April 2016
Let’s start on a high note with some good news for spring. Our major investment in up to date imaging equipment, able to work faster and give better quality images, has made it through the NHS approval process and is now ready to go. A new CT scanner goes into A&E at City very soon, to be followed over the coming two years by more kit on our sites as we get ready for Midland Met. Typically that hospital will be seeing emergency and complex planned care, and so we need to make sure in the Birmingham Treatment Centre and at Sandwell we have good quality equipment to support planned local care. For many patients not knowing what is wrong is by far the most worrying part of being unwell, and so great equipment, we can help teams to shorten waiting times. Nationally the standard is six weeks to have a scan. We are aiming for four weeks, because for much care a report is needed to explain the scan before we can form a care plan. So we want to deliver a six week routine wait from start to finish.
At the same we know that technology can help us to improve how we work. Our Board meeting in April agreed the final case for our new electronic patient record system. We are down to the preferred bidder stage, in what is a long term relationship to make sure our IT joins up, is secure, and helps us to deliver good care across our sites and into our community teams. In addition to spending money on equipment, getting this right is also a big investment of time and effort. In the next 18 months lots of our staff will need to find time to get trained, but also to help contribute to making sure the IT works for us, not the other way round! By the time we move into Midland Met in just over 900 days, we need to have got used to our new ways of working.
Anyone reading the papers will recognise that the NHS, and local government, faces huge pressure right now. Whilst demands for care, and frankly what we can do to help, is growing, funds are flat at best. That means we need to get the very most from every pound. Sometimes that means doing less of something or working with fewer people. Often it means joining up how people work to get better value. So this month we open a new building for vital back office teams at Sandwell, putting into one place staff from finance and human resources, information and IT. These teams often work together on issues and by colocating we expect real benefits in their efficiency – really in exactly the same way we see gains when acute clinical care is colocating in the new hospital.
Finding routes to do more or do better with less is the reality of life and will be for some years ahead. To invest in our workforce and in projects like those I have written about in this blog we have to make sure that we are meeting the needs of those buying care from us, as well as finding less expensive ways to work. For example, we think that by changing how we organise and book district nursing services we can add one person per day to each person’s workload. For someone at home needing leg ulcer care, or support with oxygen, that extra speed truly matters. At the same time we continue to expand the care we offer without face to face travel, and patients continue to praise the work we are doing to give advice through different media. Our investment in transport services for blood samples is cutting the need to redo lost or damaged samples, and we have tendered and reduced prices for products like home continence equipment and pressure relieving mattresses.
Our best investment, but also our largest cost, remains our people. And so we continue to work to cut vacancies and sickness and improve retention. Each idea will help us to cap spend on temporary staffing with its mark ups and premiums. By ring-fencing our training budget we aim to make it very much worth building a career within our organisation, or with our key partners. We are needing to move staff between jobs, into roles we need long term. This month we are consulting on redeployment among some back office leaders, and this summer a much wider set of changes will take effect after statutory consultation. Such changes are unsettling for those involved, their friends and neighbours, who wonder about what is going on, and see the anxiety is creates. We are very mindful of that and pleased to have award winning occupational health and wellbeing services in place to try and support people.
The continued national dispute with doctors who are finishing their training, and who provide key roles in our organisation, remains a major issue for all NHS organisations. We want these jobs filled with us, and of course we need to work to make sure that we can provide safe care during the strikes, especially the all-out action planned for the end of April. That dispute seems to have focused attention on weekend services – and the government’s 7 day narrative. But 52 week a year services also matter very much to us. As we look to treat more patients in the year ahead we know we can do more to make sure services run each week of the year, with staff cross covering. That is also an important part of the changes to our oncology service. By bringing our own doctors to work alongside those from University Hospitals Birmingham, and now Royal Wolverhampton we can provide full year cover – important in a situation where timeliness of care truly matters to cancer patients and their outcomes.
The next 100 days will see us continue to focus on our 10/10 programme of basic safety standards. These are at ward level, although our community services have developed their own. Regrettably in February we had our first never event for many months – it underlines again that we have work to do. Fortunately our patient came to no harm and we were open with him. Meanwhile, last week the Board conducted a set of visits in theatre which were reassuring in terms of staff knowledge and commitment on the issues associated with the four incidents we have had in 26 months. The focus on 10/10 is about making sure every admitted adult gets this check list complete in the first 24 hours of their stay with us: Where currently this happens perhaps four out of five times. If we can succeed in starting admissions right, with key information not just collected but acted upon, the quality of our care will be better and carers too will notice a difference.
A focus on carers remains an important part of the Trust’s work in the year ahead. We made a big start last year with open visiting, and this year we will roll out fast our John’s Campaign deployment. But the work is an attitudinal shift too – we want to involve and engage family members in care, and we know when we do that well it helps us, them, and the patient too. Fortunately local carers’ organisations are now hearing about our ambitions in this area and approaching us. There is a huge amount of goodwill out there, and lots of informal resource and social capital. For a Trust that is now, among other things, the local lead provider for end of life care this is a major bonus and one we want to work constructively but consistently to benefit from in the months ahead.
Thanks for reading my monthly posts! Our Annual General Meeting takes place on Wednesday June 22nd, this year at City Hospital, so do come along if you have chance – details can be found here.