August 2016

169As we fly past 800 days to the new Midland Met, I am back blogging about the work of the Trust after a short break to take my kids away in July.

We had great weather, but not as hot as the west midlands – with the unfortunate impact on our technology, causing a system outage, our third since the start of the year.  The good news is that by Christmas 2016 all our efforts, time and money to sort out a decade of under investment in IT will come to a conclusion.  By then we will be stable, and ready for the push to Christmas 2017 and our new Electronic Patient Record.  Cerner are our preferred provider, and pending NHS Improvement approval in a fortnight’s time we are ready to go.  As we get used to implementing new technology I sense excitement building.  In the last few weeks we have deployed new automated discharge letter technology for our wards, and are part way through deploying speech recognition into all our clinics.  Gradually technology is becoming the norm not just in how our teams interact, but in how work with patients.  With some minor adaptation to our clinic booking kiosks in October we will start encouraging patients to opt in email as a primary communication system, and from 2018 a patient portal will provide dial up access to you from home to key parts of what is your record.

There is a link here to Midland Met.  Our future model of care does put acute care onto one site.  We know from the work we did on stroke or cardiac care that that will give us outcome gains for patients.  Yet our overall clinical model, because we are determined to provide long term care closer to home, is if anything more distributed than today.  So we have to make technology work for us, in big ways like the portal, and small ways like allowing easy access for staff to long on anywhere across our systems, without having to dock in in a health centre.

Very few IT business cases are getting approved across the NHS right now of course.  And even fewer new hospitals.  Our success owes everything to canny husbandry of our finances over many years.  And now.  But it also a vote of confidence in our clinicians and managers, and their ability to do.  That implementation talent is what we need to apply to deliver our exciting quality and safety plans.  These are not reorganisation type plans, or changing organisational form.  These are clinically led plans to change outcomes for the better.  The sorts of plans people assume are commonplace in the NHS, though they are not, and certainly not with clear promises of excellence.  At a time when national newspapers are campaigning to make sure rationing does not creep into nhs finances, and when we are resisting obscure policies to restrict cataract surgery only to those made most infirm, it is important that our local NHS remains determined to better itself – whether it is in cancer outcomes, cardiac rehab, or sight loss.  After our recent never event publicity our commitment to openness of matters of safety and quality remains something that should build confidence in our candour and openness.  We have excellence in our midst, but much more to do.

Sometimes change can be a slow burn.  Sickle cell disorders are prevalent in our local community, and the Trust is in line to become the west midlands centre for the care of people with these conditions.  Yet it was only this month that we relocated the Apharesis service from London.  Great news, especially for the families of unwell patient who came to make their voice heard on this matter at our Board in spring 2015.  I am delighted that their passion has won the day, just as I am thrilled that we have made the investment in staff in our primary immuno deficiency service.  These are not the changes of headlines, but they change lives.

We have managed to combine both life changing and headlines in our work on diabesity.  I think we have racked up many appearances now on Midlands Today.

Click link to read: Type 2 diabetes treatment hailed as major breakthrough

Through each we illustrate that our determination to innovate and to tackle the major health crises of our age is undimmed.  It is no wonder our clinical teams keep winning awards in their field, and our patient reach goes beyond the immediate vicinity.  Yet before you get the impression we are trying to grow, our goal is to shrink!  That is why in 2014 we relocated clinics into general practice on a grand scale.  This is our answer when the easy lure that a new hospital is just aggrandisement is levelled.  Our new hospital must do what only it can do.  That is why campaigners are right to keep the pressure up to make sure the infrastructure around it is fit for purpose.  My view remains we all signed up to a plan to do just that.  If we see it through we can and will succeed.  If we get distracted by other policies or fads we will fail.  That distraction of the new is an NHS flaw, maybe through politics, maybe through here today-gone tomorrow management cultures.  We can resist it, and I am sure we will.

Innovation and investment matter.  But in the end what we do is people dependent.  Those studying our board papers will recognise that efforts to recruit more and faster remain stubbornly impervious to action.  Of course through 2015 that was true of sickness absence, until we cut it by a fifth!  So I am optimistic that our changed approach, aiming to capitalise quickly on applicants of calibre before our competition, will bear fruit.  Next month more than fifty newly qualified nurses join us, drawn from our students trained and accredited locally.  I hope they find the Trust welcomes them with open arms, support and mentorship.  If you look back over these blogs you will find innumerable references to our educational investments.  We know that if we match our new joiners’ ambitions we have a platform from which to develop.

Our workforce consultation, headlines about redundancies, have every potential to cut across this drive.  It should not, if properly understood, because we are securing jobs, by moving people into roles we can support.  But we can have no complaints if such big change casts a shadow of anxiety.  We aim to reduce our spend by over £2m a month from April 2017.  A major task as we look to end a reliance on bank and agency staffing.  In doing that we are part of a national effort, locally applied.  We are helped by our success in recruiting doctors into training roles.  Hindered by duplication across two sites.  Joint work with Walsall and Dudley continues to help, though there remains little sign of real action to align on a much wider scale.  Our regulatory regime, and other impulses, creates an every man for herself mentality still.  Perhaps in time Sustainability and Transformation Plans (STPs) will help us tweak that sufficiently.

However, in my own view, the real measure of STPs will not be how much creative destruction can be wrought in reorganising care boundaries, but whether, together we tackle the potentially terminal decline of general practice.  The Trust continues to work to play our part in addressing this (and not by the warm glow created for partners by us losing the annual cricket match against primary care!).  But by a whole variety of partnerships and influences.  We are exploring basing a GP surgery on our Sandwell site.  We are to advert now on some joint clinical roles and are developing plans to host various core functions on behalf of general practice partners.  I think we should be proud of key steps taken in the last two years to improve connections in care – query-able computers for results and the ability to re-order batteries of tests, diabetes clinicians based in practices, improved turnaround for blood samples, and better discharge letters, as well now as transformed times for clinic letters and the ability to email clinicians in every specialty for advice.  It is a start.  In the end the test is whether someone wants to come and be a GP in our part of the west midlands.  Without such partners our Trust’s strategy will fail, and more importantly, we will not deliver the changes in underlying health needed to make care – and the NHS itself – sustainable in 2030.