Tuesday, 25 April 2017

Reflections on 16/17 – the highs & lows!

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.

Thursday, 13 April 2017

Supporting our staff to report violence and aggression at work

The Trust Board and relevant Committees very closely scrutinise our staff survey scores so that we know where we are doing well, and where we can better support our staff.

Our latest results show that the number of colleagues experiencing physical and verbal abuse and assaults at our hospitals is in line with the national average for acute trusts; however, regrettably the number of times this happens does appear to have increased slightly over the last year. 15% of staff said they have experienced physical violence from patients, relatives or the public over the past 12 months and 2% say they have experienced physical violence from other members of staff over the same period (up from 14% and 1% the previous year).

It is one thing reading staff survey reports and Board papers. It is another thing seeing for yourself the impact of such abuse and assaults on our staff and the related damage caused to our wards. On my regular walkabout earlier this week, I saw the damage that a violent and aggressive act by a patient last week had both on our staff and their working environment, with equipment smashed and broken as a result and staff clearly shaken by what happened.

We ensure our frontline staff receive conflict resolution training where these incidents are more prevalent. Such training is available to other areas if requested (via our HR team). We also work with our Police partners to prevent such incidents. My conversations with colleagues this week however, really brought home to me that there is even more we must do at NUH to do to prevent such incidents happening in the first place.

While these incidents are very often minor and carried out by patients who did not know what they were doing due to medical conditions, some aren’t and more serious damage is done. And the reality is, it isn’t acceptable for staff to experience them. Our staff are here to care for patients, their families and their carers; not to experience such distressing behaviour when at work; many having a lasting impact.

It is really important that our staff report such acts of aggression and violence so that the Trust can take the necessary action.

Where necessary, we seek sanctions or redress, and have robust policies and procedures in place to withdraw or withhold of treatment where this unfortunately becomes necessary. We may have good reason to implement this policy in the coming days in response to the incident I have described above. I wanted to write this blog to let our staff know that we are here to support them and will take action where behaviours get out of hand – to protect our patients, visitors and of course our staff who are here to do their best job for patients, not to be subject to unnecessary and uncalled abuse.

We offer counselling support through our Occupational Health department either immediately after such incidents or at a later date depending on what is most helpful for the individuals concerned. We have a free and confidential phone line that colleagues can call for support, including counselling, where needed and our Chaplaincy and Pastoral Team also have an important role to play. Which support mechanism is chosen depends on what works best for individual staff. And all this support is available to all members of the team, whether on permanent contracts or temporary contracts, including our locum and agency staff.

There is clearly more we need to do as a Trust to protect and support our staff, and encourage reporting of such incidents. This is a matter the Board will be closely monitoring, such are our concerns about the wellbeing of our staff. Having to suffer violence and aggression should not be part of the job.

Tuesday, 11 April 2017

Public vote opens tomorrow

Today, we’ve announced this year’s Nurse and Midwife of the Year finalists, with 21 individuals shortlisted across 7 categories.  

Very many congratulations to the following colleagues – who are our 2017 finalists:

Midwife of the Year
Heather Bartram, Midwife, Lawrence Ward, City
Carrie Hayward, Community Midwife
Sharon Molineux, Labour Suite, City

Student Nurse of the Year
Jessica Flanagan
Shevon Wragg
Christina Oloughlin

Healthcare Assistant of the Year
John Marriott, Emergency Department Assistant, QMC
Gail Taylor, Discharge Co-ordinator, Ward C4, QMC
Nicola Brennan, Maternity Support Worker

International Nurse of the Year
Rehan Mosafeer, Radiology Ultrasound, QMC
Silvia Ghione, Staff Nurse, Ward F22, QMC
Andreia Almeida, Staff Nurse, Ward C5, QMC

Children’s Nurse of the Year
Claire Pothecary, Staff Nurse, Ward E40, Children’s Hospital
Josie Fearn, Staff Nurse, Ward E39, Children’s Hospital
Adele Frost, Lead Nurse Children’s Long Term Ventilation, Children’s Hospital

Adult Nurse of the Year
Diane Capel, Staff Nurse, Patience 1, City
Laura Hardwick, Ward Sister, Lister Ward 1, City

Karen Semillano, Staff Nurse, Haematology Day Case, City

Nurse/Midwife Leader of the Year
Lucy Gillespie, Preceptorship Support Nurse, City
Anne-Marie Riley, Deputy Chief Nurse, NUH
Clare Mayfield, Sister, Emergency Department, QMC

QMC 40 Anniversary Award
In the year we celebrate 40 years of QMC, our Chief Nurse, Mandie Sunderland, has personally chosen the winner of this special award, which recognises a long-serving nurse or midwife for their exceptional contribution to patient care. The winner will be announced at this year's awards evening which will be held on 18 May.

Tomorrow’s Nottingham Post will feature a special supplement, which includes profiles of everyone who has made this year’s shortlist. This is a great way of reading more about the outstanding patient care that patients, their families and other members of the team believe is worthy of special recognition.

You can vote for your winners at the following link from Wednesday: www.nottinghampost.com/nurseandmidwifeoftheyear, and voting will close on 4 May.


Many congratulations to all of our 2017 nominees and finalists, and a big "Thank you" to Nottingham Express Transit and the Nottingham Post for making these awards possible.

Monday, 10 April 2017

431 lives in 5 years

The NHS is full of numbers that mean different things to different people.

But here’s one number that I think is really important – 431.

That’s the number of people alive today who wouldn’t have survived otherwise, thanks to our East Midlands Trauma Centre (MTC) team and their colleagues working in the air and land ambulance services.

QMC took on the important responsibility of the region’s MTC in April 2012, and now covers the whole of the East Midlands. The MTC covers a catchment area of 4.5m people; and a mix of rural and inner city areas.

In that time, we have seen and treated 5,650 trauma patients – many of them the most serious trauma cases. By working closely with our emergency service partners, we have developed a service that gives patients the very best chance of survival.

The East Midlands MTC is now the busiest outside of London, with the strongest clinical outcomes in the country. We are very fortunate that Nottingham is home to many of the leading surgeons and experts in this field.

We have significantly improved rehabilitation outcomes for our patients. Our team of doctors, nurses and therapists develop long-term relationships with trauma patients and their families as they often return to hospital for many months, sometimes years, for further rehabilitation and treatments to help them to recover from their injuries. 20% of trauma patients require ongoing inpatient rehabilitation and most patients require rehabilitation in an outpatient setting.

To hear that teams from other parts of the UK are now coming to Nottingham to learn from our teams makes me very proud. We also know that being a major trauma centre is attracting the next generation of clinicians to Nottingham and helping with recruitment.

The future for the centre is certainly bright. Next year we will open the new helipad at QMC, reducing transfer times from the helicopter to the Emergency Department for our most critically-injured patients. Thank you to the Nottingham Hospitals Charity and air ambulances for supporting the funding of this important development.

I am also excited by the opportunity offered by the new £300m national defence rehabilitation centre at Stanford Hall.  Due to open 2018, this important facility will be a centre of excellence for injured service men and women and NHS patients in the East Midlands. It will further enhance rehabilitation, helping patients and their families to return to normal more quickly.


We know that there are more than 431 grateful families in the region. We also know in the years to come, thanks to the skill and dedication of the team at our MTC, many more lives and families will be saved.

Wednesday, 5 April 2017

In this together

Health and social care leaders from across Nottinghamshire came together with Regulators yesterday to discuss the system’s response to our recent CQC Urgent and Emergency Care inspection.

Inspectors visited QMC on 7, 8 & 11 December 2016 and rated NUH rated ‘Good’ in the ‘Caring’, ‘Well-led’ and ‘Effective’ domains and ‘Requires Improvement’ for the ‘Safe’ and ‘Responsive’ domains, giving a rating for urgent and emergency services of ‘Requires improvement.’ Our hospitals’ overall rating (following the 2015 Trust-wide inspection, which was published in March 2016) remains ‘Good’.

On both their announced and unannounced visit, CQC Inspectors observed staff caring for patients with “compassion, patience and kindness” and said that they would be pleased for their relatives to be cared for at QMC.

This feedback was echoed by our system partners at yesterday’s meeting, many of whom have spent time in our hospitals either as a patient or walking the floor meeting patients and staff. We are acutely aware that patients don’t always get the timely care we would wish them to have, and that the Emergency Department environment is no longer fit for purpose for the demand on our services. However, this report and feedback reinforces that the quality of care and service provided in our Emergency Department is generally good. We welcome this strong external validation that staff are caring and are doing a good job, often in very difficult circumstances.

What was most striking at yesterday’s meeting was the strong system ownership from all health and social care leaders to solve this problem. It’s not just an ED problem, or even an NUH problem, it’s a system issue that we collectively sign up to addressing so that our patients more consistently get the timely care they deserve. There has been a step-change in the effectiveness of our partnership working across health and social care in Nottinghamshire this winter, and this bodes well as we set out on the implementation journey for the Nottinghamshire Sustainability and Transformation Plan.

There were no surprises in the report, nor any regulatory breaches; though there were 11 specific areas the CQC recommended NUH made improvements.

The Report highlighted that overcrowding in ED all too often impacts on the experience of our patients, with staff working in a department that was designed to see an average of 350 patients a day now consistently seeing 550 patients daily. We will do all we can to accelerate our medium-term plans to address overcrowding, through what we are calling ‘Creating Tomorrow’s NUH’, which includes the development of a business case for a new urgent and emergency care centre at QMC.

Just this week we have changed the way we assess patients at the front door to further strengthen our streaming processes. Patients are now met and assessed by a senior NUH nurse before being directed to the Urgent Treatment Centre (UTC) or to ED depending on which is most appropriate. The UTC is a GP-led primary care service, which is now in place 7 days a week, 8am-midnight. We hope that this new way of working will see the numbers of patients who present at the front door and are then transferred to the UTC increase from 11% to over 20%, in line with what is being achieved in other healthcare systems around the country.

Importantly the system’s efforts are leading to improvements, with Nottingham’s 4 hour performance improving over the last three months.

NHS staff across the system in Nottinghamshire are embracing the concept of Red2Green days which aims to support teams to prevent delays in patient pathways and give patients as many precious days to spend at home with their loved ones as possible.  A ‘red’ day is when nothing positively contributes  to minimising a patient’s length of stay in hospital or in the community and a ‘green’ day gets patients closer to being medically safe and going home or to a more appropriate place of care.  Red2Green days has been rolled-out across over two-thirds of NUH’s wards since the end of 2016 (60 of 90 wards) at QMC and Nottingham City Hospital.

And it’s good to see the campaign now also having an impact in out of hospital services too, including health centres and in the community, including the Short Stay Reablement Unit at the Grand Care Centre in West Bridgford and Nottingham Citycare’s facilities.

At NUH staff are using new technology to digitally log and track red and green days in real-time. The main reasons for internal and external delays are now known for each Division and can also be drilled down to ward level allowing teams to look at how they can review practice to reduce delays to patient care.


It is clearer than ever to me that we are in this together as a system, that there is a clear commitment collectively getting this right for patients, and that we have real  grounds for optimism as a system as we go into 2017/18 together.

Tuesday, 4 April 2017

#UniteForParkinsons

On Tuesday 11 April we will mark 200 years since Parkinson’s disease was first recognised as a medical condition.

Some two centuries later, the disease can still be difficult to diagnose and there remains no cure. Parkinson’s disease can cause a range of physical and mental health symptoms including tremors, swallowing problems and hallucinations. Until recently, I wasn’t aware that one in 500 people have Parkinson’s (source: Charity Parkinson’s UK). In the UK, this is approximately 127,000 people; and more than 2,200 people across Nottingham and Nottinghamshire.

Ahead of Parkinson’s Awareness Week (10-16 April), our Parkinson’s disease nurses at NUH have organised a series of activities to improve people’s understanding of the condition. Please do pop in to the drop in teaching sessions that will be running in the D11 teaching room (QMC) on 4 & 7 April, from 1-3pm. The team will provide information on Parkinson’s disease and there will be an opportunity to ask questions and discuss previous cases. The team are also happy to arrange teaching sessions for specific areas. Colleagues can contact the team for more information by email or by calling ext 63439. 



If you are unable to attend the sessions or would like more information you can access a 15 minute teaching video and learning resources in the Musculoskeletal & Neurosciences section of the intranet.

Our Pharmacy team and Emergency Department have also conducted a study assessing how patients with Parkinson’s disease, who arrive at Emergency Departments, are reviewed to ensure they continue to receive vital medication for the condition. Without timely and appropriate reconciliation of medicines by a pharmacist, length of stay in hospital can increase and the symptoms of the disease can deteriorate. This demonstrate the vital work our Pharmacists can play in supporting these patients, including those who require emergency care and those who require ongoing support to manage their condition.

On World Parkinson’s Day health organisations and charities, including Parkinson’s UK and the European Parkinson's Disease Association, are asking people around the world to #UniteForParkinsons. For most people Parkinson’s disease will not reduce life expectancy but some of the more advanced symptoms can make individuals more vulnerable to infection. As health professionals we may therefore have more contact with patients who have Parkinson’s and will need to understand how their condition impacts on them. On 11 April let’s unite and make a concerted effort to find out about the disease and how we can make a difference to those with this life-altering condition.

New contracts for doctors in training…. the silver lining

Last year was difficult for our doctors in training as many had concerns about the new contract and how it was introduced by the Government. Our first cohort of doctors in training moved over to the new contract in December and were joined by some more senior colleagues in February. Doom and gloom was predicted, but in fact there are now some positives emerging.

I have been so impressed by the maturity and professionalism shown by trainees in their approach to working under a new contract which, as we all know, was not what many would have chosen. Our Board discussion last week with the new Guardians of Safe Working Hours filled me with confidence that actually our trainees are benefiting from some of the additional safeguards in the new contract – for example in terms of the number of hours worked, the number of hours / shifts that can be worked consecutively and the prompt action that is taken when trainees find themselves working beyond their rostered hours. Our trainees are now working more safely, with better protection, and importantly, are able to put patient care and experience first. This is far from the place many thought we were going to be.

With a regular quarterly report now being provided by the Guardians of Safe Working, our Board has more visibility than it has ever had when it comes to overseeing the world of our junior medical workforce. The fact that we are working with hard data and not anecdote, makes a refreshing change.

NUH is following the national timetable for implementation of the new contract. Currently a quarter (200) of our doctors in training are on the new contract. The smooth transition for these trainees has been possible thanks to the hard work of colleagues across NUH and the support and strong engagement of senior doctors across the Trust. Every trainee on the new contract has an individual work schedule which describes their hours of work and if trainees work more than the hours specified or are unable to be released to attend training or education they can raise an exception report. Currently around one-third of trainees have raised at least one exception report - an average of 2 reports being received daily. In some specialties these exception reports have flushed out longstanding issues with rotas or workload and have led to positive change. Examples include changes to trainees’ work schedules so they accurately reflect the working day (and ensure trainees get paid for the hours they work) and securing additional doctors via the trust grade programme or bank to provide medical reinforcement to very busy departments carrying vacancies. Along with our medical and HR colleagues, we should all be actively promoting exception reporting to our doctors in training as an effective mechanism for raising concerns about safe working hours and access to education / training.

Of course it is still early days and there is still lots of work to be done to rebuild relationships and trust with our doctors in training, many of whom still feel bruised by the events of last year. But what we can say with confidence is that as we look to the August changeover we are in a much better place than many expected, and we will continue to develop and rebuild our relationship with trainees. Following the difficulties of 2016 we introduced new forums to listen to trainees’ concerns; these have been incredibly productive, giving our doctors in training a platform for raising issues, and our Board more direct connection to how our trainees are feeling. We also appointed a Junior Doctor Liaison Officer whose sole function is to support our doctors in training.

I would like to thank our new Guardians of Safe Working Hours – Dr Steven Gill and Brian Davies – and our Medical HR team for their tremendous work to date, and colleagues across NUH for their continued engagement in this process. I know it hasn’t been easy.

For those who are interested and would like more detailed information – you can read our latest Board paper here.