much to focus on winter as an adult, often older persons, ‘event’. Yet seasonal variation in children’s services is far, far larger as a proportion of summer as we move into winter. That is why we have always had a winter bed base. From Wednesday this week we have begun the process of changing our children’s services at City. By March 2020 that will mean that D19, our paediatric assessment unit, will move down to be run alongside our assessment unit for children in A&E. That will bring together staff and allow us to run a genuine 24-7 children’s service, as we will do in Midland Met. t also means that we will be much stricter, or tighter, about transferring children who need to spend more than a day with us to our childrens’ wards at Sandwell. We will bring on line more beds for that purpose but we will also be working to make sure we have the staffing, expertise, and equipment to support sicker kids in HDU level beds, as well as to introduce CPAP, and in time BIPAP, services. It must be right, as the NHS, including @SWBHnhs, talks about who is cared for in a bed who may be better cared for elsewhere, that we invest and support better services for the residual more complex patients we serve, who then make up a larger proportion of our inpatients. You know that in 2015 we invested in CCOT, in 2017 we opened dedicated NIV and surgical monitoring beds, and that in 2018 our critical care services were rated as outstanding. This gearing up will continue, in parallel with a focus on enhanced community based options.
These plans are all about patients, but their huge constraint will always be staffing. If you follow the Trust’s social media presence, you will know about recruitment work that continues. I published new guidance for line managers here last week. We absolutely have to welcome new starters and make sure that they the support they need to understand our communities, the team environment, and how to use our equipment and our IT. Everyone in the Trust can play a part in that welcome.
This Sunday is Remembrance Day. There are ceremonies and services advertised in our communication bulletins, but please do take a moment to reflect for yourself even if you are at work, or to listen to someone’s own reminiscence. At a time of conflict in many parts of the world, from Kashmir to Syria, Uganda and Mali, we need to work ever harder to support people impacted by war and destruction. You will be aware perhaps of the work done by teams across the Trust with refugee communities. That emphasis continues as we look to create fair access and dedicated services suitable to those needing our help.
My congratulations to everyone involved in last week’s Diwali Celebrations Trust-wide. The countdown is inevitably on for Christmas too, which means that arrangements are in hand for our annual decorations contest. Your team can get up to £50 towards decorations and can enter the contest by contacting Katherine.Bayley@nhs.net. There are of course prizes, and with the decorations staying up through the festive season, there is a lasting impact for people spending their Christmas with us. The judging will be on Friday 20th, to leave Monday 23rd December free for what will need to be the largest day of safe discharge of 2019!
Finally, if this message, if Heartbeat, if myConnect, are not enough to satiate your need to know, and to be entertained, we now have @radioSWB online Trust-wide and world-wide. This has been a long journey, and not just to get reliable WiFi. The volunteers behind the station need your support. They are sharing musical favourites, conversations, requests and the odd corporate message to a headset near you. Give them a go!
#hellomynameisToby