Chief Executives Blog – November 2014

I do not usually quote the Nursing Times in aid, but I am absolutely thrilled that our iCares team, which provides specialist community care across Sandwell, has scooped their top national award for Integrated Care.  I was just as pleased to spend time with the team and hear individuals describe how empowering the multi-professional nature of the team and its leadership is.  Working in a genuinely inter-disciplinary way really matters if we are going get the most from the skills of individuals, not just blend job descriptions in the usual NHS role culture.  So, all in all, a great start to November, coming on the back of four nominations in the Health Education West Midlands Apprentice Awards, with two gold medals.  One of those was for the region’s Top Apprentice Champion – Lauren started here two years ago as an apprentice and now coordinates the whole programme and coaches some of those involved.  The next steps in our ceaseless improvement quest, is to get over 100 apprentices in place (this year’s aim) and expand iCares into West Birmingham, which will happen this winter.

The end of October saw Simon Stevens, Chief Executive of NHS England, publish an important forty page document about the future of the NHS.  The NHS Five Year Forward View outlines how the needs of communities require changed models of care. That means that the status quo for service providers like us is not an option.  I would be truly disappointed if any of my 7500 colleagues at the Trust did not recognise in Simon’s document lots of ideas and possibilities that we have been working on here in recent months, and have delivered success on in recent years within the Right Care, Right Here partnership.  Our 2020 vision, which we now expect to issue in early 2015 (slightly later than advertised), continues to focus on co-ordinated care organised around the outcomes that are important to patients and carers, and of course that means that local people will score our success (not glitzy London award ceremonies!).  I hope if local diabetics were scoring our DICE team they would give them high marks for the changed care model now in place across general practice and the hospital – a real tribute to the go-for-it spirit: No regrets.

Getting ready for the coming winter matters very much to us right now though, medium term plans notwithstanding.  Our flu vaccinators are out in force and we are doing better than last year, which was our very best ever year.  Internationally, there is concern that flu will be more virulent this year, and we need to always keep in mind that this is a killer disease (500 deaths last year).  So it matters greatly that we get it right.  If you did happen to click through our website and find the film clips of our Annual General Meeting (openness?) you will hear exactly that conclusion to my review of the year.  Local people care about our NHS and ask me routinely, “what can I do to help?”.  Get your flu vaccination is the answer.

As a Board team the next step in our openness agenda is to conduct our first public board meeting outside our own premises, when we venture across to Perry Barr on Thursday November 6th for our meeting at the Tower Hill Medical Centre (which opened earlier this year).  The whole leadership team is determined to be not just visible but approachable.  Non-executive directors led the prize-giving at our own annual Staff Awards a few weeks ago.  But the tasks of leadership are varied and those same individuals joined our Chief Nurse and myself as we undertook go-look visits as part of our due diligence in thinking about revised establishments for nursing care on our adult wards.  Other non-executive roles see specific involvement in key projects like our joint venture on palliative care, or our  work in finalising the right IT option for the Trust’s future – a new system will be in by 2017.  And yes it will offer access for patients to their data.  That precise ambition was, for me, the high point of our AGM, as we heard how the Regis Medical Centre made that happen in 2014.

Our staff awards, or the other celebrations that I have mentioned, serve to highlight the brightest and best of what we do.  Of course, we are presently consulting internally on major workforce changes.  These will see some colleagues being redeployed, and it is too early to rule out some compulsory redundancies.  Nobody approaches this topic with enthusiasm, and considerable caution has been adopted in examining the changes.  Even those that go forward, and the consultation is a genuine one in which ideas and proposals are adapted based on feedback, will be tracked in detail after implementation.  We are pretty good at collating and examining our care at a very local level, and that will give us early warning if there are difficulties.  The commitment is to act where that is a risk.  Even safe, smart ideas can get lost in implementation and of course, changing roles within a team often means change for those ‘left behind’ when someone moves on.

One of the risks of major workforce change or financial strictures is that the topic becomes the all purpose explanation for everything that happens.  This month we kick off our Choose Green campaign (#SWBHchoosegreen) to support healthier eating and healthier lifestyles – by Christmas we hope finding a sugar-filled can in our Trust will be pretty tough.  I suspect this work will end up costing us a modest sum, but it is an example of acting now for the longer term.  Similarly we have invested in staff mental health and wellbeing.  Our future financial plan is about making choices – difficult choices about priorities, not about never spending money or putting off decisions.  It can difficult to hear about ‘cuts’ in one department, and then see us expanding urological surgery, or spending more on oncology.  But that is exactly what we will do to make sure that where we commit taxpayer’s money reflects the needs of local people now and in five years from now.

I hope our leadership team is equally focused on big plans and little things that matter.  Certainly as we develop the governor role we want to make sure that they help us to anchor the details that matter in our patients’ experiences.  So the move to changing our inpatient food will need careful watching.  My sense is that the soup and sandwich offer works, but only if we do better to meet people’s expectations and choices.  Our inpatient food menus have a range of meals to cater for different people’s tastes, diets and preferences. We still have more to do to make sure that we have enough variety within our menus so that patients who are eating with us for several days and choose certain food for religious beliefs or cultural preference, have a sufficiently varied choice. We have something to learn from Walsall here who have seen local views of their food offer improve in the last two years, just as we are trying to learn from partners at Dudley, who have some of the best Friends and Family scores locally, and have done some great work on handling and learning from complaints.

Whatever you read in the local papers, I would urge you to consider seriously the real strength of the local NHS.  The CQC report into our Trust will come through in early 2015 I understand.  So far, no surprises in the feedback.  Some areas to improve, which I think could all be found in public board papers over the last twelve months, as acknowledged weak spots.  But against a backdrop of the lowest mortality of any local hospital, it was fantastic to hear the inspection team report how overwhelmingly positive patient feedback had been about what we do and the teams that do it.  In a place where we like to say that everyone matters, that matters very much to every one of us.

Toby Lewis
Chief Executive
Follow me on twitter at @Toby_LewisSWBH