March 2016

As we move into an early Easter, and the public sector year reaches an end in the next week, there is time and a chance to reflect on our year at the Trust.  What has been achieved and what lies ahead.  There remains lots of improve and there is no need to hide that.  We have had four never events, with one last month, after three last spring, and we all want to stop those errors.  Health-watch have produced an interesting report highlighting some issues in our wards last autumn, and even today we continue to struggle with having to open extra emergency beds.  And although our efforts to tackle staff sickness rates are bearing some fruit, we are well over 100 absent staff away each day from where we need to be.

And yet, we need to face the coming year with some confidence.  Just this week we had news about successful work to cut sepsis related deaths in our care.  The Trust undertakes mortality reviews on a scale uncommon in the NHS – peer examinations of whether there were missed opportunities to improve someone’s outcome.  These show still a handful of opportunities each year, lives we might save.  And we know that by far the commonest instance where that chance arises is in identifying and tackling sepsis.  Now we know that our sepsis related deaths are falling, and that our 24-7 critical care outreach team are helping patients to stay in our wards and not be moved into our critical care unit, as sepsis related admissions there have more than halved.

In 2015-16 of course we heard twice from the Care Quality Commission (CQC).  Together these reports show tremendous care being delivered in our community teams.  Our children’s teams are rated as outstanding.  And every one of our services was rated good or better.  Given that that is half of what we do it is a good start.  We know there are still improvements that we can make.  This year we focused on some key indicators around health visiting, and saw big strides with making sure routine checks are carried out within families.  And in 2016 we need to make changes in end of life care, so that our hospice support is as good as it can be.  It is no secret to suggest that we feel that Bradbury is not a facility where we can achieve the standards that we aspire to.  A more integrated approach is needed.

The CQC also told us that our acute care could be better.  A single site for emergency services are part of that vision, and having signed the long term contract for Midland Met before Christmas, the countdown clocks on our sites tell their own story.  But moving services is not sufficient.  We want to meet seven day standards, and we want to make sure our ward care is delivered by teams trained and known to our Trust.  We relocated acute surgery in November to Sandwell and are seeing real care benefits from those changes, with key teams like imaging really changing how they work to support these moves.  Our 2015 clinical team of the year in cardiology moved interventional care to City – and the steps forward in terms of both access to care and the volume of what we can do is wonderful to see and hear about.  That consistency, across the week, and across our teams, will come.  There is no substitute in making those changes to having fully staffed teams – which is why we continue to recruit far and wide.  I was grateful to the Express and Star for publishing this last week my response to slurs about staff born outside the UK.  In our super-diverse local community, it makes sense to get talent from across the world, bringing ideas and dedication to our services.

We will find end the year with money in the bank, and a small surplus.  Truth is though that the financial challenges are going to get much harder.  Extra money is coming, but it is often short term funding and with caveats and promises attached to it.  We must get our cost base down, by tackling agency spend, and by redeploying staff into roles we need for the medium term.  These changes are never ever easy, either for individuals or for the organisation as a whole – we think our ourselves as an SWBH family and it matters very much that there is hardship and difficulty in our midst.  This year we published our long term education and learning plan.  Among other things that offers a route to change roles and careers.  That is true for long-standing employees, and for those joining us from schools and local communities.  We work closely with lots of partners, perhaps especially right now at Sandwell College (whose health and beauty students will be visiting our wards this spring) and the Sandwell UTC, offering 14-18 year olds specific skills in health and social care.  Sometimes our learning partnerships are through others – West Midlands Ambulance helped us deliver training to care assistants in nursing homes – and we cut admissions to hospital by a third.

Just before the EU referendum we hold our annual general meeting (AGM).  There we will report back to the local community on care and on taxes spent.  I know the highlight will be our fantastic progress in tackling complaints.  We get around 800 each year from 1.5 million patient contacts.  But each one matters very much and this year, for the first time in many years, almost all have had comprehensive replies, after detailed investigation, inside five weeks.   In prior years that would have been 15 or 20 weeks.  We make smart use of those complaints to improve care – for example our services for ladies undergoing a miscarriage, and their partners, or families, are much changed.  When we meet for the AGM we will also be able to talk about our trust charity.  In the last year we have made big investments in projects and ideas, ranging from equipment, to pilot services to tackle big issues like domestic violence, affecting many people locally, including our own staff of course.  We want in the year ahead to work with others to tackle Child Sexual Exploitation (CSE), having read and understood the horrors of what happened in places such as Rotherham.

Before our AGM, we will choose our electronic patient record partner.  This is another long term deal.  Technology can improve care.  Our purchase will give patients access to their records.  And help us access local GP records.  It will give us technology which prompts and standardises what we do in areas like prescribing.  In short, it’s a big deal.  In 2017 deploying this technology will be the major work of our organisation.  By 2018 we will have moved onto to moving into Midland Met.  So, there’s simply no scope to delay.  We have brought in new leadership expertise to help us deliver, and we’re gearing up now for embedding clinical pathways for the future into our new computers – and being better able to offer great care as a result.

John’s Campaign is much, more low tech.  But it is just as important.  Tens of new beds are going onto our wards – from Rowley to City.  They are there for carers, those with a right to stay – just as parents long ago won the right in our paediatric wards with their kids. sets out very clearly what this work is about, and why it arises.  As we tackle dementia and understand the network of care we need to support to do that, we want to make sure we work with carers – individually and the organisations we have locally to make that happen.  Our 2020 Vision – another achievement from the year just ending – is explicit about what we mean by integrated care:

“I can plan my care with people who work together to understand me and my carer(s), allow me control, and bring together services to achieve the outcomes important to me”

The much publicised launch of our Mutual Tolerance and Respect guidance provides a very fitting bridge into the new year ahead.  The Trust Board is determined that the organisation should be regarded in our local communities as one that is resolute in welcoming all into our care, and clear about the standards we expect.  This requires balance and judgement in facing issues with fairness and clarity.  Our guidance tries to do that.  We aim to be clear what we can provide to patients who wish to exercise their own discretion about who looks after them; clear with visitors and relatives what our staff can expect us to do if they are mistreated or abused; and clear among our staff what professional standards we expect of them.  I very much hope that the guidance requires little enforcement, but of course there are bound to be situations where it is called upon.  We will always provide emergency treatment, but will offer planned and non-urgent treatments on the basis of these standards.  We look forward to them helping us to build continued constructive relationships in the communities that we serve.