r Trust Board CEO report July 2022
This report aims to provide an update on key developments over the last couple of months in areas that will be of particular interest to the Board. Appended to this report is a list of the fantastic winners of our Trust CARE Value awards for April and May (Appendix 1), and a summary of Executive Management Committee and Transformation Board meetings over the last two months to provide oversight of the significant discussions of the senior leadership team in other areas (Appendix 2).
Like the national picture of NHS services, our Trust has been experiencing significant pressure in recent weeks. We have seen an increase in the numbers of colleagues testing positive for COVID-19 and either isolating and working from home or needing to take sick leave. This has added to the challenge of ensuring safe staffing levels across our sites. On top of this, the extraordinary temperatures we have seen in recent days have meant the Trust has operated under our Heatwave plan with additional support for hydration, air conditioning and fans where appropriate in terms of infection, prevention and control, and working from home to minimise unnecessary travel where possible.
These pressures come at a time when colleagues are continuing to recover, mentally and physically, from the past two years of working through a global pandemic, and I would like to take this opportunity to extend my gratitude to Trust colleagues as well as those in our partner organisations, for their continued dedication to delivering services for our patients and service users, and each other.
CQC inspection report
The Care Quality Commission (CQC) performed an unannounced inspection of our medical and surgical services in February 2022, followed by a well-led inspection in March. The CQC have now published their report of the Trust based on their findings during the days that they visited us as well as requested information that we submitted.
I am very pleased that the CQC have maintained our overall rating of ‘Good’, as well as ‘Outstanding’ for the ‘Caring’ domain. This is a remarkable achievement given the events of the past two years and the context at the time of the inspection, notably the high demand for our services in winter and following the peak of the COVID-19 Omicron variant, as well as associated staff absences. I personally feel privileged to work alongside colleagues who have been able to maintain a caring and compassionate attitude in their dedication to our patients and service users at such an incredibly difficult time.
The CQC identified several areas for improvement, some driven by known challenges in our estate, and reduced our rating for the ‘Safe’ domain to ‘Requires Improvement’. We acknowledge that coming out of such a tumultuous time, we have work to do to ensure the fundamentals of safe patient care are routinely in place and there is lots of work underway by many towards this.
The CQC improved the Trust rating in the ‘Well-led’ domain, which is now ‘Good’. This domain reflects the leadership and governance systems in place across the organisation and I am very pleased that the inspectors were able to see we have made progress in these elements since our last inspection in 2019. Of particular note, the report sites: “the Trust has an open culture where patients, their families and in general staff could raise concerns without fear”. Establishing a speaking up culture in NHS Trusts has been a significant focus over the past several years since Sir Robert Francis’ Freedom to Speak Up review in 2015 so, while every organisation will always have more it can do, I am pleased that this was something the inspectors noticed about BHT.
Performance and recovery
Significant focus remains on seeing patients as quickly and safely as possible.
In terms of urgent care, we continue to have challenges in seeing some patients in our Emergency Department (ED) within the timeframes that we aspire to and have recorded 71.9% performance against a target of 95% for the percentage of patients spending 4 hours or less in ED in June.
Ambulance handover times have been the subject of national news recently and for June we are reporting 27.3% against a target of 65% of handovers taking 15 minutes, and 78.6% against a target of 95% of handovers taking 30 minutes or less. Work continues in earnest with partners to improve the flow of patients through the hospital, focusing on facilitating discharge of patients who are medically fit to leave hospital.
For those patients waiting for planned care, a lot of hard work continues across all specialties, including a focus on those who have been waiting the longest. I would like to reiterate my thanks to members of the public for their patience while waiting for their appointments or treatment.
We are paying particular attention to the performance of our cancer services. While we are meeting our target of seeing 95% of patients referred for cancer testing within two weeks, due to the large numbers of patients waiting to be seen following the pandemic, we know there are many patients waiting at the next stage in their cancer pathway, whom we would typically expect to see within a maximum of 62 days. As of Friday 15 July, 342 patients had been waiting for longer than 62 days. We recognise this does not provide the experience we want to offer our patients, at what can be a particularly anxious time, and are working hard to improve this through enhancing our administrative processes so that patients receive communication as quickly as possible; expediting surgery where we can; and working with colleagues in neighbouring Trusts to help our patients see an oncologist.
We expect to be able to report an improvement within the next couple of months and are aiming for the number of patients waiting longer than 62 days to be reduced to fewer than 200 patients by the end of September.
In the community, we are currently performing above the 80% target for patients with urgent referrals seen within two hours by our community teams (the Urgent Community Response services); however, our total waiting list for community services has been growing over the past few months and we have more to do to meet the demand for our services.
I would like to draw attention to the latest project to be rolled out in our digital programme – we have just launched Intellispace Critical Care & Anaesthesia (ICCA) in our intensive care units at both Stoke Mandeville and Wycombe Hospitals. ICCA is a digital application which enables charting, prescribing and clinical noting and is integrated with existing systems for patient monitoring. It will replace the current non-digital records used in the units. My thanks to our teams for their continued hard work enabling this.
In May we recorded seven instances of clostridioidies difficile infection and four in June. We reported zero instances of MRSA bacteraemia infection in May and June. In May we recorded 423 births and 375 in June; in the same months we recorded 78 and 89 deaths, respectively. We did not report any never events in May, however, I am disappointed to confirm that on 1 July we reported an incident that had occurred a few days prior in June, had met the criteria of a never event. A guide wire was found to have been retained during a chest drain. This has been discussed with the patient involved and the guide wire removed, and colleagues involved are being supported. A full investigation is now taking place.
We continue to learn from what we have done right as well as where our patient care may not have met the high standards that we aspire to. In May we recorded 37 formal complaints and 39 in June; in total we received 164 excellence reports in these two months.
The following is an example of the personal and compassionate care we aspire to deliver at all times:
“XXX supported the admission and treatment of a very challenging paediatric patient. The surgical team which the child was admitted under were unsure whether this child would be able to attend and proceed with their treatments because of the level of her anxiety. XXX was able to build a relationship of trust with the child and enabled [the child] to remain calm throughout her admission. An excellent example of patient-led, compassionate care.”
We are currently experiencing challenges in responding to enquiries via our Patient Advice and Liaison Service (PALS) and formal complaints. This is due to staff resourcing issues which are being rectified but, in the meantime, I know that those currently using these services may not have experienced the high standard that we continually strive to deliver, and I would like to apologise for this. Our teams are doing their utmost to communicate and respond within the expected timeframes, and we greatly appreciate the public’s patience at this time.
People and Partners
Under the Health and Care Act 2022, from 1 July two core parts of the Buckinghamshire, Oxfordshire and Berkshire West Integrated Care System (BOB ICS) became statutory bodies: an Integrated Care Board (ICB) which amongst others takes on the functions of the Clinical Commissioning Groups (dissolved on 30 June) within the area; and an Integrated Care Partnership (ICP) which has responsibility for delivering a health and wellbeing strategy for the system together with local authorities and other key partners.
I would like to welcome Philippa Baker as ICB Place Director. Phillipa has a wealth of experience in the public sector, most recently overseeing delivery of the Health and Care Act 2022 through Parliament. We look forward to working closely with Philippa and the rest of the Integrated Care Board, further details of which can be read here: https://www.bucksoxonberksw.icb.nhs.uk/what-is- the-icb/our-board-leadership/.
I would also like to take this opportunity to congratulate Dan Leveson, Deputy Director of Strategy, for his appointment as ICB Place Director for Oxfordshire. Dan has worked for our organisation since 2018 and has been instrumental in developing our corporate and clinical strategy, as well as engaging with our communities on many initiatives during this time. This promotion is a tremendous achievement for Dan and I have no doubt he will lead great things for the health and wellbeing of our neighbouring county.
In June we celebrated our annual staff awards – One Team, One Goal – with several categories including but not limited to: Quality Improvement & Innovation, Lifetime Achievement, People’s Award for Personal and Compassionate Care, Volunteer of the Year, and Rising Star. It is always a highlight of the year taking time to celebrate our colleagues and especially reading their nominations. As an NHS Trust we are lucky to work with dedicated people who have a huge variety of skills and expertise in many different specialties, several of whom are leaders in their fields, and it is wonderful to have the chance to recognise when individuals and teams go above and beyond.
We were also able to celebrate 30 years of Scannappeal, a charity that fundraises for equipment for several different fields. Since being established in 1987 they have raised a total of £16m and funded equipment in every major department in our hospitals. I would like to take this opportunity, on behalf of the Board, to thank the charity and especially all of the volunteers, both past and present, for the incredible support they have given, and continue to give, to our organisation and our patients and service users.
Proud to be BHT
In the height of the COVID-19 pandemic, Olympic Lodge was set up in a joint initiative together with colleagues in social care from Buckinghamshire Council. This was a pilot of an integrated discharge hub with the aim of providing a setting for patients who are medically fit to be discharged from hospital but who require ongoing care. I have appended to this report a poster (Appendix 3) outlining the project and its successes in more detail. I look forward to using the evaluation of this pilot to inform future initiatives in partnership with Buckinghamshire Council.
The Thames Valley Trauma Network recently conducted a peer review of the performance of our trauma units. The review made several recommendations but did not raise any immediate risks or concerns. They highlighted “many areas of good practice” and were “impressed by the proactive and often innovative solutions that have been implemented and the level of care by the teams involved at the trauma unit”. My congratulations to all the clinical, operational and support teams involved in the service.
The Trust has been awarded the Ministry of Defence Employer Recognition Scheme Silver Award by the Reserve Forces’ & Cadets’ Association for the South East. Four years ago we started our journey in formally recognising our support for veterans of the armed forces under the Armed Forces Covenant and I am grateful for the huge amount of work by many colleagues to ensure our services meet the needs of these members of our local population. Work now continues in our ambition to achieve the Gold Award.
Huge congratulations to Mr Edward Arbe Barnes, one of our junior doctors, who has won the F1/F2 Research Award in the prestigious 2022 Dr Falk-Pharma/Guts UK Charity national awards for his investigation in the biology of tumours in pancreatic cancer titled: ‘Single Cell RNA Sequencing of Pancreatic Ductal Adenocarcinoma (PDAC) Epithelial Cells’. Lots of colleagues lead and participate in research in different areas across the Trust and it is always brilliant to see individual projects receiving such significant awards.
In June we held several celebrations. At the start of the month we joined the nation in decorating our wards and offices in honour of Her Majesty the Queen’s Platinum Jubilee. Many colleagues went to huge efforts to create extraordinary displays and celebrate as a team in their breaks. My thanks to those who showed particular dedication to our patients and fellow colleagues by working over the weekend and bank holidays.
We also celebrated our amazing volunteers during Volunteers’ Week. We currently have over 320 active volunteers providing invaluable support to patients and colleagues in many different parts of the organisation, from ward support and meal-time companions to gardeners.
June was also Pride month and this year marks 50 years since the events that led to the establishment of LGBTQ+ rights. I was honoured to raise our new Pride Progress flag outside the main entrance of Stoke Mandeville Hospital and join the celebrations with colleagues. We have more to do to ensure everyone feels they can bring their whole selves to work, but I hope that our open and visible support to this community helps towards our ambition to be an inclusive organisation and a Great Place to Work.
Lastly, I would like to thank the RAF Halton recruits who recently volunteered in the gardens at our Brookside Clinic. Their hard work has helped hugely to progress the development of a new garden for use by colleagues and users of our Community Head Injury Service. We are extremely grateful for their support.