June 2016

Just finished reading the proof of our Annual Report, due for launch at the annual general meeting – on June 22nd.  The report will be on our website a few days beforehand, and is close in content to the version from our public board papers last week (on our website).  The auditors have commended both our quality and our financial accounts teams, hitting the self-imposed June timetable, the new national guidance, and our own high standards!  But come along the night before the Brexit decision, and be our judge.

I am thrilled by the report, as you can maybe tell.  Not only does it tell a story about our successes and issues, but it reads and looks like our organisation.  We strive to represent the diversity of what our teams do, who our staff are, what we care about and how try to listen and learn.  I have blogged before about our complaints transformation (the big theme of the report), our Quality Improvement Half Day programme, the work we are doing on whistleblowing, and on clinical audit and research too.  All of that shines through.

We ended 2015/16 officially fourth in the NHS for our financial results.  That “champions league” finish is good news for taxpayers.  It is that stability that allows our CCG to deliver such a big surplus and to continue to invest in primary care and to make new investments in mental health.  And it allows us to make big decisions like our IT programme, including our Electronic Patient Record with Cerner (now at preferred bidder stage).  But crucially it helps us with services and staff.  So we adopted the living wage (ignoring the chancellor’s under 25 rule), ring-fenced our training budget and increased it, and are beginning now to fund new types of roles – nurse anaesthetists, nursing associates, and so on.

That does not mean we have any complacency.  We are making difficult decisions.  In July we will start another workforce consultation, this one headlined by our aim to safely make £30m of changes, with around 450 roles removed from our budgeted establishment, with perhaps 250 colleagues needing to be internally redeployed.  No amount of rationale can make this easier for those involved, or for those working closely on the implementation.  I really hope our track record in the last two years on both listening during consultation and on redeployment helps people to accept our intentions and aims are like theirs – even if the means employed are unavoidably ones which require choices to be made.

Our choices must all be consistent with our future.  That means we are adopting now the models and approaches we plan for 2018 and 2020.  We intend that Midland Met will see consultant delivered inpatient medicine.  Our clinics will be fewer and more purposive.  Technology will help with care and robots will take on some back-office functions.  Paper notes will not feature, and indeed paper more widely will be absent – in ordering, in communicating, in letters we email to patients.

These arguments apply at every level of your NHS.  The end of June will see a sustainability and transformation plan submitted across the Black Country and west Birmingham – facing up together to gaps in quality, outcome and funding.  The area starts from a stronger position than many, and it is important that the urge to be radical does not produce a “shock of the new” spirit.  Not least because in around 850 days’ time we are closing two busy acute general hospitals, and replacing them with one:  this is definitely transformation, and we need to make sure it is sustainable.  On the other hand innovations like our Black Country Alliance do bring together organisations to work in concert, and that is exactly what the future will need.  Our partnership with Sandwell Council over children’s’ services is an example of something similar – and the work we do with various GP organisations.

Yet it is our third sector partnerships which probably matter most.  Because they ground us in our communities.  They deliver real value, engage people actively (itself a health gain) and help us to fight the isolation and loneliness that is at the root of so much ill health.  Our pitch for 2016 and 2017 must be to deliver more from our volunteering work, expand from strong alliances like those with Midland Heart, St Mary’s, John Taylor Hospice, and Age-well, and to make sure we are using the resources we find in every corner of the patch we serve.  The Sandwell Community Offer, in my view, represents a fantastic opportunity to make a reality of that intention – but we need to use it or lose it.  That was the upshot of the health and wellbeing board review last month.

This is one big challenge in our way.  No, not arguments about oncology, nor squabbles over multispecialty community providers.  Not even the real issues arising in major workforce change.  It is the search for care consistency.  That was the weak spot in our CQC report.  It is the gap highlighted by our own inspection work in late May, it comes out in our complaints, and in still not hitting 100% VTE assessment, after so much work on our ten out of ten patient safety checklist.  We need to learn from other industries how to do the many micro behaviours that underpin successful implementation.  At an executive level our next step is to begin to stop a tolerance of low level failure.  That was what we tried with our Ok to Ask campaign last year.  What we addressed by making sure we stepped up on information governance mandatory training.  Yet is applies in many small ways every day.  Not a reproachful thing.  But a raising of standards, and statement of pride.  What we do round here has to be because, not in spite of, how we work.  It needs to be inculcated into new starters, into teams, and through leaders.  Without that we will always have weak spots, which get in the way and chip away at the many successes.  Culture in that sense starts with a broken windows model, which makes sure we always do something both to get it done and to create an expectation about what we value.  I see a determination to do just that, but hope next year’s annual report sees that determination turned into action, and action into results.