k CEO report September 2023

National and system update

In August I wrote to the organisation following the unimaginable actions of Lucy Letby, and I have attached the letter all NHS organisations received from NHS England (Appendix 1). I am a firm believer that it is our role, and that of the NHS, to provide a place of safety and care to the most vulnerable in our community – a responsibility that we should put above all others. Our strongest defence against a similar event occurring here, is the culture within which we work – one that listens; values hearing feedback, no matter how good or bad; and strives, amongst all our competing priorities, to do the right thing as a result. The events are a reminder of the critical importance of having a culture of speaking up, and our Freedom To Speak Up Guardian (FTSUG) has conducted a gap analysis of our services against the five priorities outlined in the letter from NHS England. This will be reviewed by the Executive Management Committee this month, and subsequently reported at the next Strategic People Committee. Whilst this review identified no material gaps, there are areas we can further improve including more proactive outreach work with international and student nurses who are new to our organisation, and how the FTSUG team links in to the Board sub-committee focused on quality. We are also on track to adopt the national FTSU policy by January 2024.

There has also been significant national news regarding the risk of failure of RAAC (concrete) in public buildings including schools and hospitals. When this was first highlighted as a potential issue in hospitals, we undertook a detailed desktop review of all sites, and carried out intrusive testing at both Stoke Mandeville and Wycombe hospitals during 2020 and 2021 under NHS England guidance. We were also part of the NHS RAAC oversight group, one of 30 trusts in England. At the time we confirmed that none of our hospital sites have RAAC and the Trust Board received a report to this effect in September 2021.

Ongoing national industrial action by junior doctors and consultant bodies continues to have a significant impact on our services, contributing to delays in providing outpatient appointments or planned procedures. We would like to extend our continued gratitude to those that have been affected for their patience and understanding.

Colleagues will have seen the government’s commitment to ‘Martha’s Rule’ following the tragic death of Martha Mills and campaign by her mother, Merope Mills. Whilst patients or relatives can already request a second medical opinion if they have concerns about their care, we will review our processes to confirm we have a structure to ensure this takes place if requested.

Outstanding care

Key performance data are reported in the Integrated Performance Report with supporting narrative. It now includes a slide summarising the measures we are focusing on this year through our ‘breakthrough’ objectives (i.e. those which we are using to tell us if we are on track with our multi-year goals.

In terms of performance in urgent and emergency care (UEC) and cancer, we are starting to see some improvement overall in UEC metrics, which is particularly important as we head into the winter period. We are also seeing some improvement in our 62-day cancer performance, as well as in length of stay. We do continue to experience significant challenge on our diagnostic performance, and substantial planning is going in to driving improvements.

I am delighted to congratulate our Inpatient Pain Team who have won the Deteriorating Patients and Rapid Response Initiative of the Year at the HSJ Patient Safety Awards. The Mobile Block Unit provides rapid regional anaesthesia for patients admitted with traumatic rib fractures at risk of deterioration – the first for an NHS Trust in the region. Winning this award is fantastic recognition for a passionate team striving to deliver exceptional patient care.

The team are also shortlisted for this year’s HSJ Awards alongside our breast unit who were one of the first in the UK to offer the MagTotal approach to improve the surgical process for treating some breast cancers. Read more about both services here.

I am pleased to advise we have received funding to build a new unit at the Stoke Mandeville Hospital site to provide space for up to 21 additional inpatient beds to boost capacity. It is hoped this new unit will help to lessen the wait faced by patients arriving in our Emergency Department need to be admitted to hospital and is due to open early next year. The cost is coming out of £250 million of government funding allocated to NHS hospitals to increase capacity as part of the national Urgent and Emergency Care Recovery plan.

Earlier this year we attended the Buckinghamshire Health and Adult Social Care Select Committee to seek approval to develop Wycombe as a centre of excellence for ante and postnatal care; the papers and webcast for this meeting on 11 May 2023 can be viewed here. At its meeting on 20 July 2023, the HASC confirmed its support for this change and requested updates in due course on key performance data and service user engagement; papers and draft minutes from the meeting can be viewed here.

The Care Quality Commission (CQC) National Adult Inpatient Survey report findings have been published from data collected in November 2022 and can be read here. The survey involved 133 NHS acute trusts in England. 463 of our adult inpatients responded to the survey, which was equivalent to a 38.4% response rate. Our results were broadly in line with other trusts, despite November 2022 being a particularly challenging time for the organisation due to high demand for inpatient and emergency services. However, we were disappointed to score worse than most other trusts for: food; opportunity to give views on the quality of care; and being prevented from sleeping particularly due to hospital lighting. Actions to address these areas will be monitored and reviewed by the Quality & Clinical Governance sub-committee of the Board.

Earlier this year the CQC visited Stoke Mandeville Hospital paediatric emergency department to conduct an unannounced focused investigation following concerns raised around early detection of sepsis and the robustness of incident investigations. The inspectors found that children and young people were receiving safe care with leaders running services well. We were also pleased that they reported that our colleagues felt respected, supported and valued. However, whilst the overall findings of the inspection were positive, there were some areas highlighted for improvement which we are addressing. The full report can be read on the CQC website here.

We also had a planned inspection from the CQC of our maternity services at Stoke Mandeville Hospital. We are currently awaiting the final report from their inspection and will update the Board when the results of their findings are published.

This month we celebrated World Health Organisation (WHO) World Patient Safety Day. This year the focus of this international day was ‘Engaging Patients for Safety’ with the slogan “Elevate the voice of Patients!” This was timely as we begin our transition to the new Patient Safety Incident Response Framework (PSIRF), a new approach to responding to patient safety incidents.

Healthy communities

Congratulations to our sexual health service which has been supporting the national response to the Mpox outbreak since June last year. I have appended a thank you letter from NHS England (Appendix 2).

Our Research & Innovation (R&I) team has close links with the University of Buckingham Medical School, and it was a pleasure to be involved in the final judging of the third year medical Student Selected Component on Clinical Innovation and Enterprise. The groups worked on real-life problems faced by colleagues working in fast-paced clinical research at Stoke Mandeville Hospital. My thanks to the R&I team for their time and energy in supporting the development of our next generation of clinicians.

Our new Bright Futures @BHT work experience programme has just been awarded the Silver Quality Standard by NHS England. The new standard helps healthcare organisations to quality assure their work experience placements, assessing planning, delivery and evaluation. It also aims to ensure that all learners across the country can access high quality exposure to health careers regardless of location or organisational interpretation. Since we piloted this in February this year, we have welcomed more than 250 students on individual work experience or small group workplace visits across the Trust. Creating an early talent pipeline – engaging and upskilling our local workforce supply – is vital to fulfil future workforce requirements. Work experience is also key to delivering the NHS Workforce Plan: we need to ensure enough young people are interested in pursuing a healthcare career if the expansion of training places is to be successful. The Schools Engagement Team are now developing plans to achieve a Gold Award, and applications for 2023/24 academic year placements are now open here.

Great place to work

In line with the national vaccination programme, we have begun our internal campaign to offer COVID-19 and flu vaccinations to all colleagues.

Huge thanks to the 30 employees from Shirley Parsons recruitment, who spent the afternoon working in our gardens at Brookside Clinic in the centre of Aylesbury earlier this month. Brookside Clinic is where several of our community health services are based, and the gardens continue to go from strength to strength; it is wonderful to see a local business engaged in helping our colleagues and patients through improving their outdoor space.

Finally, it was an honour to be invited to join in and speak at the Bucks Kerala Nurses celebration this month, reflecting the Kerala Festival Onam. Our workforce is increasingly diverse and with this comes welcome opportunities for all of us to learn about beliefs and cultures that may be different from our own. My thanks to colleagues working in services across the Trust for putting on such a special and vibrant event.

See full PDF report for appendices:

Appendix 1 – NHS England letter verdict Lucy Letby case
Appendix 2 – NHS England MPox Programme letter
Appendix 3 – CARE Value awards
Appendix 4 – Executive Management Committee and Transformation Board
Appendix 5 – Place & System Briefing