September 2013


We had to cancel our cricket match against local GPs yesterday.  Winter has arrived.

It happens every year.  I could well imagine people buying or using our service are mystified by the fuss.  Having just celebrated our 65th birthday as an NHS, we ought to have worked out how to do this by now.

In fact, we do know what to do.  The evidence is very clear.  The challenge is implementing what we know works.  In my organisation that focus on implementation is what is defining the management effort.  As one of eleven organisations supporting the CLAHRC (collaboration for applied research and leadership in healthcare) we want to become expert in getting things done.  The West Midlands has the largest such project in the NHS – there is much to learn.

What works?  As ever in healthcare it starts with people.  We have had a major push to hire nurses.  And with good success.  That is why we managed to open two new wards this week and by November we will have 5% more beds than last year.  There is further to go, but this Tuesday my executive received its first really meaningful report on our vacancy position.  The good news is we are below 5%.  The bad news is 19 out of 20 staff is not who we want to be, because with a 4% sickness rate (NHS average) the day to day experience can be less good.  When I started as Chief Executive here in April I suggested workforce was “the big issue” – I stand by that.  It is everywhere in the health service.  Healthcare is delivered by people to people.  We want to be the best employer locally, a place everyone wants to work.  Hence, among other things, our pride in our award winning health and wellbeing services, and in our Learning Works service – recruiting, sorting out apprenticeships, going into schools, and the rest.

The Royal College of Physicians published a report this month on the future of acute care.  I was delighted that our own programme for improvement (winter must be better 2013) was so congruent with it.  Since earlier this month we are adopting a new model of emergency care.  It will take a little time to bed down.  But it works elsewhere.  And it is our plan for the new hospital.  Admission to an assessment unit, for no more than 48 hours.  To make that work, mathematically, we have, literally, doubled the size of our assessment units.  About forty percent of people admitted will be discharged home.  The balance will need longer stays with us and should be moved, once, to a base ward.  If we become better at discharging patients in the morning, then those moves will happen in daytime, in time for tea.  That matters because the supervising medical team, therapists and nursing staff, are available during the day, before handing over to a night-time team.  So it is both safer to be moved in daylight, and offers better continuity of care.  Our longest stay wards (be they rehabilitation, re-ablement, or medically fit for discharge) are being developed and expanded.  As are teams like our iCares service (one year old in October), who link acute care with community services.  Make no mistake.  What we are trying to implement, what the RCP recommend, is a major change.  That is why it is important we change advisedly and evaluate what we are doing.  David Oliver, National Clinical Director for Older People’s  Care, visits us this month to help us to think about how we deliver fantastic care for people over 65.  I am delighted we received almost £1m in funding for dementia care – we want to be recognised for our work in building a dementia friendly community here, with national voluntary sector bodies and local heroes like BUDS.

Of course, the challenge of health care is about doing many things in parallel.  In difficult times nationally, our finances are going pretty well.  That is why we have been able to make major investment decisions in 2013.  Nearly £2m in new A&E staffing.  Expanding our radiology/imaging services into the weekend.  Ensuring we have obstetrician cover 96 out of 168 hours in the week (among the highest in the region).  None of that minimises the challenges of the cuts we have to make nor the individual devastation of redundancies.  But it is important we move the money we have around our organisation to put it where it most needs to be spent.  These decisions are made advisedly.  The cuts are all assessed by our medical director and chief nurse, and those assessments go before our Quality and Safety Committee.  The investments are all reviewed by our finance and strategy teams, and approved on my behalf through our Clinical Leadership Executive.  We are already planning in detail for 2014-16, as well as finalising a ten year financial model, which goes to our Board in November.  Working out how to treat 20% more patients with the same funds is never easy, but it is easier if you plan ahead, and that is what we are determined to do here.

Understandably everyone from local members, to residents, my Chairman and Secretary of State, want to know if the upcoming winter will be safe and will be better.  I am a realist, but I am confident that it will be.  The doors we are installing on the bays of our wards will help with infection risk.  The permanent staff we have hired will give us expertise, continuity and resilience, that temporary folk cannot.  The changes we have made to our care model, should give us a system, to add to the heroic effort the NHS is known for.  Yet in the end we are utterly dependent on others.  On social services, GPs, nursing homes, schools and others to play their part.  There is no lack of effort or focus here.  We believe that we can be the difference from last year’s difficulties.  And that our plans for emergency care offer a better quality of service for those we serve.

Toby Lewis
Chief Executive