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p Trust Board CEO report September 2022

National context

On Thursday 8 September, the country entered a national period of mourning following the passing of her late majesty, Queen Elizabeth II. With this, in line with government guidance, we paused our external communication and events, and many of our planned internal activities, unless operationally essential or for the purposes of patient or staff safety. Colleagues joined together in a memorial service held on Tuesday 20 September, and our union flag was flown at half-mast during the ten-day period of national mourning.

We are acutely aware of the current economic climate regarding the cost of living challenges experienced by both colleagues and patients, impacting their personal and professional lives, from energy and food costs to petrol prices. We are coordinating our response with Buckinghamshire Council and I will highlight in this report some of the initiatives we are putting in place to support colleagues where we can.

In August, Advanced, who provide several types of software used in the healthcare industry, experienced a cyber-attack. Oxford Health NHS Foundation Trust, who provide mental health services in Buckinghamshire, experienced significant disruption to some of their digital systems. For us, the attack led to the switching off of our financial reporting and procurement software to protect our internal systems from risk, as well as one system used in both our Urgent Treatment Centres. I would like to extend my thanks to colleagues for implementing business continuity plans and working through these challenges, as well as our suppliers for their patience during this period.

In line with guidance issued by NHS England, we are adapting to living and working with COVID-19 and have paused routine asymptomatic testing by colleagues, unless working with particularly vulnerable patients. We continue to operate our services with additional COVID-19 infection prevention and control measures in place and pay close attention to local and national infection rates.


Outstanding care

Key performance data are reported through the Integrated Performance Report (IPR) and supporting narrative provided. I acknowledge that our performance in the Emergency Department remains around 70% against a target of 95%. We also continue to focus on our delivery of cancer care; the volume of patients waiting is illustrated by our performance against the 62-day target. Further detail and supporting narrative are provided in the IPR.

At our Board Seminar in July, we were pleased to welcome Professor Jacqueline Dunkley-Bent, Chief Midwifery Officer for NHS England and National Maternity Safety Champion for the Department of Health. Professor Dunkley-Bent took us through key maternity safety messages and the ways in which we as a Board can seek to gain assurance of the quality and culture of our maternity services.

As of month 5 we remain on trajectory to hit our financial plan but I would like to bring to the attention of the Trust Board the risks to our financial forecast due to the current energy market. These are two-fold: the cost, which could be significantly greater than budgeted; and the fact that at the time of writing we have been unable to secure a deal. The typical annual cycle for Stoke Mandeville Hospital (through our PFI contract) is to procure energy twice a year for the six months ahead; this year the energy market is so uncertain that we have yet been able to do this. All other sites are on a fixed term deal until March 2024.

For 2022/23 we budgeted £7.5M, a growth of £2.3M from last year (44%). Current market prices suggest an outturn at £9.2M, although this is changing regularly, and markets are as yet too volatile to land on a price. We await more details on the proposed business cap cap from the government and will keep the Board updated as and when we know more firm details.

We have received our External Audit from Grant Thornton for the financial year 2021-22. The report gives the Trust an unqualified audit opinion, and makes seven recommendations regarding our efficiency plans, continuing to refine our Board Assurance Framework and Corporate Risk Register, oversight of procurement activity at Board level, monitoring of operational performance, and responsiveness to recommendations from internal audit reports.

Healthy communities

We continue to experience challenges in finding suitable onward care for patients who are medically optimised for discharge; the numbers on our acute inpatient wards are the highest they have ever been at almost a fifth of our adult acute beds. Key challenges are capacity both to complete assessments in a timely fashion and domiciliary care capacity. We are working closely in partnership with Buckinghamshire Council to try to find different ways of creating the capacity needed and we expect to re-establish the Olympic Lodge facility in October. This is a key focus of the integration programme as referred to in the place briefing appended to this report.

In the meantime, some of the demand for community care is being absorbed by our Rapid Response & Intermediate Care (RRIC) team and this is contributing to the reduction in their caseload reported through the IPR.

In other community services, we continue to increase our urgent community response offering and for the first time, include a trajectory for our virtual wards – one of the ways we will be increasing capacity and supporting discharge of patients from acute inpatient settings.

I am delighted to share that Rachel Platt, a young, local garden designer, has very generously chosen to donate her ‘Covid recovery garden’ from RHS Flower Show at Tatton Park, to our organisation. The garden received several awards at the show, including People’s Choice and a Silver Gilt medal. It has been rebuilt over the summer at Brookside Clinic, one of our community sites in Aylesbury where we deliver podiatry, sexual health services and our community head injury service. The beautiful space will provide an area for rest and quiet contemplation for colleagues and patients alike, and our clinical teams are planning innovative ways in which it will benefit patients and service users. Unfortunately, the official opening of this garden was one of the activities we postponed due to the national period of mourning, but I look forward to joining Rachel, colleagues and service users soon.

We were pleased to welcome Sarah Green, MP, to visit our therapy pool at Amersham Hospital and see how aquatic therapy benefits our patients. Further details including photos from the visit are available on our website.

Great place to work

We have already started to see the cost of living challenges impacting our staff retention rates and it is a common theme when I speak with colleagues. Appended to this report (Appendix 4) is a brochure being posted to colleagues’ homes, outlining the various programmes available to all colleagues and which we hope many will take advantage of.

I am also pleased to highlight the Buckinghamshire Healthcare Food Collaborative, a newly established venture in partnership with Wycombe Food Hub, Sodexo, and Medirest launching imminently at the time of writing this report. Through this we aim to offer colleagues easy access to groceries at a reduced price and delivered to their place of work. Initially this will be non-perishable goods although our ambition is to expand this to include that requiring fridge or freezer storage. The success of this venture will be by nature bittersweet, but I hope it helps to relieve some of the stress that I know colleagues currently face.

In September our programme for COVID-19 booster vaccinations began, soon to be followed by that of influenza. Once again both jabs are being offered to all colleagues and we encourage everyone to take this up for their own health benefit, and to help protect colleagues, patients and visitors.