January 2016

The start of a new year brings with it resolutions, commitments and promises to ourselves and our loved ones.  Although as I am writing this over a week into 2016, for many people it also involves some guilt and doubt too, at slips on those intentions!  My message to colleagues inside the Trust so far this new year has been, I think, plain and simple.  The same message in 2016 as in 2015.  The same ambitions, projects and programmes.  The same dedication.  The same honesty when we fall short.  Remember in November 2015 we published our 2020 Vision – a five year forward view for what would change and what would stay the same in our Trust, your local NHS.  Whatever the announcements and the policies we see in the months ahead, we need to shape them to fit with the plan we have built after over a year’s consultation with patients, partners and clinical staff across our Trust.

During January, we will release more detail on the shape of services at Sandwell in the years ahead – look out for a banner on the side of the General which spells it out clearly.  Talking that through with patient groups and staff in the last few weeks, my sense is slight surprise at how much will be in West Bromwich, just as there will be on Dudley Road in the Birmingham Treatment Centre.  In the next few weeks we unveil various enhancements to the new departments at Rowley Regis too.  More phlebotomy, car parking, health visiting, and day treatments on site.  Whilst the headlines will be stolen by Midland Met – 1000 days away on Friday January 22nd 2016, the story is much more localised.  We are serious about our promise to move services that can safely be provided locally, up your street, to be provided there.

And of course that includes end of life care.  The Trust, in partnership with local hospices and voluntary sector groups, has been offered the contract for the next five years to provide, and to reshape, care for people who are dying.  This award is a tribute to what has been achieved in recent years.  Huge reductions in the time people spend in hospital, as we have got better at supporting people to die at home or in hospices.  And successful work to make sure our palliative care spans communities, faiths and traditions in a manner that is safe and respectful.  The basis for our contract success is supporting more people to die in a place and manner of their choosing.  That means using the skills of our district nurses well.  Creating a seven day “hub” to connect relatives, patients and staff with expertise available across our area already.  And developing a day hospice model which is stable and sustainable, where respite from home care and companionship from peers is needed – and necessarily therefore changing the current Bradbury service.  Making all of this work depends on teamwork, including with local GPs, and crucially more successful identification of patients in their last year of life, who are often admitted to hospitals several times.  Perhaps 900 people a year die “expectedly” in our hospitals – community and acute.  Our audit work shows the opportunity to improve care by quicker identification and support packages being put in place.

As a Trust we have focused hard on mortality.  Well before the recent investigations in southern England, we had put in place a detailed review of all unexpected deaths in our care.  That gives us intelligence on the lessons to be learned and what might have been prevented.  The preventable number of deaths is very small each year, but our focus on those people, and our learning from them, is remorseless.  It will be embedded within our forthcoming Quality Plan for the next three years, and resourced.  Though we have spent the last 18 months focused on sepsis identification and treatment, putting the human and IT systems in place – and now in place in our A&Es – to try and ensure the best possible coverage for known good practice.

The next few weeks will see us continue to blend the immediate with the long term.  Throughout the three strikes announced by the BMA we have and will look first to be safe, and to avoid where we can inconveniencing patients.  Trainee doctors are a crucial part of our emergency care and so it is impossible to operate “as usual” in their absence.  Yet alongside that very operational planning, our planning for 2016/17 is in full swing – trying to make sure that our training plans for the year ahead, our capacity plans to match demand with supply, and our funding plans to reduce our costs safely all marry up.  Excitingly in February we are close to selecting our IT partner for our electronic patient record.  This is the kind of investment decision that our financial rigour makes possible – and the type of improvement programme that helps us to work across multiple sites, get smart at flagging patients in need of expert attention, or become more consistent in how we apply best practice always not just usually.

I started this blog noting that 2016 would be like 2015.  Refining that idea just a little, I think I mean that it is the same ideas and habits, implemented a little more consistently.  Changing outcomes, altering culture, creating teams are not a matter of major lurches or swings of intention.  In fact that lack of clarity or fear of revolution militates against the changes, improvements, and tweaks we need.  Instead we are after a steady march of improvement grounded in innovation and adjustment.  In the best parts of our Trust that is what we have already, and our promise for the year ahead is to try and make that a more common feature of our whole system.

At Board level I hope we spend the year still focused on the big picture, and the small stuff that matters so much.  We continue to work to improve the food we provide for patients, visitors and staff.  I am delighted that our public health efforts since 2014 have seen sales of chips and other less healthy items fall sharply, by over 50%.  Meanwhile, we are growing the choice on our healthy options, and sales are rising too. new food outlets go into City Hospital in the weeks ahead, and by Easter vending machines overnight will give access to healthy hot food throughout 24 hours.  At roughly the same time our widely publicised changes in smoking policy start to take effect.  The sense that our care, our offer, our partnership locally is about health, not about being a hospital for sickness, underpins a lot of our current work and future vision.  Unlike the delivery habits I have written about in this blog, that demands that we influence not our own employees but everyone we work with, including patients.  Learning how to do that brilliantly will take beyond 2016 – but if we are to succeed it is something we have to have mastered by 2020!   Happy new year…