September 2016

We are almost into autumn. In fact on October 3rd we launch our Winter Wellness package for staff and partners.This year’s flu vaccination drive will be launched there, combined with our SWBH benefits portal which draws together all the upsides and fringe benefits of joining our team and family.  One of the big successes of the last six months has been the impact of our drive to slash sickness absence.  I very much hope that the next six months sees similar impact from the work we are doing on recruitment, especially among band five nurses and midwives.  We get off to a great start in October, with fifty new joiners, and by the time we enter the New Year we are confident we will be below a hundred vacancies.  Both situations and interventions go to the heart of the balance between great local management and brilliant corporate support.  That is a balance we are changing to get results.  From October applicants for high volume vacancies will get an answer from us on the to hire or not hire question inside two weeks.  We want joining our Trust to be simple.  Though the benefits of working here to us are obvious, we want to make them explicit to staff who have a choice across the West Midlands.  This Trust offers both scale through which to develop your skills and dreams, and friendliness in which to enjoy your work and find companionship with colleagues.  That is, compared to neighbours, an unusual combo and one that we believe makes our offer a strong one.

In the last few months we have seen retention within the Trust improve.  Fewer people leaving us.  More recognising that the grass is not greener.  We have a bright future with the opening of Midland Met in seven hundred days’ time, and a new computer system joining up care in less than a year from now.  And an organisational integrity that is something to buy into.  We tell it like it is.  The future has challenges.  Roles will change.  Structures will adapt.  Partnerships will be developed.  But if we stick to our aim to create patient shaped services in 2020, then these alterations have a coherence to them that goes beyond responding to Ministers or commissioners.  In the last four weeks I have participated in a series of Board initiated ‘go see’ events, which brought home to me again the work we still have to do.  Patient reported feedback about our Trust remains average for the area.  We want it to be outstanding.  Our work on volunteering and involvement, though passionate, has yet to grab the organisation and shake it up.  That needs to change.  And my promises to local people with learning disabilities remain, our ‘sometimes’ offer not something we do consistently.  In each case it would be easier for the board to contrive a sense of progress and move on.  Instead I am held to account by my colleagues and peers in the public board room, and we are intervening to shape the pace and nature of improvement in all three cases.

 Looking back over 2016, technology has featured reasonably routinely in these blogs.  I have oscillated between enthusing about a digital future and bemoaning the resilience problems we have faced.  I hope I am not jinxing them by noting that a month has now gone by quite calmly, and our promise to have sorted hardware dilapidations by Christmas will in fact be met by Diwali.  Last week, we signed the contract which marks a ten year partnership with Cerner.  A “clinical wrap” EPR will be in place from late 2017, with paper notes phased out from next summer.  This is a brilliant opportunity to change how we provide care and how to use IT to drive up standards of care.  We are fortunate indeed to have a first class leadership team in place for this revolution, led by our medical director, Roger Stedman.  In a very real sense our digital progress will dictate the success of the more widely understood move into Midland Met:  Partly because the latter depends on the paperless state to be delivered by the former, but even more directly because we will learn through doing about change in our organisation.  In coming weeks we roll out a single improvement approach for changing how we work in the Trust.  This is probably an overdue initiative.  We know that our management culture can be sclerotic and overbearing.  We know that a leaner, more data driven, focus on problem solving and managing to timetable is what we need.  That shift requires changes in my own work, that of my team, and of many senior leaders in the Trust.  I am absolutely determined that our leadership model should reflect the improvement culture we want to create, and that that culture is best placed to deliver the results our 2020 vision promises and our communities deserve.

The Trust is on a ten year journey.  We will be mindful of plans to work collaboratively across our STP.  We want to work well with valued neighbours like the Children’s Hospital in Birmingham and local mental health Trusts.  We continue to value our collaboration with the University of Birmingham, even as we deepen partnerships with Aston and with Wolverhampton.  Yet the key to that ten year journey, which takes us past our well regarded 2020 vision, is how we establish a way of doing business.  Partly a set of values or promises.  Partly the integrity and openness agenda, which we believe, and others tell us, is distinctive about our leadership culture.  But mostly how we involve and inspire staff across our organisation to believe. That they can make changes and adaptations, follow some norms but judge when to deviate from them.  If we look at the role model of high performing healthcare organisations we aim to join, Salford, Northumbria, Virginia Mason in Seattle, or chains like the Royal Free, those are the characteristics we see.  I can give you a long list of differences and reasons we might not succeed.  But unless we are clear about the aim, ambitious but achievable, we will never get started moving in that direction.  In the last three years we have sustained viability, and used that to get in place fundamentals that matter – EPR and MMH most obviously.  Now our challenge is to convert that potential to outcomes that are transformational – we have a safety plan commitment to things that should always happen, undelivered anywhere in the UK, and a quality plan that aims to manage outcomes and raise them up, again in a manner not seen in the West Midlands.  The most likely outcome is modest change.  The improvement challenge is to outperform that curve – not get distracted by new IT or a new hospital as so many have before us, but use those things to galvanise a spirit of innovation and experimentation.

Last week we added two more services to our roll-call of the very best, our Beacons.  Alongside occupational health, FINCH, Stroke Services, The Children’s Therapies Services, Gastroenterology, the Breast Unit and Gynae-Oncology, we have now added rheumatology (our first BCA beacon in some ways) and cardiology.  It is not yet in our culture to boast or celebrate our services as outstanding.  Perhaps that will come in time.  But our beacons represent care provision, care integration and research excellence in our midst, and something we should all celebrate.  In October we have our annual Star Awards, over twenty prizes on offer, some by nomination, and others by staff or patient votes.  It is always the highlight of the year for me – a chance to thank friends and family of our nominees and to celebrate with partners.  I am delighted once again to see teams put forward from across the Trust, hospital and community services, adult and children’s’ care.  Villa Park traditionally does us proud on the night and I look forward to leading the charge to make it a memorable evening from dance floor to podium.

In the last month all of our sites have seen major change.  At Rowley Regis we saw the official opening of the treatment centre function, in which we have invested heavily.  Regrettably we saw our commissioners withdraw support from our PCAT emergency care service.  There will always be a creative tension with partners, and I acknowledge that volumes through the service could have been bigger, nonetheless it is always difficult for staff to reconcile a rhetoric about innovation with a reality which judges those changes against a traditional hospital model.  At City Hospital, Sarb Clare has led a remarkable set of changes in the scale of ambulatory care we are providing as an alternative to traditional bed based admission.  There is further to go, but as we scale back some wards on the site in preparation for Midland Met, it is encouraging to see the changes being made.  Meanwhile, at Sandwell, the unfunded winter ward which reflected huge admissions growth in 2016, is now being managed via our older people’s assessment unit.  This is part of providing more appropriate care, and to some degree gives the lie to the persistent bed numbers question we face – are the couches on an AMAR unit beds or not?  I am not meaning to be evasive but our aim is to always to offer appropriate care models for those we serve.  A huge part of that change is the creation of intermediate care alternatives to admission and to being in a hospital.  Across the Dudley Road, Leasowes, Rowley and Sandwell sites we have in place facilities and philosophies of care ready for 2018.  The challenge now is to build the care pathways and the care teams to deliver.  Let’s be blunt, that demands commissioning continuity and commitment to 2019, or 2020, to learn with us how to get this right.  Chopping and changing approaches will lead to the out of hospital failures which lie at the root of so many failed moves into new hospitals – and we must, and should, do better than that.

The latest version of the area’s STP plan has been uploaded.  To confirm the obvious, the new Midland Met Hospital lies at the very heart of future system change.  It opens in October 2018.  The real issues lie in how we ensure that home, residential and care home services are of a consistently high standard at that time.  And how we make sure that local general practice is fully staffed, with GPs who want to work with us and with each other.  This is the work to develop new models of care, accountable care organisations, and cooperative working arrangements.  We have one such in place already in the partnership between the Metropolitan Borough Council and ourselves over both public health and children’s services.  Between now and April 2017 I hope we find the courage to move rapidly to create a clearer accountability for demand management and the changes needed to support people at home with their care.  The Trust’s Board recognises that intent and obligation, and if we can develop trust across our system, we believe these changes can be put in place more rapidly locally than in some other localities in the region.