October 2016

I understand that the much hyped Sustainability and Transformation Plan (STP) for the Black Country (and west Birmingham) will shortly be posted and published.  It will contain no surprises.  Extant plans for change will be at its heart, and it is explicit about what we are trying to do.  Spend more on patient care from a decreasing pot.  Prevent hospital admission by better upstream self-care, primary care and support for the third sector.  These are difficult aims to disagree with.  The challenge is seeing real change happen.  As we have experienced with the better care fund over the last two years it is possible to do the right, or the noble, thing, and see very limited, or indeed no results.  There are subtle nuances that make change succeed.  We have seen that with outpatient care, where many efforts to “triage” referrals from general practice by GPs saw limited change.  But the same thing undertaken by consultant physicians has shown real promise.

Of course the Birmingham and Solihull STP, which covers three quarters of the city, has already been published.  It sets out a huge financial gap, and the aim to rationalise hospital care across HEFT and UHB.  Its heart too is a big expansion of community based alternatives.  Local people will see similar, yet different, approaches in the city, and we need to all commit to learn from what works.  Inevitably perhaps media focus remains on hospitals and their beds (even though 90% of what the NHS does is in general practice) – and I was pleased to hear Council Chief Executive Mark Rogers explaining that far from the STP “closing City Hospital”, our plan from 2018 – as it has been since 2007 – is to move acute care up Dudley Road to the new Midland Met.  BMEC and the Birmingham Treatment Centre will remain and grow.  And a brilliant new housing development will sit on the old infirmary site.  Midland Met of course will be the closest hospital for adults to the centre of the city, and will be at the heart of the city for a long time to come.

Our fluperheroes have been extraordinarily active across all of our sites and bases since the flu campaign began at the start of October.  We are now 15% ahead of the same time last year.  Last week we told the Board we were at 64%, but we have leapt even since then, and now stand at 71% of patient facing staff vaccinated.  This puts us right at the forefront of the NHS wide effort to tackle preventable ill health.  As an exercise in collective action, I always find our work in this area inspiring:  We should be proud of the dedicated staff we have driving this forward year after year.

Like every single NHS Trust we face profound financial pressures.  Whatever your view of the purported £10m provided to the NHS during this Parliament, the reality is that this year, and the coming two years see a financial squeeze unprecedented in the last few decades.  This comes at a time when inflationary pressures in the “real” economy are rising, and after many years of wage depression for NHS workers.  Demand for care, and an expansion of what we can do, is growing – and in our local community three times as many local people will be over 85 than at the start of the century.

We continue to spend more than we can afford.  Regrettably we are having to manage cash by delaying payments, whilst exempting local and small suppliers from these strictures.  We need to drop our monthly outgoings by £1.7m.  Our existing cost improvement plans aim to lose £1m a month.  And yet at the same time we have two wards open for which we do not have funding, and face a proposed £6m cut in our income from commissioners.  If this sounds worrying, it is because it is.  As an NHS we need to find a way to not be playing pass the problem between partners (even though the commissioner/provider divide does exactly that) – yet we, as a Trust, have to establish greater control over our spend and the ability to turn off cost.  Staff are weary of this message.  Yet the medicine remains the medicine, if we are to continue to be able to invest in technology, in training, and in new facilities.  We must do that, because it is that investment which will unlock change, transformation and improvement in the years ahead and see us enter 2020 in a clinically and financially stable position.  I am, as ever, open about the challenges we face and so will use this blog to keep you posted, on what is your NHS, not ours.

As a Trust we have worked hard to construct ways in which local people can influence or determine what we do, or certainly what we focus on.  Our members’ leadership group has chosen to really get to grips with transport plans for the new hospital.  Meanwhile, we are working closely with Healthwatch around some of our ward performance issues.  And local people, including retired NHS staff who are part of NHS Fellowship, then contribute to our inspection regime.  The latest round of which took place at the very start of November.  This “outside in” point of view is critically important to the Trust not becoming one which believes its own publicity, or simply explains away error by reference to the pressures or challenges we face.

Of course the formal layer for that scrutiny comes via our Board.  A unitary function headed by our chairman, Richard Samuda, and comprising seven executive and six non-executive directors.  Every meeting contains a story from a patient or carer.  Most meetings focus most of their time on our risk register, our assurance framework and specific quality or safety issues.  This year the Board has spent time on food, on Carter’s rights, car parking, and transport.  These are nitty-gritty matters which define the experience of care for many patients.  Looking over our matters arising tracker in the board’s papers it is immediately obvious how issues raised by patients are being chased up and moved forward.  We have further to go on food – and loads more to do on information formats for patients.  Our plans for Midland Met move beyond the traditional leaflets!

Whilst we need to cater for most people most of the time, part of the test of what we do is how we meet specific needs.  The last Board meeting reported the work being done with the hard of hearing and deaf community.  Later this month we make some specific changes to our estate to support transgender residents and staff.  And our staff networks for colleagues with protected characteristics start their work in the next fortnight.  I am proud that the Trust I help to lead has such a focus on these specific needs.  We want to represent everyone locally.  And our values reflect a determination not to settle simply for the needs of the majority.  Whether it is our focus on homelessness, or work with those whose first language is not English, we want to support people to support themselves.  In January, the Board will receive a final report on work to improve care for people with learning disabilities – and to create employment opportunities too.  I am personally sponsoring this work, and I am determined we will get this right. Not on the basis of a special effort, but as a standard, which is deserved, as of right.