November 2015

Inspection team 2On Monday next, 23rd, our internal inspection teams get to work.  We have asked staff from different tiers of the Trust, patient reps from our own structure and Healthwatch, as well as individuals from allied organisations like the CCG and TDA, to join us in inspecting our work.  The background is the Improvement Plan that we published in March 2015, after the CQC visit we had in autumn 2014.  Though we have plenty of data on how we are getting on, we know that the biggest challenge is consistency – over time and across place – and so an inspection model which goes and looks, asks and finds, is the right way to assess our progress.  We know there will still be room for improvement.  Let’s pinpoint where that is, but let’s also hear from teams that have really improved and understand what has helped and what has hindered that journey.  The best of what we do in SWBH, needs to be what we do everywhere.

We know we can succeed.  Last Tuesday, 17th, I had the massive privilege to be celebrating our first ‘Outstanding’ service, in the eyes of the CQC.  Community children’s services are one of our biggest teams – with therapy, nursing and medical staff working in young people’s homes, in children’s centres, on our sites and with some local schools.  Care of children in Sandwell has been something that has been scrutinised and criticised plenty in the last decade, so it is doubly pleasing to see this recognition.  It is a partnership, and organisations like the Local Authority must take part of the credit for what is being achieved.  On our website you can not only find a link to the full report but details of some key points within it under our banner:  We rated outstanding for the caring nature of our services, and outstanding too for leadership.  What struck me about the detail on the latter was the degree of cohesion and support between team leaders, local managers, and the executive team that I lead.  Even where we were describing difficult challenges like recruitment in health visiting, we understood the plan for the future and were working jointly on it.

Midland Met moves ever nearer.  In fact the building work has started now in earnest.  An advanced works team from Carillion are on site, getting ready for contract signature and the build period which kicks off in the New Year.  We are now thinking we may beat the clock and achieve contract signature in December 2015, ahead of plan.  Last week the Chairman, Richard Samuda, led our team down to London to meet with the investment committee of our regulator, and yesterday the TDA Board once again endorsed the scheme.  If we can get Ministerial confirmation later this month then the signatures can be applied locally.  Of course agreeing the build and the bill is only the end of the beginning.  The hard work starts now to have our clinical model ready.  I have found that when I talk or write about this, there is an inbuilt reflex which assumes I am describing bed numbers!  I am not.  We are there or there-abouts, on beds and have two plan Bs if efforts to reduce admissions locally were to be delayed.  The real change in care lies in changing outpatient work, which will, among other benefits allow us to focus more expert time on inpatient care.  It will allow us to have surgeons operating for more of the week.  And of course we are keen to set, meet and then exceed our own standards for how quickly different parts of our care system work.  The changes in emergency surgery are part of trying to set maximum wait times.  We have set standards now for radiology scans and reports.  And for vital steps like PEG insertion for nutrition.  As care becomes more multi-professional, with patients looked after by teams together, it is right to set mutual and peer expectations.  That is our focus and something we will develop further when we publish our safety and quality plans in the new year.

Our new hospital is a symbol therefore, and a reason for, change.  But this month we formally published our 2020 Vision.  I hope it is clear in that important document that the Trust’s future and purpose is not about a building.  Our aim is ambitious.  We want to deliver coordinated care, and the outcomes that matter to our patients.  We can only do that as an integrated care organisation, working with others.  Sometimes that will mean formal new alliances.  We heard this month that our bid to provide high quality palliative care for the next five years locally has been selected by the CCG:  We will be working with third sector and hospice colleagues to join up care and help more people to die in a place and manner of their choosing.  Sometimes the 2020 Vision simply means existing relationships working better, as we develop Right Care Right Here and aim to create stability and improved outcomes by 2025, even as austerity reshapes services around us.  Through estate changes, through IT, but mostly through people, and their development, our 2020 Vision aims to chart a course through a difficult but exciting time.

At our last public board meeting, we had some challenging debates.  And one in particular made me reflect on our outcome aim.  We discussed what happens when we need to change a well loved and well regarded service.  Should the popularity of the provision make us stop.  My view is that it should make us think and reflect, but sometimes we have to press on, because popularity is one metric of quality, but cannot be the only one.  If we take oncology care, we know that there is excellence in our Trust.  Our gynae-oncology service has the lowest mortality rates in the UK at one and five years.  But we also know that four in ten Cancer MDTs do not have consistent clinical presence, which makes us an outlier over many years.  And that as volumes of cancer rise and expectations grow, as genetic medicine becomes important in more of what we do, we must have a strategic partnership in cancer care, grounded in shared values and intentions.

Even in a Trust that wants to work in partnership with patients and the local community sometimes difficult change, even compulsion, is needed.  The Board in December will finalise our anti-smoking plans, which hit the media this month after we debated them in outline in public.  We recognise and I know we have to find a balance between nudge, push and shove, between carrot and stick.  We want to take action using evidence and act to develop evidence where none exists.  What is not an option locally is to do more of the same.  Our new hospital is big enough and funded in full from day one.  By 2030, we must change underlying health status locally or we will have failed.  We need to combine three things:

– Little changes that matter like the wellbeing that comes from the Living Wage creating sustainable jobs;

– Major societal changes, where we know the change we could get from something like alcohol repricing;

– With the third and most vital strand: A clear story and explanation for the people we serve, which enhances trust that we are acting in the collective best interest.

I am optimistic we can succeed.  If we learn from strength like community children’s here, and successes like Midland Met approval, we can build the confidence to set ambitious aims and do things that perhaps others tell us cannot be done.  That that must carry public support is so fundamental that it almost feels unnecessary to emphasise, but co-production is easily lost or overlooked, and it is that mutuality that will determine our chances.