The end of the financial year is nigh. As life in the NHS is obsessively annualised, it seems appropriate to reflect on what has happened at the Trust over the last twelve months. In doing so, I would reflect that the NHS does not typically congratulate itself or its teams especially well. This is something we have been talking about inside Sandwell and West Birmingham in recent weeks, because we need to find the best ways to thank colleagues for the extraordinary work that is done day after day. Nationally, social media is abuzz with a campaign called Big UpThe NHS, which encourages any of us to talk more openly about what works well about our health service and what we value about its work. Inside the Trust we will shortly begin to post on our intranet system (visible to all 7500 people) the compliments that we receive from patients and their relatives; your words being better than mine at expressing gratitude.
We know we are not always great at introducing ourselves. That may seem both a simple and a little thing. But we know how important it is to know who is taking care of you. That is why we have our name badges and a rule that they are always worn. Now we are trying to adopt an idea started by a doctor in Yorkshire, herself a cancer patient, who kicked off a campaign to have health workers start any conversation with the phrase ‘hello my name is…’. This project is compassion giving rise to a national set of awards (this is the traditional NHS way to say thank you) – the Kate Granger Compassionate Care Awards, in which I am pleased to report that our new long-stay ward model (our medically fit for discharge wards) placed in the final six from hundreds of entries from across the country. Congratulations to Helen Jenkinson, Justine Irish and the team.
We will end the financial year, with much satisfyingly unchanged. Our rate of mortality remains better than “expected”, and the difference between City and Sandwell continues to be narrower than three years ago. Our infection rates remain low against other places, and we will have the lowest rate of c-difficile infection in our history. We have seen big improvements in our screening rates for MRSA on admission. Similarly, we are now consistently managing to complete VTE assessment on most patients being admitted, and our goal that we do so for everyone is looking feasible. That sense of right every time is what lies behind the ‘ten out of ten’ campaign we will kick off in the spring, which is aimed at ensuring everyone admitted to our wards has certain things happen within the first few hours of admission.
There have been some big changes and improvements, as well. Waiting times this winter are our best for five years, and after a very difficult February, we are once again typically managing to see patients quickly, with few waits in ambulances and very, very few long waits. Unfortunately, patients with complex mental health assessments remain those most likely to be delayed in the system. That has to change in the months ahead. I am pleased that in March we have at last managed to cut cancelled operations on the day of surgery, after a year in which they have doubled. We will work hard to maintain that success, which reflects a change of policy internally. Similarly, changes in approach have seen us slash the number of patients who share a bed bay with some of the opposite sex. We continue to work hard to maintain access and reduce waiting times. This summer we wrote to thousands of patients about their waiting list status as we sought to sort some administrative errors dating back over the previous seven years. As a result the size of our waiting list (the number of people waiting) grew. It is especially pleasing therefore that we remain a Trust that meets the national 18-week standard in total. We want to try and do that at specialty level during the year ahead.
We are regulated by many organisations. Perhaps the two most obvious are the Care Quality Commission (CQC) and the Trust Development Authority. Both have published data in the last few weeks about our organisation in comparison to others. The CQC issued its last Intelligent Monitoring report which shows a slight improvement for us from a ranking of 4/6 to 5/6. The TDA has published its review for the last four months, which shows us improve from 2/5 to 1/5 – a provider with no significant concerns. Of course external regulation is no substitute for internal candour and a determination to fix problems before they arise. Our own programmes to do that continue, and over coming weeks we will see successively the publication of our risk registers Trust-wide, then the first our monthly managers ‘go-see’ afternoons where 150 senior leaders spend dedicated time listening to patients in corridors and clinics, and finally our ‘mock’ CQC inspections. This last was actively requested by teams – as we talk through how we address five simple questions, which I wrote about here last month: Are we safe, do we care, are we responsive, are we clinically effective, and are services well led?
2014-15 is an important year for the Trust. One way or another our configuration of acute services and the Midland Metropolitan Hospital will be settled (the final case has now been with the Department of Health for two months). We will continue to work with Local Authority partners on children’s safeguarding as we try to improve the care of young people. And we need to do everything safely necessary to avoid the Trust deteriorating its finances. We look set to end 2013-14 with the surplus that we had expected. But the financial outlook is a challenging one, as income tariffs are held steady and inflationary pressures in energy markets, consumable and drug costs rise. We will undoubtedly need to make some difficult choices, if we are to have the resources available to make investments over coming months, that we believe are essential for the years ahead – most notably in IT and in our people. Our leadership development work kicks off at the end of March and deploys across the following eighteen months. Our view, which the CQC seem also to favour, is that the calibre of those we can attract and retain to lead services will make a major difference to the quality of care and the safety of what we do.