It’s fair to say that despite the 10th year of NUH being our busiest and most challenging yet, there were many more highs than lows.
I know from the regular walkabouts that I do and the conversations that I have just how tough this last year has been for staff. I am proud of each and every colleague for not losing sight of doing what is best for patients, even in the most challenging times.
Patients are safer in our care year on year. In the last 2 years we’ve reduced avoidable stage 3 pressure ulcers by 70%. In the last 5 years, we’ve halved the rate of patients falling in our care. The 6,000 mobile devices now in use across NUH (more than any other NHS Trust) are giving clinical teams access to real-time information, with more than 3million sets of observations carried out on these devices in the last 12 months. “Nervecentre,” smart phones and Apps are literally revolutionising the way in which clinicians are accessing information, further improving safety and experience for our patients. We are now managing our beds electronically and using the same devices to screen almost 200 patients every day for sepsis. While the roll-out of Digitised Health Records didn’t go so well, after listening to clinical colleagues we have changed our approach and will prioritise completion of this project in the coming year.
With so much focus and pressure on urgent and emergency care, it would be easy to lose sight of how important planned care is to our patients who are waiting for what may be life-changing operations. So I am delighted to report that more patients in Nottingham have had their planned operation within the target of 18 weeks than in most other areas of the country, and for 37 of the last 39 months, fewer than 0.8% of planned operations (the national target) have had to be cancelled on the planned day of surgery.
Estates and Facilities staff and services safely transferred from Carillion back under NUH management earlier this month. It’s been a difficult year for these teams. Our focus is now on welcoming these colleagues into and back to NUH, and improving services where this is needed, starting with cleaning.
One of the highlights of the year was Nottingham receiving £23.6m to establish a Biomedical Research Centre (BRC), with the themes of Gastro-Intestinal and Liver, Deafness and Hearing, Respiratory, Musculoskeletal, Mental Health and Technology, and Imaging. This has consolidated NUH’s position as the most research active Trust outside of London, Oxford and Cambridge, and supports our aspiration that every patient should have the opportunity to participate in research.
The NHS faces significant nurse recruitment challenges. I am pleased to report that our hospitals are in a strong position relative to other Trusts thanks to our proactive recruitment campaign, which includes new quarterly recruitment events and international recruitment. 355 UK nurses, 130 overseas nurses and 602 HCAs have joined ‘TeamNUH’ over the last 12 months. We have the best retention rate in the country for international nurses. Furthermore, NUH was recently named as 1 of just 11 Trusts in the country to pilot the new Associate Nurse role, with our first associates beginning their training in January 2017. This is a really important workforce development.
We recently started our journey towards Magnet status, which is a recognition of nursing and midwifery excellence. NUH is seeking to become the first hospital in Europe to achieve this status. Thank you to the Nottingham Hospitals Charity for supporting our journey, which over time will provide a platform to further improve the recruitment and retention opportunities for nursing and midwifery staff.
The last year has been a difficult one for our doctors in training, due to the many concerns about their new national contract and how it was introduced. One of the positives to come out of the dispute is the work we have done to improve our communication and listening with doctors in training to improve their overall experience of working at our hospitals, and we look forward to building on this work in the coming year. Our first cohort of doctors in training moved over to the new contract in December 2016 and were joined by some more senior colleagues in February 2017. As at April 2017, a quarter (200) of our trainees were on the new contract, thanks to the support and strong engagement from senior doctors across the Trust.
While it was confirmed in 2016 that there will no longer be a formal merger between NUH and Sherwood Forest Hospitals NHS Foundation Trust (SFH) , clinical colleagues have made a major contribution to important safety and quality improvements at SFH over the last year. We remain committed to working with our neighbours at SFH where it is in the interest of patients to do so and where closer relationships lead to better ways of working. We will do this through the ‘strategic partnership agreement’ that is now in place and which both Boards will take forward in the future as part of the work to deliver the 5-year plan for health and social care across Nottinghamshire (the Sustainability and Transformation Plan).
While we should be rightly proud of our many success stories, it’s important I mention some of the areas we haven’t done as well as we would have wished for our patients, their families and carers.
We didn’t achieve the 4 hour Emergency access standard in 16/17 (76.6% vs >95% requirement), despite the hard work and focus on flow and reducing discharge delays by staff across NUH and wider health and social care system. Our 4-hour performance improvement between January and March 2017 is encouraging, though much still remains to be done across the health and social care system to deliver this standard consistently. The feedback from December 2016’s Care Quality Commission (CQC) inspection of urgent and emergency care, along with system support from the Emergency Care Intensive Support programme (ECIP), has informed where we need to focus our efforts to ensure patients get timely care in our hospitals.
We achieved all but one of the main cancer targets, but fell short of the national target that 85% of patients should be seen and treated for their cancer within 62 days of referral. We are determined to meet this important standard consistently from June 2017.
Financially, 2016/17 was incredibly challenging. Contrary to where we thought we were going to be year-end after a difficult January and February, thanks to the efforts of staff across NUH, we have delivered our £22m year-end ‘control total’ (deficit). We achieved £41.5m savings against our very challenging £43m target and significantly reduced our agency and premium pay spend thanks to our proactive recruitment campaigns and the more rigorous controls we have put in place, particularly by nursing and midwifery colleagues.
We only achieved our 16/17 ‘control total’, however, because we did better than we expected in a number of areas. We delivered our patient activity and income target in March and the Trust received a number of one off payments, making us eligible for additional national funding for meeting our agreed financial plan. We earned £23.1m of the £24.2m national monies (STF funds) available in 16/17, with allocation linked to financial and operational performance. The coming year will be tougher still.
As I approach the end of my tenure as Chair at NUH, writing blogs such as this one reminds me yet again why this is the best job ever. I work with a team of 15,000 colleagues who are caring, dedicated and completely committed to doing the best for patients. Yes, we have our challenges – but together I am confident that ‘Team NUH’, together with our partners across health and social care, will address these.