n Trust Board CEO report October 2022

National context

NHS England published a new Operating Framework on 12 October, setting out how the NHS will function under the 2022 Health and Care Act, including the accountabilities of Integrated Care Boards following the establishment of Integrated Care Systems as statutory bodies in July this year. As a ‘provider’, we are required to continue to meet our statutory responsibilities for delivery of healthcare and compliance with our provider licence and the Care Quality Commission standards. A copy of the framework is available here.

NHS England have also issued further guidance regarding winter resilience planning, including a series of actions to maximise bed capacity including through virtual wards, establishing a community falls response service, and continued focus on reducing the number of patients waiting for planned (‘elective’) care. The guidance also emphasises the importance of offering vaccinations for influenza and COVID-19 to all healthcare colleagues and continued activity regarding COVID-19 testing.

Outstanding care

Like much of the country we have been experiencing continued high demand on our services over the past few weeks, particularly through our Emergency Department at Stoke Mandeville Hospital, with high numbers of acutely unwell patients arriving and requiring admission. The number of patients in our hospitals who are medically optimised for discharge also remains high, partly due to the known challenges in social care capacity.

On Thursday 6 October 2022 we declared a critical incident because it was increasingly difficult to maintain safe care for all our patients. Significant dedicated work by teams across the organisation over the subsequent 48 hours meant we were able to stand this down by the weekend.

Key performance data are reported through the Integrated Performance Report (IPR) and supporting narrative provided. The aforementioned challenges in delivering care within the time that we aspire to are reflected in the data presented for September, particularly in emergency care and cancer. I would note our particularly challenging performance against the cancer 62-day standard, recognising this does not represent the high quality of service we endeavour to offer our patients. Resuming trajectory is a considerable focus for colleagues in multiple teams and disciplines, reflecting the cross-service nature of cancer pathways.

In Amersham Hospital, our new skin centre opened on 13 October with dermatology currently running some services from here, soon to be joined by teams from our plastics services. The centre will increase capacity and enable more flexibility and a better experience for our patients.

As of month 6 we remain on trajectory to hit our financial plan at the end of the year and have a particular focus on our temporary staffing spend, which has been driven higher than planned partly due to the aforementioned significant activity pressures.

Healthy communities

The demand on our services continues to extend to our community services. Through our partnership working with Buckinghamshire Council we are starting to develop a more sustainable model of integrated intermediate care and will be sharing more details of this programme with the Buckinghamshire Health & Adult Social Care Select Committee next month.

At Health & Wellbeing Board this month we reviewed the Buckinghamshire Health & Wellbeing Strategy, which the Board will see included later in the agenda of this meeting. We discussed the Strategy in our Executive meeting and agreed the importance of ensuring our activities align with the priorities in this Strategy and support the delivery of the goals identified.

Our public involvement and engagement team, working alongside the Medical Examiner, Bereavement, Mortuary, Chaplaincy and End of Life teams, invited over 50 national and independent funeral directors to a stakeholder event. The role of a funeral director is heavily linked with our Trust but also provides an integral service within our local community. The relationships built with our local funeral directors are key to both organisations providing caring and empathetic services at what is often quoted as being the worst moment in someone’s life. It was a valuable opportunity to share information, listen to stakeholder’s views and understand where improvements could be made to our services. Thank you to those who gave up their valuable time to attend this event.

I was delighted to be invited to Lindengate, a local mental health charity that offers health and wellbeing opportunities through nature. We have an established partnership with Lindengate through our Health & Wellbeing team and they provide bespoke sessions for our colleagues, as well as supporting some of the gardens on our sites. It was fantastic to join with other local businesses and organisations to hear about their recent achievements and recognitions as a charity.

Great place to work

At the end of September my Executive colleagues and I spent some time with colleagues across the Trust in senior leadership positions to review our priorities for the remainder of the financial year, discuss our winter planning, and start to think about how we will approach business operational planning for 2023/24. I thank everyone who participated in the day for their time and energy.

In September we celebrated Great Big Green Week with a variety of events designed to encourage us all to make small changes to live greener lives, reflect on our impact on the environment, and enjoy the local countryside. I was pleased to participate in the Reflective Reading Club in which we discussed an article on embedding sustainability in nursing and midwifery education.

For World Mental Health Day on 10 October I was humbled to be interviewed alongside two of my Executive colleagues by our lead Clinical Psychologist. In this video we share our personal thoughts on mental health, including our own experiences that have made us feel anxious. Statistically one in four of us experience challenges with our mental health, and the significant pressures both over the last few years and currently, make prioritising our mental health all the more important, especially for colleagues in healthcare services.

October is Speaking Up month and each week our Freedom to Speak Up team have organised an opportunity for colleagues across the Trust to come together to debate and discuss issues relating to theme on Speaking Up. I was pleased to be asked to participate in the session on Civility in which we explored some of the data and evidence of negative interactions that some of our colleagues have been experiencing.

I was pleased to welcome our latest cohort to join our Trainee Leadership Board. The Board will remember the impressive projects previous cohorts have produced during their short time in our organisation, and I look forward to seeing the ideas and initiatives this group develop over the months ahead.

As a final note, I would like to welcome Steve McManus as interim Chief Executive of the Buckinghamshire, Oxfordshire & Berkshire West Integrated Care Board from the end of this month. My colleagues and I look forward to working with him in this capacity, as well as Dr Janet Lippett, Chief Medical Officer at Royal Berkshire NHS Foundation Trust (RBFT), who is stepping into the role of Chief Executive at RBFT.