Friday, 2 December 2016

Putting the priority on safety

This week I was delighted to be invited to the Trent Simulation and Clinical Skills Centre at NUH. The team at the Centre do fantastic work developing safety skills and behaviours in individuals and teams taking their mannequins, simulated patients and human factors knowledge around the Trust to make NUH even safer for our patients. This time,  I was invited to the centre to meet the Healthcare Safety Investigation Branch (HSIB) who were visiting NUH. Patient safety is and must always be the priority for NUH, so the opportunity to discuss how we can improve learning when unintended events occur in healthcare, particularly with the soon to be functional HSIB, was very welcome.

HSIB will be operational from April 2017 and while their scope is yet to be confirmed, it was positive to learn how they will undertake certain investigations, but also provide an exemplar approach to investigation of incidents, with support and guidance to NHS organisations. The discussions orientated around how we can improve our learning processes; we owe a debt to patients who have been harmed while in our care and must do everything we can to prevent future occurrence. While it may be impossible to completely remove errors in healthcare, we can certainly do our  best to minimise them as far as humanly possible.

Talking about incidents can often be seen as negative, but the conversations were very positive and provided an opportunity to explore NUH’s new approaches to improving patient safety. Much research now considers how we can also learn from excellence and successful outcomes despite staff facing complex and difficult situations. This focus on celebration and resilience has been embraced with a new pilot of a “Learning from Excellence” reporting system across certain areas at NUH, including in the Nottingham Children’s Hospital. The anticipation is that this will provide vast learning to help minimise incidents by learning from “where things go well,” as well as celebrating staff success. We hope to roll out “Learning from Excellence” to wider areas across NUH from 2017.

“Learning from Excellence” is just one new safety initiative at NUH, with others including enhancing learning from our electronic observation systems, electronic handover, sepsis screening, medications safety, patient involvement in safety, developing high-performing teams through the NUHTEAMS programme and integrating more processes into incident analysis that help truly explore influences on performance.

The enthusiasm of the improvement teams is evident. They are passionate and committed to improving care and experience for both patients and staff. Often this work is done as an extra to their day jobs and recognition is well deserved. They are honest with the challenges that they face, but also willing to share to help others overcome similar problems.

We end the year at NUH with an ever-growing mountain of innovative programmes aimed at improving patient safety and the quality of care that patients receive. There is no doubt that these programmes make patients safer and NUH a better place to work for staff.

This week we started our ‘Advent Actions and Festive Facts for Safety’ messages to celebrate, each day during December, our 2016 safety success stories and areas we need to give greater focus as part of our continuous improvement. You can find these daily messages via @nuhstaff and on the intranet.

And of course, don’t forget, the deadline is approaching for this year’s Patient Safety Awards (13 Jan) – find out more here. Let’s celebrate our safety achievements. Our Communications Team can help with nominations x65063/

Roll on 2017!

Friday, 25 November 2016

‘Oh what a night’!

Celebrating outstanding achievements and contributions with 400 plus members of ‘teamNUH’ at the NUHonours Awards tonight was undoubtedly one of the highlights of 2016.

Over 650 individuals and teams were nominated for NUHonours, in the year we celebrate 10 years of NUH, 10 years of the Nottingham Hospitals Charity and 10 years of NUHonours.

And what a night it has been. To see how much receiving this well-deserved recognition means to our staff was worth its weight in gold.

We don’t often get to ‘let our hair down’, given the nature of the busy jobs we each do, where every minute counts. It’s been a tough year for staff working at NUH, and the wider NHS. And for this reason, never has recognising and celebrating our staff been so important. And Friday night was another reminder to me of the truly talented and committed people we are lucky to have the pleasure of working with at our hospitals. Listening to the success stories and achievements on Friday and saying ‘thank you’ to our teams who could not work harder for our patients, was just incredible.

Thank you to Mike Sassi, Editor from The Nottingham Post for being such a brilliant host and demonstrating the strength of NUH’s relationship with our local media. There were a few sentences in Mike’s column that will feature in next Wednesday’s special NUHonours supplement in the Post that stand to me and which I would like all NUH staff to hear. He wrote: “The staff at NUH keep our hospitals running 24 hours a day, 365 days a year and have always performed brilliantly. And they continue to perform brilliantly. They skill and hard work is worthy of the highest praise. We are indeed lucky to have such a dedicated band of healthcare professionals always on-call to look after us……Their desire to make a difference is unrelenting. Patients and families are hugely grateful…….. Thank you for your care. Thank you for your professionalism. Thank you for being there when we need you.”

A very well-deserved pat on the back from our local newspaper, giving credit where credit’s due.

Thank you also to other ‘known’ Nottingham faces and our partners who supported NUHonours this year – whether attending in person or via the medium of video to express their appreciation to our staff.

I look forward to reading more about our 2016 winners in the special supplement that will feature in The Post and be available (free) at the entrances at QMC, City Hospital and Ropewalk House on Wednesday 30 November.

For now though, what a way to see out the year. Let’s celebrate members of ‘team NUH’ who were this year’s nominees and shortlist, and of course our class of 2016 winners.

Carers’ Rights Day: supporting and involving carers

I’ve been taking a closer look at the amazing role carers play in our society,  as often unsung heroes, supporting the people they care for.

Some of the facts I read were quite startling. Did you know that there are over 7 million carers in the UK? That’s 1 in 10 people.

Here are a few more statistics;
  • At least 3 out of 5 people will become a carer at some point in their lives
  • 65% are older carers (60-94yrs)
  • There are 700,000 young carers. That’s about 1 in 12 secondary aged pupils, with the average age being 12
  • By 2030, only 14 years away, the total  number of carers in the UK will increase by 60%
  • The economic contribution made by our carers is estimated at £132 billion per year

Today marks Carers’ Rights Day today, and the campaign this year is focusing on ‘Missing out? Know your rights.’  So what can NUH do to make sure our carers are not missing out during the time they are with us?

First and foremost, we have our Carers Policy. This sets out how we should work in partnership with patients and carers to make sure that carers feel safe, confident and included in the care of patients and decision-making during their hospital stay.

There are some simple steps we can take to better help and support our carers and their friends/families, including:

  • Asking friends and family of patients if they are the primary carer
  • Give Carers and ask them to carry our Carers Passport
  • Ensuring that the ‘About Me’ form is completed
  • Highlighting the information about carers in the bedside folders
  • Involving carers in key decisions
  • Supporting carers by signposting where they can find support,  in the community or from  

There is always more we can do to maximise the support we provide carers right across our hospitals, not just in our healthcare of the elderly wards. It is so important that we involve carers in discussions with patients, including where patients may have capacity to make decisions yet are confused. In this scenario, carers can play a vital role in ensuring that patients really understand what is happening next in their treatment and are able to talk through the decisions that are being made about their care.

And finally, I mentioned our Carers Passport, and I was so pleased when this was shortlisted recently for a national award by the Academy of Fabulous Stuff. The awards event was held yesterday at the O2 and although the Carers Passport didn’t go on to win in its category, being shortlisted just goes to show what a great idea it is.  The Carers Passport is now being rolled-out and used in other hospitals across the UK, and I’d like congratulate everyone involved in putting the passport together for their hard work and innovation – such a simple idea that can make such a real difference to the experience of patients and their carers. 

Thursday, 24 November 2016

NUH Just Does It

This afternoon I had the privilege of hosting our second 'Just Do It' showcase for 2016. I really welcome the opportunity these events give the Board to meet and give recognition to the individual colleagues and teams behind the excellent ideas which have made things better for our patients, visitors or staff. 

This time we’ve had some great ideas put in to practice by our colleagues in Midwifery, Spinal, Wards C4 and & B3, and our Infant Feeding Team. One 'Just Do It' I particularly liked was from Michelle Emsley and Penny Tindall in our Spinal Inpatient Team. Their idea was to introduce a special hands-free drinking bottle, which enabled their patients with spinal injuries to keep themselves hydrated and regain a sense of independence.

The many thousands of ideas that have been put forward over the last 5 years have been instrumental in improving the care and support we provide to our patients, and their carers. The ‘Just Do It’ culture has become synonymous with ‘NUH’ and the way we do things in Nottingham.

Our 'Just Do It' Awards are not only about recognising the achievements of staff who have been inspired to turn a good idea into good practice, but importantly are about showcasing these ideas to staff who work in other parts of the Trust and sharing good practice. They are also an opportunity to promote our improvement work with our patients and local community, and I was delighted that members of the public were able to join us for the showcase this afternoon.

Ideas are really easy to put forward. If you have something you'd like to see changed for the better (no matter how big or small) and you would like to ‘Just Do It’  send it via our online ideas form by clicking here.

If your Just Do It idea requires a little bit of financial support (up to £2,500), you can apply for funding from Nottingham Hospitals Charity’s dedicated Just Do It fund by following this link.The idea is that Just do Its are quick and easy and you will hear back from the Charity within a few weeks about your request for funds to implement your idea. To date, our Charity has funded £113,000 worth of Just Do Its. Thank you!

For now, very well done to all our Just Do It ideas makers for their wonderful achievements, and thanks to all who support and help make these ideas happen.

As our friend Roy Lilley said recently:

“The Just Do It Initiative at NUH is so important. So many places I go, the frontline have to get permission to change things and it’s a whole palaver. But NUH ‘just does it’ and that’s the whole point; changing things from the ground up. The front line knows best what needs to be changed.”

I could not agree with Roy more.

More good news - I've just heard our 'Just Do It' scheme has been recognised nationally, winning an award at the Academy of Fabulous stuff's awards ceremony at the O2 this afternoon. Well done to everyone who has put forward a 'Just Do It' idea, you are an inspiration to us all.

Notts STP – responding to the ‘burning platform’

If we do nothing differently as a health and social care system in Nottinghamshire, we will face a funding shortfall of a staggering £628million by 2021.

We have a burning platform, and this means the status quo is simply not an option if we are to deliver a financially and clinically sustainable health and social care system for our patients in Nottinghamshire.

Through the Nottinghamshire Sustainability and Transformation Plan (known as the STP), which has been published today - our shared task as a health and social care system is to do all we can to close the financial gap and design our future ‘system’ based on what is affordable. The STP also sets out how we will tackle the two other main challenges we face as a system, notably how local services will work together to improve the quality of care and the population’s health and wellbeing between 2016-2021. NUH plays a critical role in addressing, with our partners across Nottinghamshire, each of these challenges.

Our hospital services are operating under relentless pressure, as I write about frequently in my blogs. Demand is rising inexorably year on year. Patients, particularly those admitted in an emergency, are sicker, frailer and older, and stay in hospital for longer.

The STP is the solution to the very real financial and demand challenges we face. It is the only game in town – no longer an option, but a necessity. More of the same isn’t the answer – in terms of how we do things, how we deliver care and how we work with one another as health and social care system leaders. We need changes at every level to deliver true transformational change in Nottinghamshire.

We have signed up to an ambition to reduce demand on our hospitals through increased system investment and redesigned working in prevention, primary and community services. Hospital services will be re-scoped to meet future demand.

As we look ahead to what the future needs to look like - our acute hospital resource will be smaller, with only patients who need acute and specialist care coming into hospital, and staying only as long as they need acute or specialist care or treatment.

One of the headlines that will inevitably attract interest in the Nottinghamshire STP is the ambition to redesign the health and social care system to enable the reduction of 200 NUH beds (aiming for 100 in 17/18 and 100 in 18/19).

Many will inevitably ask whether this is a realistic prospect at a time when demand continues to increase year on year and our hospitals are so pressured.

The answer is this: if we can find a way to re-orientate health and social care, including services provided in the community, we will no longer require the number of beds we have now and this reduction will be achievable. Without different community services being in place as an alternative to hospital care and without work to reduce demand on our hospitals, this won’t be achievable. Every partner has signed up to the STP on the basis that we believe this is possible – if we all think and work differently. This will mean very different models of delivering care in the future, which will of course be the subject of engagement and where necessary consultation with patients, carers and the local community in due course.

The full STP sets out where the system will focus its efforts to bring the required changes to achieve a sustainable health and social care system in the future. There is a summary version too. This is just the start of the conversations about the STP and ‘what next’ for Nottinghamshire. Health and social care in Nottinghamshire is on a 'burning platform' and cannot stand still. The STP is our system strategy for the future.

Tuesday, 8 November 2016

Help us plan for transport in the future

Planning for the future transport needs of patients, visitors, carers and staff is a difficult task without the help of a crystal ball.
It’s seems like only yesterday we talked about the amazing prospect of linking QMC to Nottingham City’s new tram network.
That ‘distant prospect’ has now been a reality for some 15 months, with QMC the only hospital in Europe with a tram station on the campus. We can look forward to the new pedestrian footbridge opening Summer 2017 that will link the tram platform to the main hospital, completing the vision of a hospital served by a 21st century transport network. But this doesn’t mean we can stop planning for the future.

City Hospital, QMC and Ropewalk House all have transport challenges that require wide and ongoing consultation with patients, visitors and staff.
That’s why we carry out a biannual staff and patient survey to get an insight into the lived experiences of people who travel to and from our hospitals.
It was feedback from these surveys that led us to changing our staff car parking permit scheme to free up more spaces at both QMC and City Hospital for those who most need to park on site.
Information received from the travel survey also influenced the expansion of our popular (and free) Medilink service to cover more hours with greater frequency. 
But these are just two examples of how your feedback directly impacts our future transport planning. The survey covers all forms of transport, spanning those who choose to use public transport, car drivers, cyclists and walking to access our hospitals and services.    
It is vital that we know your travel preferences so we can improve our facilities and lobby partners to improve theirs.
I would be very grateful if you could take a few minutes to help complete our latest travel survey (for patients and visitors or staff and students) on our website.

Monday, 7 November 2016

Respecting patients' time and its value is a system job

I write as a follow-up to the blog I posted last month about the 1,000 days concept. After some helpful feedback from clinical colleagues and emergency care/frailty experts, I’d like to set the record straight. 

My earlier blog was in no way intended to suggest that NUH staff are not doing all they can to minimise patients’ stay in hospital. I know from the walkabouts and frontline visits I do every month that NUH colleagues are working incredibly hard to ensure that patients don’t have to stay in hospital any longer than is absolutely necessary.  Our significantly improved SAFER results (which are among the best in our peer group) demonstrate this.  I share the frustration of colleagues on the frontline at the barriers - often outside of the individual’s or even the organisation’s ability to influence - which get in the way of being able to achieve this.

What I wanted to emphasise in my earlier blog is that a whole system response is required if we are to make the step-change needed so that patients towards the end of their lives get a better experience from the health and social care system.  The required system changes (which the recent Emergency Care Improvement Programme visit highlighted) are on many levels – including changing culture (from an institution to a system focus) and improving the information systems across health and social care that enable our frontline teams to deliver better care for patients. We need to dedicate more time to reducing the treatment and investigation burden for our frail older patients.  Importantly, we need to acknowledge that talking to and making plans about the next steps in patients’ treatment and often their destination of care, takes time, and that these can be really difficult decisions for patients, families and carers to make.

We all know that we operate in a very complex system and there are no quick fixes for many of the challenges we face.  However, the reality is that on any given day, around 200 patients are in NUH beds who could be cared for elsewhere. Not only is an acute hospital bed the most expensive bed in the health and social care system, we all know that it’s also not the best place for someone who has no need for the acute hospital interventions we provide.  Our job, collectively, is to tackle this so that, over time, as many of these patients as possible can be cared for at home or in primary, community or social care when they have no need for acute hospital treatment and care.

Patients’ time is the most important currency in healthcare and timely discharge of patients is one of the many measures that impacts on this. Our job in NUH and across the system is to support our teams to  give patients as many precious days to spend with their loved ones as possible. We are doing this by introducing the concept of ‘red’ and ‘green’ days; ‘red’ when nothing happens to positively contribute to minimising a patients’ length of stay with us and ‘green’ the opposite. We have trials starting at QMC, at City and also in the Community this month as we aim to get every patient and every ward having more green than red days.   I will report back on the results of our trials in a future blog.

We are also working with our community partners to streamline the information we share with one another about complex patients and on discharge to avoid unnecessary duplication of work and wasted time. Better use of technology by frontline staff is similarly releasing more time every day – precious time that is valued by patients and staff alike.