y Trust Board CEO report January 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 eight fantastic winners of our Trust CARE value awards for October and November (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).
Due to the threat of the Omicron variant, a Level 4 National Incident was declared on 13 December in recognition of the impact on the NHS of supporting the increase in the vaccination programme as well as preparing for a potentially significant increase in COVID-19 cases.
COVID-19 cases in Buckinghamshire still remain very high. Although new cases are now declining following a spike over the festive break, case numbers are approximately twice as high as they were in November (at the time of writing). The COVID-19 vaccine booster is a key part of our plans to keep people safe and well this winter and our teams moved quickly to set up vaccination centres at Amersham Hospital and at Stoke Mandeville Hospital. I am incredibly grateful for all the support given in helping us deliver both colleague and public vaccinations. I would encourage you to book in for your vaccine if you have not already done so and please encourage your neighbours, friends and loved ones to do so too.
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 with a specific additional Trust Board meeting held each month and additional Executive Management Committee meeting held each week to review and address this.
At this challenging time, I am delighted to welcome our new Trust Chair David Highton who joined the Trust at the beginning of this month. David, who originally trained as a Chartered Accountant, began his career with the NHS as a Finance Director in 1990 before being appointed Chief Executive of Chelsea and Westminster Hospital NHS Trust and then Oxford Radcliffe Hospitals NHS Trust. He was also previously Ministerial Advisor on Private Involvement and Public Private Partnership to the Minister of Public Health in Qatar.
David succeeds Hattie Llewelyn-Davies who has left the Trust after almost 8 years. Hattie moves onto fresh challenges having been appointed as the chair of The Princess Alexandra Hospital NHS Trust. Under Hattieâs leadership the Trust has been on a remarkable journey thanks to the dedication of our colleagues, partners and volunteers, moving out of special measures to achieving âgoodâ with âoutstanding for caringâ in our last CQC inspection in 2019. Both the Trust and me personally are extraordinarily grateful for Hattieâs wisdom, compassion, leadership and most importantly, her staunch advocacy for our residents. With his wealth of experience in healthcare, both here and overseas, and a commitment to driving change, David is ideally placed to lead our team on the next phase of our journey.
I am also pleased to announce that Raghuv Bhasin has been appointed into the substantive Chief Operating Officer role. Raghuv joins us with a wealth of experience; he started his career in the Civil Service working in a range of roles at the Department of Health and Social Care including as Principal Private Secretary to the Secretary of State and the Senior Civil Servant responsible for NHS Performance. Since then Raghuv has worked at NHS Improvement and most recently at Royal Berkshire NHS Foundation Trust in Operational and Strategy roles. He was also a part of the Executive Team that set up, built and managed NHS Test and Trace.
Raghuv will be starting with us in March. In the interim period, I am extremely grateful for Gavin Macdonaldâs continued support and leadership through this challenging period.
At regional level, Javed Khan has been appointed the Chair Designate of the establishing Buckinghamshire, Oxfordshire and Berkshire West Integrated Care Board (BOB ICB) and James Kent has been appointed Chief Executive Designate, following an appointment process managed by NHS England and NHS Improvement and agreed by the Secretary of State. I look forward to working with Javed and continuing to work with James at a time when regional collaboration and support is of significant importance.
COVID-19 response
Following declaration of the Level 4 National Incident, the Trust has taken actions to prepare for and respond to the Omicron threat including: a ramp up of the vital COVID-19 vaccine programme; exploration of new virus treatments; ensuring availability of COVID-19 treatments is maximised; support for colleagues; increasing capacity within hospitals and community settings; developing surge plans and processes to be ready for implementation; regular review of infection, prevention and control processes; and ensuring quality and safety oversight.
The Trustâs incident reporting structures of Bronze, Silver and Gold Command meetings have been stood up and there is increased collaboration with partners across Buckinghamshire and BOB Integrated Care System (ICS) with daily briefings circulated from the BOB System Operations Centre, recently operationalised ahead of winter.
Quality, performance and recovery
The Trust Improvement Plan continues to be key focus during the current COVID-19 surge and services remain fully operational.
We have successfully been reducing the number of patients with extended wait times and are forecasting zero patients waiting over 104 weeks for planned care from next month with no increase from March 2022 in the number of patients waiting over 52 weeks compared with September 2021. Both metrics are on track for delivery. However, there remains a significant challenge for achieving diagnostic wait time compliance and specific recovery plans are in place.
Disappointingly, the number of patients on the cancer pathway is rising and cancer performance against the 62 day standard was not delivered in month, though it has improved. The number of patients waiting longer than 104 days for treatment has increased from the position in November. The two-week-wait metric was non- compliant at 80.4% in November. This is projected to be above target from April 2022.
Our pressures with urgent and emergency care performance continue to be reflected across Trusts at regional and national level, particularly with the Emergency Department (ED) 4-hour performance target of 95%. The Trust has been working closely with FedBucks over the last few months to develop a new Urgent Treatment Centre pathway at the front door of the Emergency Department at Stoke Mandeville Hospital. This will enable the management of minor illness and injury through a different pathway, allowing the ED to focus on the most acutely unwell patients. This pathway went live on 12 January â initially for all self-presenting patients to the Emergency Department.
To help create capacity to safely meet demand, the Trust has been working with the ICS, following national guidance, on Operation Reset: a multi-agency discharge event covering acute, community and mental health beds to reduce length of stay and make improvements against the baseline for patients who no longer meet the criteria to reside but remain in beds. Improvements will then need to be sustained.
Similarly, last month, people in Buckinghamshire were urged to work with the Trust to support their loved ones to leave hospital to be home in time for Christmas. Where patients no longer needed hospital medical care but couldnât return to their own home without additional support being in place first, the Trust worked closely with social care colleagues across the county and patientsâ families in a bid to help as many people to safely return home in time for Christmas.
Learning
In November we recorded five instances of clostridioidies difficile infection and five in December. We reported zero instances of MRSA bacteraemia infection in the same months. In November we recorded 395 births and 376 in December; in the same months we recorded 100 and 97 deaths, respectively. There have been zero never events since my last report.
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 November and December we recorded 72 and 55 formal complaints respectively. Overall excellence report numbers have been increasing with 83 received in November and 70 in December.
The following is an example of the personal care we aspire to deliver at all times:
âDespite having recently been moved at very short notice from Wycombe Hospital to Stoke Mandeville Hospital, *** did not hesitate when someone had to be moved part way through a shift to help out in the NeonatalUnit. She showed resilience, commitment to providing the best care to all children, and a willingness to step (even further) outside her comfort zone. While still finding her feet in a new work area *** volunteered to move wards. This is an excellent example of interdepartmental collaborationâ
People
The rise in COVID-19 rates has also had an impact our workforce and we have seen an increase in colleague absences across the Trust due to reasons related to COVID-19. Workforce availability is being closely monitored with business continuity plans in place if required. A Helping Hands initiative is also being rolled out for willing colleague volunteers to carry out non-clinical tasks in areas requiring additional support. Yasmeen Rabindranath, my Business Manager is an existing colleague volunteer and was included in the recent national NHS Health Education England report on Employee Volunteering. The report explores the impact of volunteering by NHS employees and Yasmeen was included as one of the four case illustrations; discussing her positive experiences of volunteering in various roles across the Trust, in addition to her substantive role.
In my last report I mentioned the legislation being introduced by the government to mandate COVID-19 vaccinations for patient facing colleagues (except where medically exempt) from 1 April 2022. This legislation was made on 6 January 2022 and applies in all CQC regulated settings which includes NHS provider organisations and private health care organisations. To be fully vaccinated, anyone who has not yet had their first dose will need to do this by 3 February 2022, in order to have received their second dose by the 1 April 2022 deadline. In line with Phase 1 of national guidance issued in early December, our Occupational Health Team has co-ordinated a wide-reaching communication campaign which includes webinars, emails, letters and one-to-one conversations to ensure that everyone working at the Trust has the information they need to make an informed decision about the vaccine.
To help improve internal communications, the new Trust intranet, Connect and Keep Engaging (CAKE) went live early last month for all Trust colleagues and has been well received.
The wellbeing of colleagues remains a key priority and last month we were able to provide a range of seasonal give-aways, many of which were kindly donated by external organisations. This included a donation of 7,000 advent calendars from Lindt, which were distributed across the organisation, theatre tickets from Aylesbury Waterside Theatre and hampers for teams in the 12 days leading up to Christmas. We also provided breakfasts or breakfast hampers at all sites from 10 December to 3 January and Christmas lunch or festive snacks to colleagues working on Christmas day.
Proud to be BHT
The week leading up to Christmas I was delighted to visit colleagues across each of the Trustâs hospital and community sites to give seasonâs greetings and distribute chocolate truffles and a magazine composed of colleague reflections of the pandemic: A Year Like No Other. I am so grateful for the continued hard work of individuals and teams and was grateful for the opportunity to thank them in person.
In other festive celebrations, the Trust Chaplaincy co-ordinated Christmas services in the week leading up to Christmas and I was pleased to attend the Trust Filipino Kalinga organisation celebration which included the lighting of a Christmas tree and carol singing, earlier in the month.
Last month we also celebrated the International Day of People with Disabilities to promote the rights and wellbeing of people with disabilities; and World AIDS Day to unite in the fight against HIV and to show support for people living with HIV for whom stigma and discrimination remain a life-changing reality. The Trust has three dedicated HIV clinics in Buckinghamshire: two at Wycombe hospital and one at Brookside in Aylesbury. We have a fantastic dedicated HIV team who have extensive experience and knowledge to help and support people.
I am pleased to share that the Upper Limb Studio at the National Spinal Injuries Centre, Stoke Mandeville Hospital, has been highly commended in the Acute Sector Innovation of the Year category at this yearâs Health Service Journal (HSJ) Awards. The inspiring initiative provides one-to-one and group therapy for spinal cord injured patients. This is carried out by Occupational Therapists who are specifically trained in the principles of Activity Based Restorative Therapy, which is an important and growing area of spinal cord injury research.
Therapists will work with a patient using a range of carefully selected rehabilitation technology in a designated purpose-built environment to facilitate repetitive movement in order to achieve functional activities with a particular goal in mind such as feeding, drinking, return to driving, carrying out aspects of personal care, and return to work. Using technology to support their upper limbs during therapy helps patients gain greater confidence and independence following a spinal cord injury. The Upper Limb Studio was highly commended due to their focus on excellence, conscientious hard work and the demonstrable positive impact that their project has within the health and social care sectors.
The Trustâs Buckinghamshire Neurological Rehabilitation Unit (BNRU) has been featured in the Daily Telegraph where a previous patient of the department speaks very positively of her experience of being treated by the team. It is a great endorsement of the work of our fantastic BNRU team.
Claire Brandish, Specialist Pharmacist in Antimicrobials at the Trust has been named one of the Pharmaceutical Journalâs Women to Watch 2021. According to the Pharmaceutical Journal, Claire has ârevolutionised the impact of antimicrobial stewardshipâ at the Trust by leading on a safe and ambitious programme to radically reduce the number of patients unnecessarily prescribed antibiotics. As a result, the number of patients who had their antibiotics stopped rose from 65 in 2017/2018 to 312 in 2020/2021.
Finally, at the beginning of this month, our maternity service welcomed its first new arrivals of 2022. Nine babies were born at Stoke Mandeville Hospital on New Yearâs Day. I wish the families the best of luck with their new adventures.
Reflecting on the last year, there is so much that I am proud of and grateful for. I feel incredibly privileged to work alongside such inspirational colleagues. With a new year ahead, I look forward to all that we can achieve together in 2022.
Neil Macdonald
Chief Executive