January 2015

Coming towards the end of January, I have had chance to reflect a little on 2014 and on what we are trying to achieve in 2015.    As I write this, we are celebrating one whole year at the Trust without a Never Event.  You may know that Never Events are a list of 25+ instances of error that should not happen in healthcare.  Last year, data on these instances was published nationally for the first time.  That showed many examples.  And in this Trust since 2009 we have had 17 Never Events – with six in the eighteen months between August 2012 and January 2014.  Each time we have been very public about our mistakes, discussing the cause and plan of action at our public Trust Board.  As you would guess, each one has produced plenty of actions, but what we needed was confidence that those actions were making change happen.  Our eye service – the Birmingham and Midland Eye Centre – is the second largest in Europe and has had a succession of repeated Never Events.  They have led the way in changing how they work, and are part of our year without Never Events.  I cannot promise with certainty that a Never Event will not happen here, tomorrow or next winter.  What I am now confident to say, in our eye service, is that all staff feel empowered to speak up and ‘stop the line’ if they think we are about to make a mistake.  That team building, breaking down of hierarchy, and acceptance that every employee has an equal place in making things safe, is critical to our success so far and our plans going forward.  During 2015, the lead surgeon now wants to expand some of the changes we have made in eye services into other surgical disciplines, and he will have the full support of our Board in doing that.  So, celebrating one full year is not a complacent act, but is credit where it is due to staff who have worked both hard and differently to improve quality.

Even in healthcare, with all its attendant risks, change requires experimentation.  We aim to manage those experiments, and learn as we change.  One example that you may have noticed of this is the change to visiting hours that we put into operation at the start of 2015.  Previously, we had restricted day-time hours for visiting inpatients.  Now we have a more open policy, but one that crucially depends on families not having large groups visiting at the same time.  We hope that spreading the hours helps friends and family to spread the visiting.  We also know that this requires a partnership between our teams and visitors.  Ultimately our ward managers have the right to decline visitors or ask someone to leave.  That is rarely necessary, but our first priority is the rest and care we are providing to our patients.  But if we get the partnership with visitors right then we make a vital step towards helping someone’s discharge and rehabilitation.  In March we will review how the experiment has gone, and would certainly welcome feedback on it – open visiting is ‘here to stay’ but new systems can always be improved.

While both of these examples are smaller, iterative changes – lots of actions adding to a big improvement, we are at the same time currently consulting locally on two big changes.  Relocating all acute surgery from City Hospital to Sandwell General Hospital (finishing a process that began in 2009) and moving interventional cardiology from Sandwell into City to improve resilience, safety and outcomes.  I have been asked a few times whether the CCG-led engagement meetings and process are just a fig-leaf process – in other words, will the feedback change anything?  The process is real.  We are asking what would make these changes easier?  For example, many relatives tell us that a bus between sites might help with visiting.  Of course in 2018, as is widely known, we will complete the changes to acute, emergency care, by relocating two hospital’s beds and A&E services into one: The Midland Met.  The changes in surgery and cardiology are a step towards that state, which has been the intention here for over a decade.  It is quality and safety that drives the need for these changes.  Providing emergency care is work that needs specialists from lots of backgrounds and teams.  Precisely because the exact need of a given patient is unpredictable we need those skills in one place.  I remain excited about that prospect.  Though we deliver great care now – with some of the lowest mortality and infection rates in the West Midlands, there is always room for improvement.  The culture we think we have, and certainly the culture we want to have here at the Trust, is one that always aims for further improvement.

This drive to improve is why last year we commenced our three year  leadership development programme.  The first period of that focused on 150 top leaders with the Trust, mostly clinicians.  Over the coming few months the network of those involved will grow.  The purpose of the programme is unashamedly to equip leaders at all levels to make decisions, in multi-professional teams, and operate without needing permission from the centre or ‘top’ of the Trust.  In some parts of our organisation those skills are already in place.  In other parts we need to start now and get going.  Because SWBH is a large organisation, we have to find the right way to balance the benefits of one Trust with the benefits of local control and dynamism.

As we move towards a general election, all of us at the Trust are acutely conscious of the debates that take places about our NHS.  Public control of the service matters to us.  We will be working hard to make sure that information about what we do well and what we do less well is always readily available, in line with our values.  What also matters to us is to make sure that artificial debates are not created where service strategies to improve care are already well advanced.  A great example of this is the work we have done at Rowley Regis Hospital to grow services on the site.  A new ward opened, another is coming, 27 new clinics moved onto the site, and with GP colleagues we opened our Primary Care Assessment and Treatment centre (PCAT).  The future of Rowley Regis Hospital is absolutely secure and sees further expansion.  During February, we will publicise that success further, and I hope all involved can support this ‘early down-payment’ on the Right Care, Right Here promise.  This week, in our Birmingham services, I had the privilege of showing the Chair of the city’s Health and Wellbeing Board round our site.  We took the opportunity to visit the intermediate care facilities we now have for West Birmingham residents in our Sheldon Block.  Some of those services opened a year ago, some are recently opened in partnership with Midland Heart.  This development headlined our staff newspaper in January under the banner: The future starts now.  We very much believe that choices we are making now to reshape care with our patients and partners represent what is emerging national policy.  In other words, this part of the world is, humbly, leading not following.

Finally, and briefly, our finances.  It still seems possible that we will meet our promise to deliver a small surplus of £3.6m at the end of March.  That does put the Trust among a handful able presently to balance the challenges of rising demand, quality gain and funds.  However, there is no doubt whatsoever that 2015/16 sees an even bigger challenge.  We are working with partners to try and set a budget that is workable and deliverable.  There are investments that we need to make to improve care and we will not compromise or delay on those investments.  The scale of savings / efficiencies / cuts that we need to make will again be over £20m.  Nobody in the leadership underestimates the immense challenge that that creates.  I believe that our honest and straightforward approach to communicating safety and risk leaves us well placed to try and balance the demands upon us.  We very much encourage staff and others to come forward with concerns as well as with ideas, and though the recent experience of workforce changes has been and remains bruising, the fact that a quarter of all ideas consulted upon were changed because of that feedback gives a very clear indication of the tone and nature of the leadership style that we want to use here.  Whether it is quality improvement, financial discipline, or the logistical challenges of moving to the Midland Met in three years time, that style and those skills will determine whether we succeed.