Chief Executive's Blog
I am delighted to welcome you to my blog which will be updated on a regular basis. I want this to be a two way communication process so I welcome any thoughts and feedback that you may have.
This is a great opportunity for me to be sharing news and details of what I have been doing across the Trust with you all and I do hope you enjoy reading them.
We may not officially be in winter yet, but it certainly feels like it as the weather changes! As a Trust we are well into our ‘winter planning’ preparations – as you will be aware, hospitals come under great pressure during the winter months for a wide variety of reasons.
As a member of staff, I believe that we have a professional responsibility to ensure we do everything we can to ensure services remain safe and resilient over this period. Hospital staff - front line and support having their flu jab is an important part of the planning.
This means today’s blog is about flu – I know that when we hear the word “flu” we can think “I don’t fancy the flu jab” or “I must have the vaccination because I`ve had flu before and it was just awful”.
This year we have been set the target to get 75% of all front line workers to be vaccinated, so far, we have managed to vaccinate 36.7% of the 3,166 members of staff deemed as frontline staff. This is around four times as many against the same time last year.
For the majority of people who catch it, flu is unpleasant. But for some it can lead to a whole host of problems ranging from chest infections to severe complications, and even death. We don’t want ourselves as staff to suffer, or our friends and family (no-one will thank you for passing on the flu to them) and we don’t want to share it with our patients.
In the past people have said to me, “I don`t need it Jackie: I`m healthy and I never catch a cold or flu”, but it’s not just about keeping yourself safe, it’s about protecting your fellow colleagues, your family, friends and your patients. Unfortunately you can carry and pass the virus on to others without having any symptoms yourself, so even if you consider yourself fighting fit, you might inadvertently be risking the health of others.
The good news is that we can all avoid it with a simple flu vaccine. Despite the myths and rumours that abound I can assure you that the flu vaccine is safe. A popular but untrue rumour is that the flu jab will vaccinate flu into a person and give them flu: the truth is that it’s impossible to get flu from having the flu jab because the vaccine doesn’t contain live viruses. If you are one of a very small number of people who have had the vaccine previously and then experienced side effects such as aching muscles, what you are really experiencing is simply the immune system responding to the vaccine: it’s working. So rest assured, for the most part, seasonal flu vaccine side effects are mild or non-existent and they are nothing like having the real flu.
If you have had your vaccination already: a big thank you as you are helping to fight flu, if you haven’t booked your vaccination yet please help yourself, your work colleagues, family, friends and patients by having your vaccination. All you need to do is take a look at the list of drop in sessions which we have arranged at the Occupational Health Departments across all sites and take time to go and have this vaccination.
It’s just as important that our patients and their families ensure they are vaccinated too. The flu vaccine is offered free of charge on the NHS to people who are at risk to ensure that they are protected against catching flu and developing serious complications. If have any queries about the vaccine, visit http://www.nhs.uk/Conditions/vaccinations/Pages/who-should-have-flu-vaccine.aspx or contact your GP.
I hope you like the picture of me having my flu vaccination courtesy of Kirk Panter, Staff Side Chair! I was very pleased that my Board colleagues joined me last week in also receiving their jabs from Mary Moore, Deputy Chief Nurse and Kirk.
Finally, thank you to all of those staff who have to date had their flu jab, well done – I am looking forward to many more staff joining me over the coming weeks and becoming a Flu Fighter!
In my last blog I updated on the Trust’s commitment to supporting staff who raise the alarm and of our intention to introduce ‘safety stations’.
You can read the previous blog here.
I am very pleased that during October will be seeing the first phase of this initiative come to life with the installation of the staff stations. Our aim is that early in the New Year we will start to roll out a similar scheme for the public and patients.
Our Associate Medical Directors and Deputy Chief Nurses have made the commitment that each Monday they will read any concerns that are submitted and look into them. In addition, each month they will review them with a local GP and issue a bulletin letting staff know of any action taken, the bulletin won’t reveal any names or personal information.
This system isn’t to replace any of the existing ways of reporting a concern. Our Whistleblowing policy makes it very clear that staff will be supported if they raise concerns regarding poor practice or standards of care.
Whether they are a permanent employee, an agency, or temporary staff member, or a volunteer, we want them to have the confidence to speak up when they feel something is wrong.
It would be remiss of me not to say thank you firstly to the member of the public who gave us this idea and also thank you to our clinical leaders for taking the idea and further developing it into something which I believe will make a positive difference for our patients.
I will keep you informed how we get on and with the developments in the New Year.
I am really pleased that we have been able to sign up to the Nursing Times Speak out Safely campaign, which aims to promote the importance of healthcare staff speaking out when they see poor care, in the knowledge their employer will protect and support them for doing so.
I know it takes a brave person to put their hand up and raise the alarm and say they are concerned. However, I really do want to reassure the public, staff and patients that if any member of our staff raises the alarm in our Trust, this Trust Board will support them fully.
I understand that staff may worry over making what turn out to be false accusations and our whistleblowing policy is clear on this matter. To emphasise the point, I’d like to repeat some of it here: “ If you raise a genuine concern by this policy, you will not be at risk of losing your job or suffering any form of retribution as a result. Providing you are acting in good faith, it does not matter if you are mistaken.” I hope this will give staff confidence that if they genuinely believe something is wrong, they will be supported – even if it turns out not to be accurate.
With all that in mind, it is also important to have support methods in place for those people that want to raise issues anonymously. We will shortly be launching a number of initiatives for other ways to raise a concern – some of them with an option of doing it anonymously should they wish to.
One of these initiatives is based on a suggestion from a member of the public and will involve us placing concern boxes in discreet areas around our sites, together with reply cards. This means that whatever time of the day, staff will be able to post a concern regarding the safety or quality of care for anyone using our hospitals. We guarantee that each and every one of them will be read personally by the Associate Medical Director and Deputy Chief Nurse for each of our hospitals and will be treated seriously and followed up. We will have clear signage so staff know when we will be checking the boxes, as well as what to do if a concern cannot wait.
Our intention after trialling this is to introduce ‘Safety and Quality Stations’ in public areas across all of our sites. I will be announcing more details on these soon.
I know that we all want the very best for our patients and as leaders, it is our job to support and encourage our staff, governors, and volunteers to feel confident that their concerns will be treated seriously and acted upon. No matter what our staff tell us in relation to genuine concerns they have about any aspect of care that is being provided to our patients, we will protect them. That is my promise to them.
You can find out more about the pledge we have made and the Speak out Safety campaign from our website: http://www.uhmb.nhs.uk/about-us/sos/.
One thing that I have learnt from my time in the NHS is that you cannot be visible enough as a leader. All of the surveys that we have carried out over the last year remind me of this. As a new Trust Board it is essential that we are out and about around all of our wards and departments on a regular basis, it is the only way to ensure you stay grounded and in touch with what’s happening on the front line. A report can tell you a lot, but often nowhere as much as a patient, or a nurse or doctor working in on the wards.
I visit all of our hospitals on a regular basis, dropping into wards and departments to speak to staff and I encourage all staff to do the same. Like all NHS managers I often attend too many meetings, therefore I will soon be launching a forum for operational staff, to meet with me at each hospital, each month to discuss issues that they are facing locally. This isn’t going to be too formal, there won’t be any need for staff to write papers and deliver presentations, just for staff to spend time discussing their local hospital for the benefits of patients.
I’ve spoken and written before about the ‘leadership tree’, that leadership comes from all different parts of an organisation and that we all have a role to play. Recently, initial plans were announced for staff within the department of health to spend time on ‘work placements’ on the front line, up to 20 days a year. I am sure there will be much debate around this, but it did start me thinking if this would be a good system to introduce across our hospitals for all non-patient facing staff? 20 days is a lot, but it is less than 2 days a month dedicated to learning what goes on and understanding the issues staff face on a daily basis. I can think of several challenges around this, but not sure the challenges would outweigh the benefits? I would be very interested in your thoughts on this.
We were very pleased last month to welcome our first baby into the brand new, purpose built Special Care Baby Unit (SCBU) within the Furness General Hospital’s Maternity Unit.
The location of the new SCBU allows staff to work more closely with maternity staff on the Post Natal Ward. Some babies who previously would have been admitted to SCBU (such as those needing only minimal additional support for feeding or keeping warm) can now be cared for at their mother’s bedside instead. This will help parents stay close to their babies whilst they are on the Maternity Unit.
There is also a new modern family room facility in the unit, which means that parents who need to stay with their baby whilst on SCBU can be accommodated in modern surroundings.
I know the design team and all of the staff involved in the service worked incredibly hard to deliver these improvements – it made all of the difference to see a family interviewed on TV praising the new unit, not just for the positive publicity we received, but for the difference it will make to families for many years to come.
I would like to finish this blog with a connected story that you may have seen. I am sure it will continue to receive national and international attention for a long time to come, The Dyson Centre for Neonatal Care is situated within The Royal United Hospital in Bath. (http://www.dezeen.com/2011/08/08/the-dyson-centre-for-neonatal-care-by-feilden-clegg-bradley-studios/).
The Dyson Centre for Neonatal Care opened its doors on 23 July 2011, two years on, a report is about to be published (following peer review) with some interesting results, you can watch the BBC report on the unit here: http://www.bbc.co.uk/news/health-22678145.
Some of the early indications from the benefits of the design are being reported as:
- The report found the amount of time mothers spent breast-feeding had increased from 64 per cent to 90 per cent by comparing data collected from the old neonatal ward at RUH to the new one.
- By reducing noise levels, the low-stress environment is also said to have increased the amount of time babies slept by an average of 22 per cent.
- Nurses are said to be spending roughly 20 per cent more time with their patients than they were previously, due to the consideration given to the ward’s layout.
As I say, the report is yet to be finalised and I am sure whatever the results will make important reading. Well done to everyone involved, inspiring.
It doesn’t matter at what level you are involved in healthcare; a nurse changing a dressing, a chef preparing meals, or a switchboard operator directing calls – we all have a vital role to play in the experience of our patients. Rightly or wrongly, it is difficult to open the paper, turn on the radio or watch the television without the NHS featuring for one reason or another.
I genuinely believe that everyone in our hospitals comes into work each day to do a good job, in often difficult circumstances and wants the very best for our patients. Walking the wards on a regular basis reminds me of this, I know we don’t always get it right, and sometimes the level of care provided just isn’t good enough, but we are working extremely hard to get it right, first time every time for the benefit of all our patients.
This isn’t going to be a long blog. I watched a video recently of student nurse Molly Case, at the RCN Congress. To Molly I would like to offer my personal thank you for presenting our profession in such an honest, caring and compassionate way and saying what I am sure many of my colleagues would like to. Please take a moment to watch the video of Molly:
I am writing this blog on the eve of one of the most significant changes in the NHS. When I return from the Easter break next week, a series of new organisations will have come into being. These include Clinical Commissioning Groups (CCGs), the Local Area Teams (LATs) the NHS Commissioning Board (NHSCB) and NHS Commissioning Board North Team. The scale of the change is massive, and at a time when the NHS is facing some of the most significant challenges in its history.
[The NHS structure explained: NHS Choices]
All of this organisational change is confusing for staff and even more confusing for the public. However I am feeling quietly optimistic. This is because at the end of the day people do business with people who represent their respective organisations and not with organisations themselves. This is an obvious statement to make – but I hear too many times people talking about or referring to “the organisation” or “the Trust” or “the CCG”. This is particularly true when things are not going well or there is blame involved. I always ask – “who in the organisation are you referring to”.
For me, it’s all too easy to talk about organisations simply as objects. As I know they are full of staff the vast majority of whom are vibrant talented individuals doing a great job. Being the CEO of an organisation carries a huge degree of responsibility but I for one recognise that I cannot make the changes I need to make without the support from staff, the public, our governors, the media, the MPs and from the partners I work with in the health and social care system. I feel fortunate to work with people in all of those groups who are talented and committed to making the improvements we have to make in our organisation over the next few years.
This is not to say we all agree with one another all of the time, of course we don’t. It is like family life which has its ups and downs, disagreements and so on. But at the end of the day there is recognition that together the family is stronger, happier, and healthier.
So, as I return to work in the “new world” I will look forward to continuing the improvement journey and I have a genuine sense that our partners wherever they sit in the new structure will work together to deliver the improvements we need to make. I know we all share the desire to continuously improve the experience of patients.
Internally staff are working incredibly hard to achieve our aims. I am looking forward to working with around 50 staff who have volunteered to work with me. These staff are from all corners of the organisation and have agreed to “step up” and lead a programme of work to encourage others across our hospitals to do the same and make a real difference. The work will begin in April, and I am sure the group will want to focus on many things. Topics I am already aware of include staff culture and behaviour; opportunities to work with and learn from other organisations and opportunities to develop their leadership skills whatever level they work in the organisation.
I have spoken previously about the “leadership tree” which extends across the hospital sites, across Divisions and specialties. This work will be shared during the next month. It is our opportunity to explain to staff, the public, and our partners how accountability is discharged in our hospitals. I hope it will provide a map for patients and staff of who to speak to if they have a concern. It will highlight those leaders who at the moment often seem invisible. We have recently appointed a team of substantive Clinical Directors who will lead each of the Division. The Trust committed to putting clinicians at the heart of decision making and that is what we have done. These leaders are supported by an army of leaders from all groups of staff and the leadership tree when its published next month will illustrate this.
So, our task can seem daunting. We have further improvements we have to gain in the quality of care we provide and we have a very challenging cost improvement programme which we must achieve if we are to be a sustainable hospital Trust and thrive in the future. At the same time as delivering improved quality and reducing costs. We are working with our CCGs, staff, partners and the public to determine how our clinical care services will be delivered in the future. A tall order only made possible by every member of staff contributing, really pulling together and delivering the improvements we can and not arguing about what we cannot.
I hope whatever you have planned you manage to have some relaxation, peace and enjoyment over the Easter break.
Preparing for a recent radio interview with BBC Radio Cumbria provided me with a healthy reminder of just how much is happening across the Trust. One of the greatest challenges I face is in communicating effectively with staff, patients and the public, MP’s, our partners in Local Authorities and so on.
Recently I have spoken about “The Leadership Tree”. The Leadership Tree is made up of many branches of Leaders – from the Trust Board and including Trust Governors, Divisional Teams, Ward and Department Teams and the thousands of individual leaders we have across the Trust. It is important that the leaders in the system firstly recognise the valuable leadership role they play, (and this is not about hierarchy or titles) and that other people inside and out of the organisation know about the contribution they make.
It strikes me that if we are able to be clear about our strategy moving forward and then can connect with and utilise the momentum and skill of those people who make up our Leadership Tree – we are much more likely to succeed.
To this end, I am currently developing new leadership groups and opportunities to “connect” – I hope that all staff will feel able to contribute in some way.
I recently had feedback from a senior member of staff that staff did not feel they understood where the organisation is heading. This comment served as a useful reminder that I need to give clear messages over and over, sometimes using a different narrative depending on the audience.
In my last blog, I set out the broad headings on our journey – moving through stabilisation, through to transition and on to transforming our services. This journey of improvement will take time and will focus our energy and efforts over the next few years.
During this next year (the Transition Phase) we will be focussing on three things:
- Agreeing the options for the way our clinical services will look in the future. This is work which is being led by our Commissioners in order to deliver safe and sustainable integrated services in the future. It is an important opportunity to look across the Health & Social Care system and design those services around the needs of the patients, not around organisational institutions. I want to encourage us to look beyond hospital buildings and create safe and sustainable, high quality care for our population. We will focus on ensuring that acute services are fit for purpose and with our partners to develop integrated acute, community, primary care services.
- Improving efficiency – at the moment we are living way beyond our means and this must be redressed over the next few years. This year we have a challenging target to meet (£25m). Looking at the proposals for achieving this I am encouraged that the schemes improve efficiency whilst also improving quality. These two elements are not incompatible – the reality is we must take care to do both.
- Improve quality – over the last year we have begun to address the issues at the heart of the serious failings which occurred. During the last six months I have been in post, I have seen improvements in our Maternity and Emergency Care services and in the way we provide care for stroke patients. I have seen improvements in the length of time people wait in A&E and from referral to treatment. I have seen improvements to our physical environment – the refurbishment of A&E at Royal Lancaster Infirmary (RLI), new wards opened at RLI, improved Reception areas – including at Furness General Hospital. We have implemented ‘Booking Hubs’ in our Outpatient Departments and invested heavily in a new secure storage and tracking facility for Patient Records.
I am aware that we still have a long way to go and we will continue the work to improve further in all these areas. During the next year we will focus on areas which will further improve the patient experience.
Our Nurses and Allied Health Professionals are currently developing plans to raise the profile of leaders such as our Matrons, Ward Sisters and Charge Nurses. We want to support our professionals to ensure patients and their friends and family have access to good information, feel well informed and connected to carers. In essence, we want to develop and support staff to deal with any issues as and when they arise at the front line.
When I speak to people who have made complaints about their care and treatment, they are often frustrated and upset by the layers of bureaucracy they encounter. It is my aim, supported by the Trust Board, to tackle this. In order to do that though, I need the help and assistance of all those leaders on the branches of the “Leadership Tree”. I am encouraged by the talent and the enthusiasm of staff across the Trust, they are without doubt the most effective first line of assurance regarding patient care.
I can barely believe I have been at the Trust for over four months. The time has gone so quickly, as is the case when there is so much to do. During the first few months I have met many staff, governors, GPs, MPs, patients, partner organisations and other stakeholders. My overriding sense from these conversations is that of a genuine will to improve the care we provide to our patients. This is a good platform to build on.
I see the work we have to do in three phases at the moment. The first phase is about “Stabilising” our current position.
We have been in this phase for much of this year and I see it lasting until the end of the financial year, i.e. March 2013. In this phase, we have been working to improve the quality issues identified by our regulators, our financial position and making sure we have the right leadership in place to drive progress. In terms of quality, you heard earlier about the improvements found by the CQC during their recent unannounced visits to Maternity and to Emergency Care. It was great news that they found that we are now compliant with standards in these areas. Of course we now need to sustain and indeed improve this position. I am sure, like me, you are not satisfied with meeting minimum standards but want to exceed these and be among the best performing hospitals in the country. We had work to do in other areas – for example stroke services, outpatient booking and in relation to our mortality ratings. I am pleased to report that we are making good progress in all of these areas and this needs to continue. We have been lagging behind on a number of our national standards too, accident and emergency waiting times and waiting times from referral to treatment. Once again, we are achieving the targets we set ourselves to get back on track as we approach the end of the year. It is vital we hit and maintain these targets – behind these targets are patients and we should remember this at all times.
As often happens, our short term drive to improve things has meant a surge in costs, which in the medium and long term is not sustainable. The Board of Directors, with key clinical leaders, has been working through the medium and long term financial plans and now has a clear understanding of what we need to do in order to have safe and sustainable services in the future. More about this later. Our plans include a level of financial support which we are negotiating with Monitor and the Department of Health. This is required in the short term to ensure we are able to manage our cash position and also to provide the time necessary to design sustainable models of care and to engage and agree those with our partners and the public.
The second phase is the “Transition” phase. This will run from April 2013 to April the following year. During this time we will be “crafting” our long term strategic plan with all of the people we will need to engage with. I have mentioned the cornerstone to this work - which is the clinical strategy. This will involve looking at all the options for the way services could be provided across our hospital sites in the future. We need to explore all the options - this is a unique opportunity to really make a difference and drive up quality and standards and also to ensure they are affordable long term. This will, of course, mean we will re-examine all of our underpinning strategies, estates, information management, technology, research and teaching are some examples.
Only when we have completed this work will we move into the “Transformation” phase of our journey. This will start from April 2014, when we will be in a position to implement the clinical strategy. This is the time when the agreed changes will change from plan to reality.
In the meantime, we will of course be working to improve what we do day in day out. The Clinical Directors who took up post during the summer last year have made a significant difference to the way we operate. They have been supported well by General Managers and by Senior Nurses, Midwives and Allied Health Professionals. I meet with them regularly and they are working with the Executive Team and I on all the plans to improve services.
We are currently in the process of recruiting to two key Executive Director posts – Director of Governance and Director of Workforce and Organisational Development. The interviews for these appointments are scheduled in January and I hope, therefore, to have a full substantive team in place at the start of the new financial year. I have felt very well supported by Sir David Henshaw, our Interim Chairman, and the Non-Executive Directors. Board of Directors meetings are indeed challenging and the Board of Directors have sight and a grasp of the business priorities and actions. This is further strengthened by our Council of Governors who really add value and will have an important role to play in our future developments.
The biggest challenge is communicating effectively. I will continue to get out and about as much as possible. I have arranged for regular staff briefings and to meet with different groups of staff throughout the year. Not everyone reads blogs such as this, but I will continue with them and also short “You Tube” clips in an attempt to convey the vast amount of things that are happening. It is my intention to provide as many opportunities for staff and stakeholders to get involved – particularly during this next important “Transition” phase where we will be developing our future plans.
As we head towards Christmas – all that remains is for me to wish you a Happy Christmas and a Healthy and Happy New Year. I look forward to working with you on our onward journey – improving care for our patients.
I want to thank local people for the support you have given your local hospitals and also our staff for their continued dedication and commitment.
I have worked in the NHS for over 30 years, as a nurse on the front line and as a senior manager. I care passionately about delivering good quality care and I know that passion is shared by the staff who work in our hospitals.
The people who live across Morecambe Bay deserve high quality, safe services that meet the needs of patients.
Day in and day out thousands of people have been getting good care in their local hospitals. However, you have been let down by this Trust in the past. Quite frankly, levels of care have been unacceptable.
I’m very pleased that the Care Quality Commission has recently been able to say that our maternity and emergency services are now meeting essential standards.
It shows that the Trust as a whole is turning the corner in terms of recovery. It is a testament to the hard work of our staff, together with local GPs, the public, Governors and stakeholders.
It is good news but we still have a long way to go before we are providing hospital services we can all be proud of.
The Trust now has a new Board which is providing stronger leadership and a new direction. However, the most important change in the last few months was to put doctors, nurses, midwives and allied health professionals in charge in our hospitals.
This is already making a big difference to the way the organisation approaches the issues it faces. It is helping to put patients at the centre of decision making, where they should be.
Some of the more challenging issues will take longer to deal with but they will need to be addressed if we are going to provide the safe, high quality and sustainable services we all want in the longer term. It will mean making significant changes to the way this Trust provides its services.
We need to consider how we meet the clinical challenges involved in providing high quality services in an area that is fairly sparsely populated. Spreading the money we get too thinly across the area covered by the Trust has meant that in some cases the services we were providing were simply not good enough.
Advances in health care also mean the way services were provided twenty or even ten years ago is often not the best way to provide those services now or in the future.
Services should be as local as possible for patients. However, above all people want to know that those services are safe and high quality.
There are not going to be any easy answers but I believe we have a unique opportunity to get hospital services in this area right for the people who live here.
A number of groups - involving the GPs who commission our services, this Trust and others - have been set up to review clinical services across Morecambe Bay.
These are your hospitals so it is also vital that you are involved.
So how can you get involved? In the first instance you can become a member of the Trust and talk to the Governors who represent your interests. Visit our website - www.uhmb.nhs.uk – to get more information.
In the New Year we will also be holding a series of roadshow events in each part of the area, so you can talk to managers and staff and find out more about what is happening in your local hospitals.
This will be just the start of an ongoing discussion with you about ensuring we have the best possible hospital services.
My ambition is for this Trust to be among the best in the country. I want our services to be at the leading edge of healthcare delivery and based around the needs of patients. Above all, I want every patient to feel not just safe but also confident of getting excellent care.