w Trust Board CEO report May 2021
In this report I 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 eight fantastic winners of our Trust CARE value awards for the last two months (Appendix 1), and a summary of Executive Management Committee and Transformation Board meetings to provide oversight of the significant discussions of the senior leadership team in other areas (Appendix 2).
Quality, performance and recovery
We recognise that we, like many others, have a significant road ahead to expand and transform our services so that we can see and treat the many patients who have been waiting for appointments or interventions in a safe way. Our clinical, operational and support service teams are working extremely hard both to see patients as quickly and safely as possible, while ensuring that those who are waiting continue to have clinical oversight. We are working together with Buckinghamshire, Oxfordshire & Berkshire West Integrated Care System (BOB ICS) colleagues to meet the required targets of a national initiative called the Elective Recovery Fund (ERF). This is a fund of £1 billion to support elective activity to incentivise increasing the value of activity delivered above 2019-20 baselines. There are monthly targets of increasing value. I am pleased to confirm we have been able to increase our activity levels, delivering the following for April:
(% of 2019-20)
The ERF is also subject to the BOB ICS meeting a number of gateway criteria, including: addressing health inequalities; transforming outpatient services; implementing system-led elective working; tackling the longest waits; and supporting staff. Within the Trust we are confident that work is underway to meet these.
At the start of this month we submitted our operational plan for the first six months of 2021-22, which for the first time has been prepared together with BOB ICS partners across the system as per requirements from NHS England & Improvement (NHSE/I). The plan includes the following: workforce capacity and recovery; continuing to meet the needs of patients with COVID-19; maximising elective activity; delivering improvements in maternity care including the recommendations of the Ockenden Review; implementing population health management and personalised care approaches to address health inequalities and improve outcomes; transforming community services and improving discharge of patients from hospital. I would like to take this opportunity to thank the teams involved for all the hard work in pulling this plan together in collaboration with our BOB ICS partners.
In our emergency department (ED), work continues to improve how the department and the pathways that support it perform. Though we continue to have challenges, we have made improvements since my last report, reporting 82.6% for March and 82.0% in April against the 4-hour target of 95%. Focus has also been on reducing the number of people in department with a total length of stay of twelve hours, reducing our Medically Optimised for Discharge numbers and our ambulance handover times.
Performance of Cancer services has improved as measured by the 62 day cancer treatment standard. Whilst we have not achieved the standard, we have overachieved the faster diagnostic standard, which requires us to have diagnosed or excluded cancer within 28 days of referral. This reduces the amount of time patients carry uncertainty about their condition and as well as being an important quality improvement it allows more time to arrange treatment.
In April I was pleased to meet with the Regional Chief Midwife at NHS England and Improvement alongside our Head of Midwifery and clinical teams to review our submission and action plan in response to the Ockenden review of maternity services. A clear area of focus was the current and future challenges relating to midwifery staffing and I am pleased to report that we have recently been successful in recruitment of our third year midwifery students, who expressed interest in remaining at the Trust following registration. This is the highest number of entrants we have had in the last few years.
In March we recorded two instances of clostridioidies difficile infection and six in April. We reported zero instances of MRSA bacteraemia infection in March and April, and zero never events in the same months. In March we recorded 422 births and 426 in April; in the same months we recorded 114 and 87 deaths respectively.
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 47 and 48 formal complaints respectively, and 43 and 31 excellence reports. The following is an excellent example of the patient-centric care we aspire to deliver at all times:
“Dr *** conducted a thorough assessment of a gentlemen with Parkinson’s disease who had repeatedly expressed a wish to die. Dr *** demonstrated excellent interpersonal skills, navigating some exceptionally challenging verbal behaviour by the patient, to allow the patient to honestly reflect the true impact of his illness on his quality of life. The assessment, which was excellently documented in the medical notes, reflected advanced care planning, the physical and psychological impact of the patient’s illness and a through capacity assessment. Dr *** had liaised with the patient’s GP and next of kin to gain a thorough understanding of the patient’s psychological and physical condition prior to his admission to hospital, providing essential background knowledge for the assessment.”
In my last report I introduced Thrive@BHT, our two-year programme to support the recuperation of our colleagues following the significant challenges of 2020-21 and our ongoing ambition of making our Trust a great place to work for all. As well as dedicated wellbeing support to some of our most affected teams, one of the first components of this programme is the Trust-wide rollout of ‘REACT’ mental health training for all managers. REACT stands for: Recognise, Engage, Actively Listen, Check Risk, Talk about a plan, and this comprehensive rollout is designed to ensure managers can identify individuals in their teams who would benefit from wellbeing and/or mental health support, as we know it can be difficult to identify it in oneself.
I am also pleased to share that we are once again offering £15 to all colleagues to spend on something that supports their wellbeing, and in recognition of the extraordinary events of 2020-21, are giving all individuals an additional day’s leave as a Wellbeing Day. We have received lots of positive feedback from colleagues and hope that these two initiatives will both encourage our people to invest in their personal wellbeing and give them the opportunities to do so.
Recognition of our people when they excel or go the extra mile is an extremely important part of our organisation and this year more than ever it will be a delight to celebrate those who have been so fundamental to our story of the COVID-19 pandemic: on 20 May we will be announcing, albeit in a slightly different way this year, the winners and runners up in our annual Staff Awards. I look forward to sharing more in my next report to the Board.
As digital transformation will be a continued key focus for the Trust, I am delighted to welcome Ross Fullerton who has joined the Buckinghamshire Integrated Care Partnership as Interim Chief Digital & Information Officer. Ross joins us from the London Ambulance Service where the projects he was responsible for included the digital technology underpinning 999 services and more recently leading the strategic recovery from COVID-19.
Finally, we have all been shocked and saddened by the news from India over the last few weeks. Many colleagues have friends and family in India, as well as in other countries, where COVID-19 is having a devasting impact. In addition to our existing wellbeing support services, we have asked managers to be flexible in meeting requests from their team to call friends and family for compassionate reasons during work hours as we know that this can be a problem with different time zones around the world. We have been hosting weekly ‘drop in’ virtual meetings during May with a focus on linking up with and supporting colleagues who have friends and family overseas. We have also put in place a fund to support colleagues who need to travel to countries on the “Red List” at short notice and may have difficulties in meeting the additional costs of travelling to these countries.
Place and System
Domestic Violence and Abuse (DVA) was discussed at the ICP Board Chairs‘ meeting in April where lead officers for DVA proposed a post lockdown strategy and communications plan. This is an area that affects all partners in the ICP and has been highlighted as a priority for collaboration this year. A new Domestic Abuse Board has been formed and met in shadow form in March. Key leads across the ICP will also be involved in a DVA strategy working group to drive forward this area of work.
Over the last few months, our investment in infrastructure is helping us to transform the way that we can deliver care to our patients as we traverse the pandemic landscape. We have been actively building on the work we started with our integrated care partners in the delivery of Carecentric, the local shared care record. All partners now have access to this record embedded within their systems allowing access to shared information at the point of care. Over the next few months, we look forward to working collaboratively to use this platform to transform the way we deliver care across Buckinghamshire. The ICP has recently signed up to the Combined Intelligence for Population Health Action (CIPHA) collaborative, enabling access to national data analytics dashboards fed from the information held within our local shared record dataset. We are working with our partners to develop novel ways to use our population health information to deliver efficiencies in reducing our waiting lists and identifying any potential areas of health inequalities.
The 2020-21 financial year ended with the Trust reporting a full year break even position in line with the plan agreed with NHS England & Improvement and BOB ICS. The group consolidated Trust position including our wholly owned subsidiary, Buckinghamshire Healthcare Projects Ltd, was reported as £0.1m surplus.
For the first month of the new financial year 2021-22, the Trust reported a break even position in line with plan. This included £0.8m spend on COVID-19-related expenditure. Our full year forecast was reported at £22.3m deficit, in line with our draft annual plan which includes delivery of a £16m efficiency plan.
Proud to be BHT
May has been a time to recognise and celebrate some of our wonderful colleagues and raise awareness of just some of the careers opportunities that exist within the Trust. We have had the International Day of the Midwife, International Nurses Day and Operating Department Practitioners Day.
We held our very first virtual nursing conference, ‘The Courage of Compassion’, on the 7th May 2021. We would like to extend our thanks to all our guest speakers who included Professor Dame Elizabeth Nneka Anionwu, Dr Crystal Oldman CBE, CEO Queens Nursing Institute, Andrea Sutcliffe CBE, CEO and Registrar of the Nursing and Midwifery Council and Professor Jacqueline Dunkley-Bent OBE.
In April, we marked the 20th anniversary of the Trust’s first cohort of Filipino nurses. In April 2001, over 35 nurses made the long journey from the Philippines to Buckinghamshire to start a new life followed by a further group later that year. Two decades later, over 30 of these nurses still work for the Trust and are key members of the local Filipino community. The community has grown considerably and in October 2020 the Kalinga Bucks Filipino Health Professional Organisation launched. It now has over 200 members and is open all Filipino healthcare professionals who live and work within Buckinghamshire.
Many congratulations to our colleagues who have been shortlisted for the Bucks Health & Social Care Awards. The four people and two teams who have been nominated are: the research & innovation team, the critical care team, school immunisation team, Ornella Ortensi (trauma and orthopaedics), Megan Howe (A&E and NICU), Marianne Reyes, (dialysis unit) and Hazel Nyack-Kaseke (ophthalmology). The results will be announced on the 21st May 2021.
Finally, many of colleagues have taken time to reflect on the last year and we have launched our own internal virtual wall of reflections with blogs, poems and pictures to capture their experiences and feelings about the pandemic. Our Junior Doctors Forum has also organised an art exhibition with drawings and paintings created by our colleagues during lockdown. The standard is outstanding and you will be able to view some of their work on the Trust’s website.