October 2014
The month is only a few days old, and it already feels quite a tiring start to winter. The run up to the general election and political narrative about the NHS means an array of guidance, questions, instruction and one off funds being sent in the direction of Board teams. Our strategy, vision, plan and values are strong enough to just carry on with what we know we need to do, and fit round the suggestions. One of the best things about our organisation is that we have a long term plan. Our 2020 vision is to become renowned as the best integrated care organisation in the NHS. And so when new tenders come out from commissioners (on palliative care, on respiratory medicine, on school immunisation) our consideration first is does it fit that plan? Are we advancing care and what can we offer as a partnership for change?
That sense of continuity for some staff is at risk right now. Valued NHS colleagues are working through with us our staff change consultation, titled Safe and Sound 2014/2016. It is called ‘safe’ because none of us will make changes we believe are unsafe, and we will track implementation ruthlessly to look for unintended consequences. And it is ‘sound’ because we believe that organisations with the discipline and foresight to manage public finances (act like a patient, think like a taxpayer) will be the sort of well led Trusts that also make honest guardians of public safety and patient quality. But behind the intent we have, is uncertainty, some misery and difficulty for people we work alongside.
During October the consultation on the schemes to reduce our paybill takes place, and in November we will begin the task of retraining and redeploying displaced colleagues. We are completely determined to do that wherever we can. Our Public Health plan is real, and we know that employment matters to our local economy. Of course some of our paybill is not quite so local. We are one of the West Midlands biggest users of temporary staffing and we can drive down that figure by better using the staff we employ across what is a very large organisation. Consulting on change is deeply disruptive, perhaps especially as one of the things that we are doing is changing the number of “layers” in our management structure – cutting the steps in the ladder from ward to board. So our leaders are themselves subject to disruption even as they try to support their teams.
Of course, as I wrote here last month, leading is often about juggling priorities and always about balancing and mitigating risk. On 8th October the CQC arrive at West Bromwich Town Hall at 18.30 to hear from local people what you think of our services. And on October 14th they arrive en masse in our clinics and into our wards, with fifty inspectors and patients who are experts by their care experiences. Like many of my 7500 colleagues I am looking forward to the inspection, which will be one important view of the care we provide. Not more important than a patient complaint, or a staff comment, but important nonetheless. I have been out undertaking some mock inspections, because staff said they wanted to experience what a visit might be like. I have been immensely encouraged by those visits. Huge professionalism and commitment, innovation around how we use our space, and great knowledge of important issues like safeguarding and consent.
We know we have a pretty open culture, which is why so many people feel motivated to report incidents at work (we have a relatively high rate of reporting). I read every incident reported the day before at 06.00 each morning and it gives me a real insight into how it feels in many of our departments and teams. The same insight comes through our Your Voice mechanism, which is a year old now – thousands of staff views expressed both on local team culture and how ‘the Trust’ behaves from the care-face looking out. I really hope that that diversity comes through in the CQC inspection report we see in December. At the Trust’s annual general meeting, I understand from Pam Jones, the chair of Sandwell Healthwatch, we seemed very open as a Trust Board about what we did well and where we need to improve. I want to make sure if I can that the CQC take away the same perspective, because that seems to me to be true.
In and among October sees leaders getting ready for the upcoming winter. Our flu vaccination programme has kicked in in earnest. We open additional beds in early December in Sheldon at City, in partnership with Midland Heart. We continue to recruit staff, despite our workforce consultation, where we know we will have turnover, because we want to face winter with our own teams, not relying on agency staff we do not know. There is of course no substitute for the third sector, social care, and the NHS working together. I worry sometimes that that joint working can sometimes mean endless projects and changes, not the dogged work of making relationships work day after day.
We have a wonderful facility now at Rowley Regis for primary care assessment and treatment, and I really hope both that local GP practices, local people, and our colleagues in the ambulance Trust, make bigger and wider use of it. Sandwell has some fantastic facilities in place to support technology in people’s own homes, to alert clinicians to need, and to cut isolation. Again I wonder if we are taking every chance to use that. That is why when our audiology team presented to the Board at our meeting earlier this month (we always have a patient story and, separately, a team telling it like it is) we agreed that there might be extra role for that team, given 25,000 adult contacts every year, in identifying and referring people at risk of dementia. Later in October, we open our new garden at Leasowes, and welcome back the dementia theatre team to explore how we really care through role play and acting. Yet we know if we could help people before they get to our A&E then winter planning would become a relic of the past, because we would be anticipating need year round, day in, day out.
That anticipation of risk is what it will take to tackle the unplanned readmission issues that Sandwell has had for many years. Thirty more people a week are readmitted than we would expect, and we know there is much more we can do to stop that occurring. Again, that is a year round goal – if we succeed then the much publicised Better Care Fund locally will be fairly unnecessary. One of its key goals is to cut unplanned admissions and we know that this is the area on which we need to focus – by joining up hospital insight with primary care multi-disciplinary teams, which since earlier this year now have our outstanding district nurses and community matrons at their core. Even if October carries on being tiring, I am utterly convinced that we will succeed.
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