Chief Executives Blog – March 2015

A hectic month, trying to deliver what we promised this year and get ready to deliver our (hopefully your) ambitions next year.  Many of our staff tell me either that they are not sure of the plan, or that it changes a lot.  I accept the communication challenge that implies, but the truth is that our plans are deeply consistent.  We have some long term and medium term fixed points, and we are pretty clear what we need to do now to be ready.  Our constant challenge is to make time today for tomorrow, and to be ruthless and disciplined about keeping the fads, instructions and distractions at bay, well intentioned as they are.

In 2014/15 we have achieved a huge amount at the Trust.  In July, memorably, the Chancellor committed the Government to the refurbishment of Sandwell, Rowley Regis and Sheldon at City – and to the Midland Metropolitan Hospital we plan to open in 2018.  In October we faced up to some financial challenges, which we had to and have to tackle if we are to be able to sustain services and invest in our workforce and in care in the future.  That started a painful process of redeploying around 150 staff, and a planning process for more change in April.  Between the two we started to cut agency usage, succeeding in reducing spend by a third, whilst measures of harm reduced.  Amidst this we have been plugging away at reforming outpatients, cutting diagnostic waits, and introducing some core standards into some wards through our Ten Out of Ten work.  To the point raised by staff and members in my first paragraph, we will keep at it, till we succeed, on that you have my word.

Of course success is often a case of steps of improvement, some plateaus, and then a need to press on again.  Our PCAT service at Rowley Regis shows signs of pressing on again. We need the same success with our mortality review system whereby we examine critically every death (now back in the 90s) and ambulatory care around our acute medical units.  I am still thrilled by improvements in MRSA screening, VTE, and twilight district nursing, but we have room for improvement in each in pursuit of real excellence.  Sepsis is always our focus, and there too we have scope to do better, especially in our EDs.

The year ahead should see us close the deal on Midland Met, reach agreement on our future IT platform and continue our leadership and workforce development revolution.  But smaller scale change matters too: From direct care changes in ward documentation, to making sure it is simpler to recruit to known vacancies.  We want to cut community nurse caseloads, even though all of our services face at least a four percent real terms funding cut.  The goals should be pretty clear, and our annual plan will summarise them, whilst local detail operationalises them.  We will have some scope for investments, and we want to protect and grow our training spend.

Outside influences do matter.  We can see from developments in Greater Manchester that there will be more change in organisational systems ahead.  Some local GPs want to develop more structure around what they can do locally beyond traditional general practice.  And we too have plans for change and partnerships that we need to deepen. The next few weeks will see a CQC report into some of our services, both in hospital and in the community.  That is bound to show room for improvement, not least as we ourselves identified all sorts of weaknesses and issues that we are committed to addressing.

The latest outcome data still paints a picture of great quality care in some key areas.  Not only are we getting awards in maternity services, and staying in the top 10% for stroke care nationally, but we can see our rates of avoidable infection, our mortality rates, and measures of cardiac quality improving even more.  These symptoms of safety matter.  They are an indication of success, but we are obviously alert to weaknesses and will never ‘trade’ positives off against our errors.

Later this week, we have the first, hopefully annual, Sandwell and West Birmingham equality awards.  Trust teams are well represented in the shortlisted entries: Our health visiting teams and family nurse partnerships are up there, alongside our Learning Works programme.  Not only has this team promoted employment access from their base opposite the Midland Met site, but has found time to promote unique projects, like our Live Work scheme, opened yesterday, to support apprentices among young people at risk of becoming roofless.  The refurbishment of accommodation on Hallam Street with Moat, for a new set of units to be run for us by St Basils, is worth a prize on its own.  It stands as a symbol of our community commitment, where everyone matters.