May 2016

Texts, and tests, tough choices, and poo!

Our Annual General Meeting is in June, helpfully diaried the night before the EU referendum.  The meeting will hear from Karim Raza, our outstanding rheumatologist and R&D director, and from a diabetes doctor, Bob Ryder, who is leading a ground breaking project to tackle long term lifestyle changes for local people with diabetes – research which looks hugely promising (click here to read the full story).  As a Trust we are trying to put research at the heart of our Trust.  We have a leading researcher on our Board, local GP Paramjit Gill, and for my sins I chair the region’s research partnership board.  Later this spring an academic from Warwick joins the Trust for a year, as part of our involvement with the West Midlands CLARCH.  2015/16 saw our best ever year for research work.

For many coming along to the AGM more basic concerns will preoccupy, which is why I am so encouraged that our theme this year is listening and learning, in tribute both to the amazing change in our complaint response times (take a look at that graph below), and the surging success of our Quality Improvement Half Days (QIHDs) where 1500 or more staff take time to talk, and think together about improvements we can make.  At Board level we have, for three years, had a patient voice at every Board, and now, with the move of our monthly meetings to the morning, we are out and about in the Trust as a team after each Board meeting.  In April, we visited theatres, gynaecology and HIV services, and our finance and HR teams.  In May, we followed the miscarriage pathway, as well as stepping into assessment units for adults at City to see how our 100 day challenge is going, half way through, as we aim to embed our safety checklist, the Ten Out of Ten project.


Complaints by quarter graph from p

For every forward step, there are lots more left to take.  But at a time of political complexity I am determined we should step forward proudly.  So this last month, we “went seven day” across our Black Country Alliance, for interventional radiology, a move that speeds up access to care for urological patients in extremis.  And our sickle cell specialist nursing service is now seven day too.  For patients in excruciating pain in crisis this is great news, as it heralds rapid access to specialist expertise, and possibly a known clinician too.  Of course our A&E staff reading this are wondering what the fuss is about – they are with us 24/7!  We are delighted that our recruitment to trainee doctor roles is going well, and as we are now below 900 days to Midland Met, with its single A&E and a major Urgent Care Centre at Sandwell, that gives us a base from which to build improved acute care.  We are very much in countdown mode now, across the Trust, as we look to build the teams to move us into our future.  So recruitment is in full swing, and we are seeing clinicians from across the West Midlands taking a look at the Trust’s future, with a strong values base and a funded programme of innovation, and wanting to join in.  To succeed we need to develop our existing staff, bring in new blood, and recruit experienced clinicians from elsewhere, who want to contribute in one of the most challenging, yet rewarding, environments in UK healthcare.  Whilst we emphasis R&D, and learning, this is no ivory tower.  We are very much part of the communities we serve, and want to test the boundaries of traditional acute care.

I am conscious that, although I wrote last month about our recent move to 52 week cancer care, and here today about seven days, the biggest time discontinuity remains what the NHS calls “out of hours”.  Most of the week of 168 hours is, in fact, out of hours.  So our night teams, how we handover into twilight shifts, what we do to prepare in the early hours for the next days, make a huge difference to the care we give, its pace and its consistency.  Right now, as part of our change programme, we are looking again at that night work – talking with our site nurse practitioner teams, and capacity teams, about their roles, and looking again at which rotas we need among our doctors.  We now have hot healthy food 24/7, because we have our public health vending machines in place! But we need to make sure that what we do not do in the period from 5pm to midnight is grounded in what makes sense for care, not what made sense in history.  It cannot be right that it is impossible to transfer patients by transport for an hour of an evening, or that our handover arrangements operate sequentially and knock out movement or progress in care for 90 minutes.  At the AGM we will celebrate real progress with out of hours “ward moves” where we have cut transfers of patients overnight, as we aim – by 9pm – to have our empty ward beds on those assessment units, so other wards can bed down and get a good night’s sleep.  With our amazing John’s Campaign that bedding down for some patients will be alongside a loved one on a put-up bed.  I hope that that passionate Board-led commitment to ‘little things’ will help to make all the difference.  Hospitals, perhaps especially out of hours, can be isolating and frightening places and anything we can do to change that has to be worth the effort – of course with Midland Met that night will be in a single room:  A quality benefit we must celebrate.

We have now officially confirmed  that Cerner are our preferred provider for our new electronic patient record (click here to read the full story).  This is, assuming we close the deal in coming weeks, a chance to learn from an organisation experienced in improving and standardising care.  And having the best and the right IT is critical to our plans.  It will help prompt care among our teams, alert deterioration, remove waste by tackling repetition, and, with our patient portal, mean that carers and loved ones can keep in touch and up to date.  We do not have a countdown clock for the new IT, but it arrives sooner than the bricks and mortar – most of it is live in 2017!  But right now in 2016, a more basic technology is improving what we do.  We almost have 50% coverage for our clinic appointment text reminder service, with more to go, and there is a 2% DNA (do not attend) rate benefit as we switch from paper to SMS – sounds small, until you realise we undertake hundreds of thousands of clinic appointments every year.  There is truly no excuse for missing your slot.  We want to be here for you, and by giving notice, choice, and a reminder of your appointment, I hope we will be able to improve.  Our 2018 plans work if we can move senior clinicians from clinics to wards, and that works if we can remove wasted time in clinics – slashing those DNA rates is central to that mission.

Paying for all of our improvements means staying on top of our costs.  That is tough, awkward work.  It is a great credit to clinicians, managers, and our finance team, that we are ahead of the pack.  Our AGM will see us post a small surplus, as I have discussed here before.  But this July we will begin another major workforce change consultation, moving staff between roles, to be fit for the future.  It is bound to occasion some comment and anxiety.  I hope that local residents, and our teams, can trust us when we reiterate that this is a long term plan, underpinned by a determination to support people with retraining and redeployment.  Even in areas like health records, where our plans will see huge change for employees, we are clear we can find new roles and support people who want to stay with us to 2020 and beyond.  Part of that pledge is securing long term partnerships and contracts to replace the outdated, yet still prevalent, NHS idea of 12 month deals, which leaves so little room for innovation and change.

In April I chaired the first partnership board for our Connected Palliative Care partnership, alongside St Marys, Crossroads, Age Concern and John Taylor Hospice.  This is a five year deal with the local CCG to try and deliver extraordinary end of life care – a certain need and something we want to do with compassion and consistency.  At the same time we are tying up a four year arrangement with Sandwell Metropolitan Borough Council for our Outstanding Children’s Health Services. Of course there is risk in these long term arrangements, a risk of non competitive behaviours, and of course demand risk being moved around.  Yet on balance it makes sense to our Board to put some of our turnover onto a long term secure footing – especially as we have signed a five year deal on imaging equipment, our IT contract is for up to a decade, and of course the new hospital is for over three decades.  This way we can offer our staff real clarity and security, and we know that that commitment will be reciprocated.  We want people to join the SWBH family on a long term basis – giving their skills, energy and dedication over time – and of course developing those research ideas with which I opened this blog.

Innovation is not always research based.  Not everything lends itself to method in quite that way.  Sometimes service ideas lead and academe follows.  We are all thrilled that Kelly Stackhouse has been crowned as the patient’s choice winner in the RCN annual awards at a gala ceremony in London.  Kelly is an individual whose enthusiasm and dedication inspires others, and the remarkable service helps to lead is in the process of spreading across our Black Country Alliance.  Her story and success we hope will inspire others in our Trust and in our community to contribute their passion to our cause.  And Kelly’s cause is to break the taboo about poo!  The service is one grounded in homes and local community settings which reaches into the hospital, and does have a very definite research element – and is unique in the west midlands.

At a time when the NHS is often criticised for lacking innovation, or when we seem to be in an endless duopoly for emphasis in policy between general practice and specialised centres, it is heartening to see that excellence at the centre of our community.  That is what our organisation is, and should be, all about.