January 2014

2014 has begun and tomorrow the Chinese New Year is also marked locally.  I am really pleased by the enthusiasm, compassion and resilience our services showed over the festive, new year, and mid-winter period.  Our plan never assumed every hour of every day or night would be pressure free.  But we have mobilised our organisation over the last nine months to have a better winter than in 2012.  And the data, but also the feedback and the stories, suggest that our teams have succeeded.  What has made a difference?

We have been successful at hiring to nursing roles, especially in our A&Es.  Working with colleagues you know and who know your systems is simply safer care, more able to do the right things consistently.  Our sickness rates remain stable.  And we have made huge strides with our flu vaccination work – in the top twenty nationally for the volume of vaccines delivered and the top ten for the percentage of patient facing staff vaccinated.  We want now to work with others to transfer that success into other immunisation and vaccination work in the communities that we serve.  And our infection vigilance remains.  Our bay doors on wards at Sandwell have helped, but more important has been the cooperation of visitors and the determination of staff to not have norovirus impact our ability to care in the disruptive way that it did last winter and spring.

We have changed the hours of many services.  Some of those changes have made a palpable impact.  Pharmacy staff, transport crews, bed managers, therapists, social work colleagues, mental health nurses, and others, are working new patterns.  In the main these provide weekend daytime services or extent into the early evening.  This helped us to initiate care plans sooner and to begin to improve weekend discharge numbers.  We have made some head-way to increase morning discharges, and a lot of progress to slash late night discharges.  This latter aim reflects the wholesale change in how we organise our adult beds, to try and ensure that by nine o’clock our empty beds are in our assessment units – meaning a decent night’s sleep is feasible for patients in other wards.

We should also be frank that data driven, precise, consistent management focus has made a difference to the quality of care we can offer.  We want to strike the right balance between urgency and rush.  But having a single dataset on our beds now and in coming hours and days, visually available in our ops centre does help to make decisions in the daytime about how to manage the evening.  There are many people to thank for the improvements being made, and I hope that the administrative staff, bed managers, site practitioners and senior leaders, feel that they too have made an instrumental contribution.  I believe that they do and have.

We have innovated in parts.  Some of that work has obviously succeeded.  Our ambulance assessment system has seen waits plunge and crews back out on the road more quickly.  Both acute sites have delivered consistent turnaround below 30 minutes and forecourt waits are minimal.  Other projects take longer to assess in the round.  Our Oak Unit for mental health liaison is working effectively for many patients at Sandwell.  Our primary care assessment service at Rowley Regis has taken time to get started, but is certainly preventing some acute admissions.

Candour is needed on what has not (yet?) worked.  We have worked enormously hard as a health and social care system to cut arrival numbers into acute care by providing alternatives.  As a net effect that has yet to show reduced pressure on A&E.  As we consider how we invest Better Care Funds in breaking the cycle of acute hospital dependence, we need to move from identifying opportunities for change, to truly knowing what causes significant changes in demand.  And at the ‘back door’ of hospitals, we continue to see more than five percent of our adult medical beds occupied by patients whose care is delayed and would be better provided elsewhere.  Again we need to use what we have learnt from our work this winter to critically appraise what will deliver real change this summer.

And though we have recruited well in many disciplines, we continue to operate with locum medical staff and with significant vacancies.  We know that that need to offer skilled professionals a care model in which their expertise is best used demands change in our configuration – how many A&E departments we have and what they do.  The model agreed locally over many years sees urgent care centres in key community locations but a single specialist A&E serving the half a million people who live locally.  As you may have seen on the BBC and elsewhere, the National Trust Development Authority (TDA) has confirmed their support for the Midland Metropolitan Hospital.  That follows from our own Board’s approval and that of local CCGs and the Health and Wellbeing Boards.  The Treasury and Department of Health are now examining the detail of the proposals.  We believe that they are consistent with the changes in emergency care urged by Bruce Keogh, the Medical Director of NHS England.  Our long term financial model seeks to balance investments in estate, with those in IT and in our staff, which are of equal, if not greater importance, in the care we provide.

The Trust’s leaders are not spending every hour on A&E and a proposed new hospital – far from it.  But what does link both issues is public confidence and trust.  Our Trust’s well attended Annual General Meeting in September saw a very clear view from local people about A&E and infection, as the priority for them.  And for many residents, as well as longstanding NHS employees, settling our configuration is an important indication that, amid all the changes in services we are making and need to make, there are some certainties on which they can rely with confidence.  Neither subject is yet completely solved nor settled but we enter 2014 with both in a much stronger place than when we started 2013.

Toby Lewis

Chief Executive