t Trust Board CEO report May 2022

Introduction

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 six fantastic winners of our Trust CARE value awards for March and April (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).

In response to the government’s Living with COVID guidance, some visiting restrictions have relaxed and there is no longer a need for visitors to book in advance or provide proof of a negative lateral flow test. From 3 May two infection prevention and control pathways were introduced: respiratory and non-respiratory to assist in managing the placement of patients across our sites. All colleagues and visitors are currently required to continue to wear surgical face masks at our healthcare settings (at the time of writing) and specialist Infection Prevention and Control (IPC) advice continues to play a critical role in how the Trust adapts to Living with COVID whilst also ensuring we stay prepared for any increase in cases. We marked World Hand Hygiene Day on 5 May which focused on public and patient engagement of hand hygiene this year, using the phrase “Don’t ‘Splash and Dash’ when it comes to handwashing”.

From 1 April, the requirement for NHS staff to isolate if a household member was positive was removed, enabling non-symptomatic colleagues, testing negative, to come into work. This has had a positive effect on colleague sickness absence levels which we experienced another peak of at the end of March and in early April. The Occupational Health and Well-being team continues to support COVID-19 positive colleagues and works closely with the Infection, Prevention and Control team to support outbreak management.

Earlier this month we held a Leadership Day with colleagues across services, focusing on delivery of the operating plan for 2022/23, which was submitted to the Integrated Care System (ICS) last month. Regionally, further work is required on financial sustainability alongside increased activity levels to address recovery challenges.

A key enabler for delivery of the plan is IT and Digital and I am delighted to announce the appointment of Duncan Dewhurst as Chief Digital and Information Officer. Duncan is currently Director of Transformation at Central London Community Healthcare Trust and brings a wealth of experience from across the public sector. Ian Roddis will remain as Interim Chief Digital and Information Officer until Duncan’s arrival, before returning to his substantive role of Digital Director and I am very grateful for all his support.

In the ICS, I look forward to working with the independent non-executive members who joined the new Buckinghamshire, Oxfordshire and Berkshire West (BOB) Integrated Care Board (ICB) in their designate roles at the beginning of this month. Recruitment to permanent executive director roles is also underway.

Performance and recovery

The Trust is continuing to make improvements on reducing the overall size of the elective waiting list. Recovery continues to be a key focus and we have successfully been reducing the number of patients with extended wait times. There are no longer patients waiting more than 104 weeks in any of our specialities and we continue to work towards making further progress.

Urgent and emergency care performance remains a challenge, as reflected across trusts nationally. In March, the percentage of patients spending 4 hours or less in the Emergency Department from arrival to departure was 69.7% and 71.3% in April, against a target of 95%. Disappointingly, 12 hour waits were reported at 6.9% in March and 5.6% in April, against a 2% target. Ambulance handovers also continue to be a particular issue with the number of ambulance handovers taking over an hour recorded as 115 in March and 66 in April. We continue to work closely with partners at System and Place to improve capacity and reduce attendances.

Performance in our cancer services against the metric for urgent referrals for suspected cancer to first outpatient attendance in 2 weeks was 91.3% in March and 92.1% in April, against a 93% target. The percentage of patients treated in month within 62 days was 47.0% in March and improved to 70.1% in April. A key focus for the service has been on seeing patients waiting the longest for treatment, following referral and successfully eliminated all waits over 104 weeks.

In the community, our total number of contacts was 47,199 in March and 43,380 in April. The Urgent Community Response services are a key element of our community provision and admission avoidance. A 2-hour response is typically required when a person is at risk of admission due to a sudden deterioration in their health. The percentage of urgent referrals from community services or 111 seen within 2 hours was 84% in March and 87% in April, above the 80% target.

Congratulations to the Wycombe Hospital nursery team who received a “Good” overall rating from a recent Ofsted inspection. All four areas: the quality of education; behaviour and attitudes; personal development; leadership and management were assessed as good and the report noted the team’s dedication and hard work.

Ofsted and the Care Quality Commission (CQC) also conducted a joint inspection of the area of Buckinghamshire to judge the effectiveness of the area in implementing the special educational needs and/or disabilities (SEND) reforms. The report published on 29 April identifies strengths and areas for development across the local area. The outcome of the inspection was that a Written Statement of Action (WSOA) is required because of significant areas of weakness in the area’s practice. The responsibility for the submission of the WSOA to Ofsted is held jointly by the Clinical Commissioning Group (CCG) and Local Authority. We will work closely together with our partners to address these points, including how we better meet the needs of children requiring speech and language therapy and occupational therapy, and the length of wait times some families are currently experiencing for some diagnostic assessments and consultations.

Learning

I was pleased to be a part of the re-launch of Reflect & Review (formerly ‘Lessons Learned’) which is the monthly forum for clinical and non-clinical colleagues across the Trust to learn from examples of excellent patient care and examine areas for improvement in a safe space. The name Reflect and Review describes a process by which we examine previous events, look at what went well and where we could improve and then aim to use these insights to improve as an organisation, to provide outstanding care, to develop healthy communities and to make the Trust a great place to work.

In March we recorded one instance of clostridioidies difficile infection and four in April. We reported zero instances of MRSA bacteraemia infection in March and none in April. In March we recorded 382 births and 358 in April; in the same months we recorded 94 and 81 deaths, respectively. There have been zero never events reported since October 2021.

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 March and April we recorded 69 and 46 formal complaints respectively. 67 excellence reports were received in March and 60 in April.

The following is an example of the personal care we aspire to deliver at all times:

“The Wycombe critical care team provided skilled and compassionate care to a young patient with a degenerative neurological disease who came into the ICU in a crisis situation because of a breakdown of care in the community and their high care needs (ventilation). In exceptional circumstances I witnessed the nursing team go above and beyond to deliver care professionally, sensitively and with kindness to the patient and family. High emotion was often directed at the staff over a very prolonged period. Working closely with the CCG and the palliative care team staff enabled the patient to achieve their wish to go home, where they received their final end of life care. The experienced palliative care team lead commented to me on the exceptional level of compassionate care she had witnessed on the ward.”

People

The results of the annual NHS staff survey were published on 30 March. 56% of our workforce responded which is significantly above the average response rate for trusts in this sector and I am very grateful to colleagues who took the time to share their experience of working in the Trust which will enable us to align our key areas of focus and support over the coming year with the valuable feedback received. This year the themes in the national survey were changed to align with the NHS People Promise, so it is not possible to make a year on year comparison, however I was pleased to note that as a Trust we scored at or above the national average in 8 out of 9 of this year’s themes. I am particularly proud that ‘we are compassionate and inclusive’ was the People Promise with the highest ranking and scoring.

April was Stress Awareness month and we shared advice with colleagues on managing stress with and arranged workshops to provide support on protecting well-being during challenging times as well as advice and workshops on other topics related to improving physical and mental health. The additional support offered by the well-being team mentioned in my last report has also continued. The new health and well-being centre at Stoke Mandeville Hospital opened last month which brings together all Occupational Health and Well-being services into a dedicated space.

On 6 April, we also officially opened the ‘Peace Garden’ at Stoke Mandeville Hospital, with the support of funds raised by local community groups. The garden now provides colleagues with a restful and peaceful place to take a break from their busy working environments. I am very grateful to Lacey Green and Loosley Row Community Action Groups, Princes Risborough Rotary Club and Loosley Row Garden Group for their continued support.

For our Muslim colleagues observing Ramadan which began in April, the Chaplaincy team prepared fasting gift packs containing dates, water a local prayer schedule and a disposable prayer mat. Advice was also shared with clinicians and managers on the potential impact of fasting on patients and colleagues and considerations that may be helpful to discuss. Over the last two months we have also enjoyed celebrating Vaisakhi, Easter, Eid al-Fitr and Holi, celebrating the diversity of our workforce.

In the Workforce Race Equality Standard data report 2021, I was pleased to see the Trust is named as showing sustained, long-term improvement for recruitment under the indicator of relative likelihood of white applicants being appointed from shortlisting compared to BME applicants. The team will be reviewing the highest performing Trusts to see what we can learn from them.

Our second annual Nursing and Midwifery conference took place on 6 May chaired by the Chief Nurse and her team, aiming to provide inspiration and career development for our nurses and midwives and to celebrate their immense contribution to the Trust. The theme this year was ‘the courage of compassion’ and guest speakers included Acosia Nyanin, South East Regional Chief Nurse; Duncan Burton, Deputy Chief Nursing Officer for England – Workforce & Maternity Operations and Kaye Wilson, Regional Chief Midwife, amongst others.

Last week we continued on this note with Learning at Work Week, encouraging colleagues to use the opportunity to learn something new or try something different during the week and highlight some of the great learning options available in the Trust and support offered. The theme this year was ‘Learning Uncovered’ and various events took place across the week.

To celebrate International Nurses Day 2022 on 12 May we encouraged our nurses to share a photo of when they were newly qualified, with a few words about why they enjoy being a nurse. We also celebrated national Operating Department Practitioners (ODP) Day on 14 May when ODPs at the Trust shared stories about their career pathways, delivered career talks and welcomed visitors, demonstrating anaesthetic and surgical equipment to inspire the next generation of local talent.

Proud to be BHT

I was saddened to hear of the loss of Tracey Geddis, Advanced Nurse Practitioner in neurogenic bladder management. Shortly after her death, Tracey was awarded Urology Nurse of the Year 2022 at the British Journal of Nursing awards on 25 March. She dedicated over 30 years of her career to the care of patients with a spinal cord injury and sharing gold standard practice internationally. She was a key part of the National Spinal Injuries Centre (NSIC) Team and has provided a legacy and an aspirational role model for those who had the privilege to work with her. Honouring Tracey at the event and accepting her award were colleagues from the NSIC. Zoey Pullar, Lead Nurse, and Hester Dunne, Tissue Viability Clinical Nurse Specialist, paid tribute to Tracey’s dedication to the care of patients with a Spinal Cord injury and the inspiration she has provided to those who worked with her. The NSIC Bladder and Bowel team were also awarded third place for their work during lockdown in the Cauda Equina Service. Anita Bryant, Bladder and Bowel Nurse, and Hazel Landymore, Advanced Occupational Therapy Practitioner, represented Tracey and the team for this award.

The South East Regional Chief Nurse, Acosia Nyanin visited the Trust at the end of March and was shown around some services at Stoke Mandeville Hospital. At the end of the visit, Acosia surprised four of our nurses by presenting them with the prestigious Chief Nursing Officer and Chief Midwifery Officer Silver Award – recognising major contributions to patients and the profession: Head of Nursing Acute Paediatrics Sally Harrison was nominated for being a dedicated children’s nurse, supporting the development of a fantastic team who deliver consistent high-quality care to children in Buckinghamshire; Matron for Palliative and End of Life Care Liz Monaghan received the award for being an outstanding, kind and caring leader. Liz also introduced the Purple Rose initiative which improves care for patients and their loved ones in the final days of their lives.

Advanced Nurse Practitioner in Haematology Asha Mathew was recognised for her contribution as an important part of the specialist senior nursing team who has been integral to supporting the recruitment of overseas nurses from her home country of India; and Consultant Nurse Jo Birrell was honoured with the silver award as an exceptional nurse who has dedicated the majority of her 37-year nursing career to be a voice for older and frail patients. I am extremely proud to work with such dedicated inspirational individuals.

On 5 May it was International Day of the Midwife and two of our community midwives, Hannah Tuson and Becca France were given the Alison Heffernan award on the day. The award celebrates excellence in maternity services and is voted for by women and families who have had a baby under the care of the Trust in the last year. The awards were set up in memory of the late Alison Heffernan, Chair of the Maternity Services

Liaison Committee which is now the Bucks Maternity Voices Partnership (Bucks MVP). Other events also took place to celebrate our wonderful midwives and members of our maternity teams for all they do for families and their babies every day of the year.

The Trust is pleased to announce that it is ‘Veteran Aware’ having received formal recognition on 6 April 2022, from the Veterans Covenant Healthcare Alliance (VCHA). VCHA is a group of NHS healthcare providers in England committed to providing the best standards of care for the armed forces community, based on the principles of the Armed Forces Covenant. This accreditation recognises our work in identifying and sharing best practice across the NHS as an exemplar of the best standards of care for the Armed Forces community.

I was very pleased to hear that the ICU team was ‘Highly Commended’ at the recent Proud of Bucks awards. This recognition is a testament to the dedication and hard work of each individual in the team. On 10 May I joined Karen, Specialist Nurse for Organ Donation, Matthew, Clinical Lead for Organ Donation and members of the ICU team to officially open the new Organ Donation lift wraps at Stoke Mandeville Hospital. The wraps are on the lifts near the main entrance and match those installed at Wycombe Hospital in November 2019.

Finally, I was delighted to see Stoke Mandeville Hospital acknowledged in the latest book by Dr Amanda Brown, The Prison Doctor. There is a note to colleagues on the inside cover which expresses her gratitude to the team, following the death of her husband. A further acknowledgement is also included in the ‘The Final Sentence’:

“… During his short and savage illness, David was lucky enough to be looked after by some truly remarkable people in Stoke Mandeville Hospital to whom I will be forever grateful. The care he received was outstanding, and the kindness and compassion shown to me was beyond anything I have ever experienced before. Hospital staff, many of whose names I never knew, helped me through the darkest and saddest time of my life. They hugged me when I so desperately needed to be hugged. My heartfelt love and thanks to every single person who cared for David during the last weeks of his life, from the porter in A&E who wheeled him away from me when he first arrived, to the magnificent team in ITU where he died. You will never know the impact your kindness has had, and will always have, on my life.”

 

Neil Macdonald
Chief Executive