Tuesday, 23 August 2016

Thank you Nottingham Hospitals Radio!

Our remarkable team of volunteers who have kept Nottingham Hospitals Radio going 24 hours a day, for the past 42 years, across QMC and City, deserve a big pat on the back.

Last Friday evening, it was my privilege to join Rajiv on the Nottingham Hospitals Radio as his guest on the flagship ‘Your Choice’ Programme to talk about all things NUH and all things ‘non NUH’ (including my passions for cricket, sailing and singing!)

It was a real experience to go behind the scenes and see where our very own hospital radio broadcasts from every day of the year. Although you may not have heard much about our hospital radio (or indeed known that we had our own radio station), NHR plays an invaluable part in our patients’ rest and recovery and experience in our care. The national-award winning Nottingham’s Hospital Radio team are an important part of the entertainment we offer our inpatients, with quizzes, live sports commentary (including from Trent Bridge) and special music requests and interviews with guests throughout the week.  They contribute in an important way to improving the morale of our patients when they are feeling low and often lonely in hospital.

Part of our exceptional team of 1,500 volunteers who work across our hospitals, our Hospitals Radio volunteers deserve recognition and praise for their long-standing contribution to QMC and City over the last 4 decades.  The Charity actively fundraises throughout the year to keep ‘the show on the road’ – including the radio station’s traditional annual fundraiser: the Robin Hood Half-Marathon bed push. The least we can do is lend our colleagues a bed for this adventurous endeavour!

So I’d like to say a big “thank you” to our volunteers at Nottingham Hospitals Radio for everything you do.

Our colleagues at Nottingham Hospitals Radio are always looking for more volunteers. If you are interested or would like to know more about the work they do, please get in touch: http://www.nhradio.org.uk/ or call 0115 970 45 55.

Monday, 15 August 2016

Debrief from ECIP at 08:30 – jumping out of a plane at 12:00!

Did you know that a patient older than 80 who is admitted to hospital, has, on average, 1,000 days of life left?  If that was you, your relative or loved one, how many of these precious days would you want to be spent in hospital?  That was one of the questions posed by the Emergency Care Improvement Programme (ECIP) team, at their debrief to us on Friday.

And that was after sharing the powerful story of an 86 year old patient who had a 3 week stay at NUH and in the Community, where there had been at least six opportunities for the health and social care system to make different interventions or decisions which would have avoided or reduced this hospital stay. Prolonged stays in hospital that aren’t necessary are not good for the patients, their outcomes or their recovery. How many more of these stories we can avoid on a daily or weekly basis?

Although this story was not comfortable to listen to, I was nevertheless delighted to join executive colleagues from NUH and partners from across health and social care, including the CCGs, Citycare, Notts Healthcare, NEMS, and our STP lead David Pearson from Notts County Council for this debrief on Friday morning.

ECIPs messages were very clear.  We have fantastic teams on the frontline across the system, working incredibly hard to provide high quality care, and welcoming the opportunity of learning from others.  We also have cutting edge real time patient data increasingly available to us through Nervecentre.  However, whether you look at it from an organisational or patient one, collectively, as a whole system, we are failing our patients. 

Urgent and emergency care is a complex issue – and as a system in Nottinghamshire the reality is we have made it more complicated than it needs to be.  The current approach has resulted in multiple priorities, too many pilots, trials, workarounds and layering of solutions that are all too often difficult to manage and frustrating for front line staff.

ECIP will be working with us over the coming months on the key priorities for the system they have identified which they feel will make the biggest difference for patients and our frontline staff:
  • Having a clear and compelling shared vision for the system, owned by all system leaders
  • Making sure that patients are assessed before they are admitted (whether that’s in the community, by the Ambulance Service or at the front door of NUH).  The test should be that only patients who are very sick, and who require significant medical input, should be admitted as emergencies to our hospitals
  • Doing today’s work today – having patients overnight in ED Blue zone (for whatever reason) is a major risk - it's about safety, it's about quality, it's about privacy and dignity.  And this is not just an ED problem – it should be the first priority of everyone working in the hospital and across the health and social care system to resolve this
  • Home First discharge to assess – no patient should be in an acute hospital bed simply waiting for a long-term plan to be developed or enacted 

Thank you to all colleagues across NUH who gave the ECIP team such a warm and enthusiastic welcome. We must all now seize this opportunity to deliver sustainable improvements in the experience of our emergency patients.

And as for the jumping out of a plane?  Sadly, it was too windy for the Chief Executive, Chief Nurse, HR Director and Communications Director to make their parachute jump for Nottingham Hospitals Charity at 12:00 as planned on Friday – so that means you have even more time to sponsor them before they do. The jump has been rearranged for 2 Sept, so let’s hope it’s third time lucky!

Wednesday, 10 August 2016

Addressing our toughest financial challenge

The Government’s highest priorities for the NHS are to reduce the number of patients waiting longer than 4 hours for access to emergency care,  and improving the financial position.

These are also our two biggest challenges at NUH. My blog earlier this week focused on emergency patient care. Today I turn my attention to money.

After much negotiation and a determination to only sign up to a realistic and achievable savings target, NUH’s agreed deficit (known as our control total) for 16/17 is £22m.
This depends on NUH making £43m cost savings ourselves, and receiving £24.2 of national monies through the Sustainability and Transformation Fund (STF). We will only receive the STF monies if we deliver our agreed trajectory for the key national standards, including the 4 hour standard and our cancer targets. With our current 4 hour performance, receipt of all of the national money is clearly high risk.

Our financial performance in Quarter 1 (April-July) was as planned. At £9.9M, our deficit position was £0.3m better than plan, non-pay spend £1.2m better than plan (£91.2m) and pay was better than plan, with a £1.4m reduction in agency/locum spend in this period. However, the fact remains that we are still spending more than we earn, rather than living within our means.

To get to our target, we will need to make some tough decisions. This includes only filling safety-critical posts as vacancies arise,  deciding the future of loss making services and taking some beds out of the hospital, where it is safe to do so.

The coming together of NUH and Sherwood Forest Hospitals NHS Foundation Trust provides some fresh savings opportunities, not least through the new procurement, estate rationalisation and back office efficiencies that will emerge. Our financial challenge would be of the same magnitude, with or without the merger.

Never have our financial pressures been tougher. The Sustainability and Transformation Plan (the STP) for Nottinghamshire is critical. A whole system response is required if we are to deliver a financially sustainable health and social care system over the medium to longer term. We are working with partners to develop Nottinghamshire’s plan, which will set out how local services will evolve and become sustainable over the next five years. More information about what this means for patients and staff will be available in the coming months as the plan for Notts is finalised.

Monday, 8 August 2016

Welcome to Nottingham, ECIP

Today we welcome the Emergency Care Improvement Programme (ECIP) team to NUH.

The ECIP team will work with us and our partners across the health and social care system to see what more we can do to improve the experience of our emergency patients who are not getting the timely care they deserve.

My view is that this visit is well-timed.

Our year to date performance for the ‘4 hour’ national standard which requires hospitals to admit, treat and discharge/admit patients within 4 hours of arriving at our Emergency Department (ED) has deteriorated significantly over the last 12 months.

In Quarter 1 (April-June) just 75% of patients were cared for in less than 4 hours, with some 12,500 patients waiting longer than we would have wished. In July, our performance slipped further, to 72.1%. To put this into context, on this exact day, last year, we were achieving 97%. Something has clearly changed.

We have sought to understand why our performance has dipped so markedly and why our performance has plateaued, as our peers are improving. Attendances were up 3.4% April-June, though emergency admissions and patient acuity didn’t change. There are more patients who are medically safe to leave hospital waiting in our beds than this time last year. We have visited other trusts across the NHS who are high performers to learn from them.

I know from my regular walkabouts that our staff are working incredibly hard, determined to do their best for patients. We have a relentless focus on improving our internal systems and processes. Even though our pre-noon discharges and weekend discharges are higher than they ever have been (and are better than our peers), this has not impacted positively on our 4 hour performance. We are clear that this isn’t about colleagues working harder (this frankly isn’t possible in most cases); rather it is about consistency, and subtle changes of practices that in an organisation the size of NUH, will cumulatively have a significant effect on the flow of patients in and through our hospitals. To improve our performance and ensure our emergency patients get the experience they deserve; every bed, every patient, every minute on every ward, really does count.

Our partners are reviewing the capacity that is required across the system (in the community) to meet the demand on services. More GPs are working in our ED (days, evenings and weekends). We are planning to open a new frailty unit at QMC in September to provide short-term assessment and stabilisation to frail older patients who are admitted from ED. We are exploring the possibility of creating  a nurse/therapy led step-down facility at City Hospital for patients who are medically safe and have rehabilitation needs so that we can keep our acute beds for our sickest patients who most need them.

We look forward to welcoming ECIP to Nottingham this week and learning about what we can do differently to bring the step change in our performance that is needed. ECIP will hold a mirror up to NUH and help us to step back, and reflect on how we do things, to inform our next steps in improving emergency patient care.

Monday, 4 July 2016

Long-serving staff are our DNA

On Friday evening, we celebrated the long service of some 78 NUH staff who have between them worked an incredible 2,285 years for the NHS. What a remarkable achievement.

I was honoured to be part of NUH’s celebratory dinner to recognise our long serving staff who in 2016 mark an important milestone in their careers, of 25, 30 or 35 years of service to our hospitals. I met many inspirational members of staff from across the Trust who have each – in their own unique ways – made such important contributions to our hospitals and in turn the experience of our patients, their loved ones and carers over many decades.

Each year we recognise our long serving staff with certificates, badges and an informal get-together with members of our senior team, including Peter Homa, our Chief Executive. But this year we wanted to do even more to demonstrate our appreciation to these colleagues. On Friday, for the first time, we held a formal dinner to say thank you not only to individual members of staff for their hard work, loyalty and dedication, but also to their loved ones who support them (and therefore our hospitals) in so many ways. The evening was only made possible by the generous sponsorship of our League of Friends charities from both QMC and City Hospitals who share the same ethos as we do – which is that our long-serving staff are our DNA and make us who we are – and celebrating their loyalty and commitment is vitally important.

We receive more feedback from staff on long service awards (and how much it means to staff to be formally recognised for their dedication to our hospitals) than any other single issue. And I am so pleased we have been able to respond to this feedback, by putting on this special evening for our staff and those closest to them through the generous support of the Leagues of Friends.

It was wonderful to see so many colleagues, some of whom had not met one another previously, come together to celebrate their long service and share memories of our hospitals over the last 25 or more years. It was truly an evening to remember.

Monday, 20 June 2016

Our 2016/17 priorities

In a recent series of blogs I described our 16/17 quality priorities, which have been informed by feedback from patients and staff as well as from our CQC inspection report and other local and national requirements. Further improving the quality and safety of our services is one of our four main areas of focus this coming year and includes supporting Sherwood Forest Hospitals (SFH) to deliver sustainable safety improvements as we further strengthen our partnership in the run-up to the proposed merger of NUH and SFH.

In the coming year, we plan to progress a number of long-awaited developments at QMC. This includes beginning construction work on the new helipad, a Nottingham Hospitals Charity-funded scheme that will support our Major Trauma Centre. The second major development is a dedicated tram entrance that will link the increasingly popular QMC tram stop to the main hospital, improving access for everyone.

Plans to digitise our hospitals will take another significant step forward as we complete the roll-out of Digital Health Records – eventually replacing all the 1.6 million paper records we hold across QMC and City. I recognise that this project has been a significant change for many colleagues and not without its challenges but over time will bring significant benefits to patients and how we work. We will also upgrade some of our major hospital IT systems, notably in Theatres and in our Emergency Department to make them more efficient and fit for the future.

We will continue to invest in the development of our staff and leaders so we can attract and retain the very best people at our hospitals. This includes better understanding our workforce requirements for the future and doing ever more to look after the Health and Wellbeing of our staff. The proposed merger with SFH will bring fresh opportunities for staff and their careers. The new organisation will be one of the largest in the country, bringing with it the prospect of a lifelong career in Nottinghamshire for those who choose this option and new experiences for many other colleagues.  

Looking to the coming year, we are pursuing an application valued at around £30million for a Biomedical Research Centre (BRC) with our partners, which will replace the existing Biomedical Research Units (BRU) in April 2017. Our proposal includes NUH’s existing two BRUs in gastrointestinal disease and hearing in addition to new proposed themes in respiratory, musculo-skeletal, mental health and neurodegeneration. There will also be a cross-cutting imaging theme as one of Nottingham’s notable research strengths. We look forward to hearing the outcome of our proposal later this summer and further strengthening patient participation in research across our hospitals. Our ambition is that every patient in our hospitals will have the opportunity to participate in research, through the conversation they will have with their doctor/nurse.

2015/16 was our most challenging year financially since 2006. Despite saving £44.5m (our target was £44m) we recorded a £47.2m deficit. This year will be equally, if not more challenging, with a deficit currently forecast to be £55m (although contract negotiations have not yet concluded). This assumes the Trust makes savings of £41.3 million (4.5%), which includes reducing our reliance and spend on nurse agency staff (£23.8m in 15/16). As we prepare to transition to the new organisation later in 16/17, we are developing a long-term plan to make the new organisation (NUH and SFH) financially sustainable.

Read a summary of our 16/17 annual plan and our ‘direction of travel’for 2016-2021. 

You can read my recent series of blogs reflecting on each of our Quality Priorities below.

Wednesday, 8 June 2016

Inpatient survey results

Taking the time to really listen, non-defensively, to how patients feel about their care and treatment is one of the ways we continually improve.  While it can be uncomfortable to hear when these experiences do not live up the standards we set and expect of ourselves, most of the time, the feedback we receive from patients is what we would want it to be.

The latest (annual) inpatient survey results released today by the Care Quality Commission give us an important insight into what patients think and feel about their recent experiences of care at our hospitals.  This annual ‘stocktake’ also helps us to understand how we do compared to other hospitals and therefore identify what we are doing well, and where we need to pay greater attention to improve the experience of our patients and their families.

On the whole, our results make good reading. Patients’ satisfaction levels with our hospitals and the services we provide has improved in a number of areas compared to the previous year, including:

  • The time it takes to get to a bed on a ward from arrival
  • Help available from staff to eat meals
  • Getting understandable answers when asking nurses important questions
  • Being given enough privacy when discussing a condition or treatment
  • Being given enough privacy when being examined or treated
  • Having enough notice about being discharged
  • Feeling well looked after by hospital staff while in hospital
The results also show the areas where we have more to do. We didn’t do as well as the previous year when it comes to giving patients the right information and advice before they leave hospital. Our Patient Information team are leading improvements in this area, working closely with our ward teams and patients.

Do keep your feedback coming… you can do so ‘there and then’ when you are in hospital with our ward teams, via the Friends and Family test, Twitter (@nottmhospitals) or Facebook, via the Patient Opinion or NHS Choices websites and through our  Patient Advice and Liaison Service (PALS).