w Trust Board CEO report March 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 four fantastic winners of our Trust CARE value awards for January (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).
Over the last few weeks, we have watched the shocking and disturbing events that have unfolded in Eastern Europe and my heart goes out to all those directly impacted and their friends and family. The events are distressing for us all and I would encourage each of us to take care of ourselves and to reach out if further support is needed. Please also take the time to look out for and support others who may be finding the situation particularly difficult to watch.
I would encourage anyone who wishes to make a donation to support the people of Ukraine to do so. The Buckinghamshire Council website links to an appeal that has been launched by the UK’s Disasters
Emergency Committee (DEC) to help Ukrainians fleeing the conflict in Ukraine. At the Trust, we have also supported co-ordination of key items for donation to be transported to Ukraine, at the Olympic Lodge, which closed on 11 March.
This is a difficult and troubling time for our colleagues who are still dealing with the additional pressures of the COVID-19 pandemic. We have increased the well-being support available to our people, including provision of two additional well-being days that can be taken in addition to annual leave. We held a well-being webinar on: ‘Supporting our colleagues with their children’s anxieties developed and exacerbated by the COVID-19 pandemic’ and following the success of this, we will be holding a second webinar on: ‘How to support your child during current world events’ which will be led by a consultant Clinical Psychologist for children and a Clinical Psychologist in the community paediatric service.
Due to the threat of the Omicron variant and the increase in the vaccination programme, a Level 4 National Incident was declared on 13 December 2021 and the NHS still remains at Level 4. COVID-19 cases in Buckinghamshire are currently very high and despite restrictions recently being reduced across the UK, there is currently no change to our guidance at the Trust. The safety of our patients, residents and colleagues remains our priority and social distancing, personal protective equipment (PPE) and self-isolation measures still apply. This includes the requirement for colleagues, patients and visitors to wear a surgical face mask in healthcare settings. In light of the Living with COVID-19 plans published by the government, national visiting guidance is being revised but, in the meantime, our current visiting policy with restrictions remains in place.
The COVID-19 vaccines are a key part of our plans to keep people safe and well. We are now running vaccination clinics for 12-15 year-olds, as well as 5-11 year olds who are immunosuppressed. A fourth vaccine or a spring booster has also been recommended by the Joint Committee on Vaccination and Immunisation (JCVI) for those aged over 75 or those with a weakened immune system. Following the success of the first specialised vaccination clinic, the Trust has arranged a second session this month, for people in Buckinghamshire who have a learning disability or who are autistic, and their family members.
The outpatient pharmacy at Stoke Mandeville hospital is relocating to a purpose-built pharmacy
situated between the outpatient and emergency departments on Wednesday 30 March. The current outpatient pharmacy in the Mandeville Wing will be closed from 30 March and will reopen with reduced opening times from 4 April.
Following his introduction in my last report, I am delighted to officially welcome Raghuv Bhasin to the Trust and to his first Trust Board meeting. Raghuv joined us earlier this month as Chief Operating Officer and has since been meeting with a number of colleagues and partners. Once again, I would like to thank Gavin MacDonald for his support and leadership through this challenging interim period. Gavin will be leaving us at the end of March and we wish him all the best.
I am also pleased to welcome Ian Roddis to the Executive team as our new Interim Chief Digital and Information Officer. Ian has been working in the Trust as a Digital Director, with Ross Fullerton. Ross will also be leaving us at the end of this month and I am grateful for all his support.
I would like to officially congratulate David Williams who started a new role as Executive Lead for the BOB ICS Acute Provider Collaborative, last month. I am thankful to David for all his hard work as Director of Strategy and particularly on leading on the development of the new Trust 2025 Strategy. Dan Leveson, Deputy Director of Strategy, will continue to support the development of the strategy and the health inequalities programme.
The Care Quality Commission (CQC) conducted an unannounced inspection at the Trust last month to inspect surgical and medical pathways at Stoke Mandeville and Wycombe hospitals. Earlier this month, the CQC also carried out an inspection of the Trust’s leadership and governance, using the ‘Well-led’ framework. We are awaiting reports of these inspections and I expect to be able to share further details in my next report.
We have been working on the Trust’s operational plan for 2022/23. We have developed a planning framework that aligns individual workstreams and national operating plan guidance with our strategic priorities and a draft version of the plan, including financial and workforce plans was submitted to BOB ICS this month, to be incorporated into the overall ICS plan. The final operating plan is due for submission to the ICS on 28 April 2022.
Performance and recovery
Whilst the Trust is continuing to make progress, we are very aware that people are having to wait longer than we would like for elective procedures, diagnostic tests and in our Emergency Department. Recovery continues to be a key focus and we have successfully been reducing the number of patients with extended wait times.
Urgent and emergency care remains very busy which is reflected in Emergency Department performance – both in the Trust, and also nationally across the country. We have taken a number of actions to address challenges, including opening escalation capacity and the intermediate care facility at the Olympic Lodge. However, the impact of COVID-19 on domiciliary care and care home capacity means that we have not been able to discharge patients as quickly as we would like to. Daily huddles have commenced to plan the efficient use of resources and improve the patient experience as well as to discuss all patients reaching a 12-hour wait, to address issues and optimise care pathways.
Following a successful ‘Operation Reset week’ run in January, when we increased the number of patients that we were able to safely discharge, we ran another similar operation in February. The aim of these weeks was to ensure that our assessment areas, such as surgical assessment, same day emergency care and the emergency assessment unit could operate as assessment areas rather than becoming additional inpatient wards. This enabled us to improve patient flow by ensuring our patients were treated in the most appropriate place, which in turn improved their experience. At the same time, we focused on helping patients to return home or discharged them to one of our step-down community services as quickly as it was safe to do so. This freed up acute beds for those who needed them most which is vitally important as we continue to experience exceptional capacity challenges.
Cancer performance against the 2-week wait and 62-day standard was not delivered last month. However, there was a reduction in the overall backlog by 209 patients. Improvements for cancer patients are being delivered through the cancer recovery plan which is being monitored through the Cancer Recovery Group and Trust Board.
The overall size of the elective waiting list is reducing, with further work required to continue this trend over 2022/23. Long wait patients continue to be prioritised for appointments and this is reducing those waiting over 52 weeks to be seen. There was a further decrease in patients waiting over 104 weeks in February, with a plan to offer all appointments by the end of this month. The next area of focus is to aim for no patients to be waiting over 78 weeks for treatment, by October 2022.
In collaboration with the Buckinghamshire, Oxfordshire and Berkshire West Integrated Care System (BOB ICS), the Trust participated in a dedicated theatre plan to reduce ophthalmology inpatient backlogs for cataract, oculoplastic and strabismus surgery (adults and paediatrics) and improve long wait times in these services.
Overall, the Long Waiter Initiative was a success for the service and wait times were able to be improved significantly in focused areas. 92% of the cataract long waiter backlog was reduced and there are no longer patients waiting more than 104 weeks in any of the specialities. The team is working towards having no patients waiting more than 90 weeks by the end of this month.
In the community, overall face to face contacts have increased gradually for most clinical services. In the Rapid Response Integrated Care (RICC) team, an increase in face to face and non face to face activity has been recorded. The Trust community length of stay mirrors the national community benchmark.
In January we recorded four instances of clostridioidies difficile infection and five in February. We reported zero instances of MRSA bacteraemia infection in the same months. In January we recorded 341 births and 339 in February; in the same months we recorded 92 and 99 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 January and February we recorded 51 and 62 formal complaints respectively. 53 excellence reports were received in January and 57 in February.
The following is an example of the personal care we aspire to deliver at all times:
“*** has worked tirelessly for the Adult Community Healthcare Teams for many years. A lot of the best work structures and best practice throughout the 8 teams owes a debt to *** as a pioneer and innovator of gold standard and safe working systems. *** has dedicated her skills and knowledge to making our lives better and the lives of our patients and community better.
Many do not know the impact *** has had through our Community service, from introducing unqualified district nurses to the teams to support care to supporting policy and training developing for the band 3 and 4 community healthcare assistants to administer insulin to people in their own homes. *** has met many challenges and complex problems with humour and determination.”
On 31 January, the government announced its intention to revoke the regulations making coronavirus (COVID- 19) vaccination a condition of deployment in health and social care, subject to consultation and parliamentary process. On 1 March, the government published an update following the consultation that it will bring forward regulations to revoke COVID-19 vaccination as a condition of deployment. This means that there is no longer a mandatory requirement for staff working in healthcare settings to be vaccinated. This will come into force on 15 March. We know that this issue has been a cause of anxiety and difficulty for many colleagues over the past few weeks and months and we are offering bespoke advice and support to help with this.
There have been a number of recent additional pressures on colleagues and the well-being of our people remains a key priority in the Trust. The well-being team has extended its service to provide further outreach support to our hospital and community sites over the coming weeks and is offering additional drop-in sessions. The new health and well-being centre at Stoke Mandeville hospital will open in the first week of April. This brings together all occupational health and well-being services into a dedicated space. We are increasing capacity with additional counsellors and physiotherapy resource and behind the centre, the well-being garden is also being developed.
This month we have launched Project Wingman, at Stoke Mandeville hospital and Wycombe hospital. This is run by a well-being charity that supports healthcare staff. Converted double decker buses provide a space in which colleagues can enjoy a short amount of time away from their workspace to recharge their batteries in an inviting environment.
To support colleagues with their physical health, we have installed two health check kiosks that confidentially measure weight, body mass index, body fat content, heart rate and blood pressure. Answering a series of optional lifestyle questions also calculates a ‘well-being age’ for comparison to actual age and prompts the user to take appropriate further action depending on results. This is a regional health and well-being initiative, supported by the ICS.
The second week of February was National Apprenticeship Week, during which a number of webinars were held to provide people with further information on the different clinical and non-clinical apprenticeships we offer at the Trust. These were aimed at different groups of people, including colleagues, managers, parents, carers and Allied Health Professions (AHPs). We have had a total of almost 600 new apprentice starters at BHT since the apprenticeship levy was introduced in 2017.
We celebrated National Careers Week over 7 – 12 March where we aimed to inspire the young people who will become the next generation of our workforce. Colleagues represented the Trust at the Buckinghamshire Skills Show 2022, the county’s largest career event with over 120 businesses and 4,500 attendees looking for information on their future career path. Thanks to their passion and enthusiasm, the Trust was awarded the Best Stand award by the judges. Well done to everyone involved.
I am very pleased to share that we have been selected as 1 of 23 exemplar sites for the NHS England and NHS Improvement (NHSE/I) People Promise programme which focuses on reducing attrition across all employee groups. Recognising we are entering a period of increased attrition nationally and that there is no single solution to improving retention, the programme has been developed to test the hypothesis that to improve the experience of our people, a cultural transformation is required. The programme launches in April and guided by quality improvement principles, as an exemplar site, we will adopt, spread and integrate a ‘bundle of interventions’ into everyday working practices and ensure that we have optimal delivery of all the People Promise themed areas embedded across the organisation. After the programme, a national report will be produced to evaluate outcomes and provide feedback to include details of which actions are best enabled at organisational level and which are best implemented at system level. As leaders, our behaviour sets the tone within our teams and in being a People Promise exemplar site, we are demonstrating our commitment to the People Promise and to making our organisation the best possible place to work.
We were delighted to launch our One Team, One Goal Awards 2021 last month, to mark the start of Kindness Week. Our annual awards seek to highlight and showcase all the great work colleagues have done over the last year. There are 11 award categories to choose from this year, including the new People’s Award for Personal and Compassionate Care. I would encourage our patients and service users to submit an entry, anyone can nominate any individual or team and the awards are for our colleagues, volunteers and contractors. Winners will be announced at an awards ceremony in May 2022.
Proud to be BHT
The Trust marked LGBT+ History Month 2022 in February. Our BHT Belonging staff network hosted events to celebrate, including a virtual lunch and a discussion on this year’s LGBT+ History Month theme: ‘How are members of the LGBT+ community portrayed in Art and the Media?’.
Inclusion and reducing health inequalities is a key part of the Trust strategy. We launched free community health checks for people of South Asian heritage within the local community, which started in January. The health checks are part of a research study to understand why some conditions are more common in this community. South Asian heritage people have twice the risk of cardiovascular disease and three-times the risk of diabetes compared to other Europeans. These differences are not explained by ‘classic’ risk factors, including insulin resistance and obesity, or known genetic factors. Volunteers aged 25 to 85 of Pakistani, Indian, Bangladeshi and Sri Lankan heritage are being encouraged to take part to provide information, undergo tests and give samples during a 90-minute assessment carried out by Wycombe Hospital’s clinical research team.
They will receive a report about their results and be referred to NHS care if the assessment identifies any concerns.
On 4 February, we celebrated 78 years since the National Spinal Injuries Centre (NSIC) was founded. The NSIC has an internationally renowned reputation for its pioneering work, treating adults and children from across the world. The Centre is also the birthplace of the Paralympics. Professor Sir Ludwig Guttmann, who founded the National Spinal Injuries Centre in 1944, used sport inpatient rehabilitation programmes. He later founded a competition for paralysed men and women to coincide with the opening ceremony of the 1948 Olympic Games in London.
The physiotherapy team at Amersham Hospital is incredibly proud of the new, upgraded hydrotherapy pool and is excited to welcome patients for treatment. The pool area was decommissioned in 2018 to allow for an extensive upgrade of the pool and facilities. Trust non-executive director Tom Roche attended a ceremony on 18 February to officially cut the ribbon and re-open the pool. There are many benefits of aquatic therapy that can now be offered to our patients.
Last month, the Health Visiting service Baby Friendly Initiative (BFI) accreditation was re-assessed and the department retained their award and accreditation. Despite the pressures of the last two years, the team has managed to keep the children and families they work with at the centre of what they do and most importantly, this is reflected in the experience of the parents they support. Very positive feedback was received from the assessors and of particular note is that the team received an incredibly high score of 98% from mothers reporting that staff are always kind and considerate.
Also related to our children’s services, the National Neonatal Audit Programme (NNAP) conducts analysis on six audit measures for 2020 data, as part of its annual reporting process, and I was delighted to receive notification of our high outlier status. Stoke Mandeville hospital has been identified as outstanding for the audit measure: follow up at two years of age. The Trust received 95.5% for this measure against the average result for England and Wales of 68.4%.
I am pleased to share that our Blood Sciences department has been accredited by UKAS, the UK’s national accreditation service. The team has been doing some fantastic work and it is great that patients now have the added assurance of the quality and efficiency with which their blood tests are being processed.
Congratulations to Sharon Leigh who represented Speech and Language Therapy (SLT), the National Spinal Injuries Centre and AHPs at an international conference in Lyon earlier this month. Sharon, alongside SLT peers from three spinal centres, were selected to share a poster at the conference for home mechanical ventilation and respiratory care. The poster presents the results of an audit, looking at the management of silent aspiration in acute spinal cord injury. This was a great opportunity for Sharon to showcase the work of SLTs in this specialist area, to an international audience.
Appendix 1 – Trust CARE value awards
Appendix 2 – Executive Management Committee and Transformation Board