Chief Executive's Blog

 

Chief Executive's Blog

Jackie Daniel discussing services with midwife WGH web.jpgI am delighted to welcome you to my blog. 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.

I send a "Friday Message" to all of our staff, governors and volunteers each week and I will also make these available, here on my blog.

Jackie Daniel
Chief Executive

Friday Message - 25 July

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Posted by corinnekemp

Time really does seem to pass by quickly at the moment. My week off seems like a long time ago now! I went away for a week and came back to a public campaign asking the Trust not to privatise, or sell off our pharmacy services – which we are not proposing to do.

I won’t repeat all of what Aaron said in his Friday Message. I also don’t want to get into an argument as to what constitutes a tender advert and what doesn’t, but what is a fact, is that as a Trust we are committed to working towards providing safe, high standards of care seven days a week. Our plans to further improve our pharmacy services is part of this.

Sir Bruce Keogh, National Medical Director, NHS England, last year published his ten clinical standards that described the standard of urgent and emergency care all patients should expect seven days a week, each supported by clinical evidence and developed in partnership with the Academy of Medical Royal Colleges.

They describe, for example, how quickly people admitted to hospital should be assessed by a consultant, the diagnostic and scientific services that should always be available, and the process for handovers between clinical teams.

As you will see, services such as pharmacy play a key role in this agenda, as does radiology. I mention radiology as we have shared exciting information this week via Weekly News on our plans in this area.

There are some shocking statistics which have led to seven day services being vital to the health and well-being of our communities. I would like to quote NHS England:

“…significant variation in outcomes for patients admitted to hospitals at the weekend across the NHS in England – a problem affecting most healthcare systems around the world.

This is seen in mortality rates, patient experience, the length of hospital stays and readmission rates. For example, the increased risk of mortality at the weekend could be as high as 11 per cent on a Saturday and 16 per cent on a Sunday, according to an analysis of over 14 million hospital admissions in 2009/10.”

We have significantly improved our overall mortality rates as a Trust and are now considered to be in the ‘expected range’. However as a healthcare system, we can’t continue to tolerate such variations, we must change.

Modernising our outpatient pharmacy services is just one piece in the jigsaw. For those of you that follow my Friday Message and other communications, you will know I’ve been asking you all to consider and start to develop with your leaders how you will address seven day working, and many of you have risen to the challenge.

We do intend to consider proposals from other organisations as to how we can continue to improve our outpatient pharmacy dispensing services. Once we have considered these proposals, we will weigh up the clinical benefits and then make a decision as to which is the right option for our patients based on the expert advice of our clinical leaders. As with any change there is a cost implication. Until we have completed this initial stage of the process we are unable to fully understand the financial benefits or risks, but as with any proposed change to patient services, we will fully assess the risks.

This week we received a petition from the “no health sell off” campaign and I would like to thank them and the public for taking the time to make their feelings known and to show their support of local NHS services.  We wrote last week to the campaign group and invited them to meet with our Chief Pharmacist and her team, and also to tour our pharmacy services and discuss possible future improvements.  We do hope they are able to take us up on this offer.

 

CQC IMPROVEMENT PLAN PROGRESS

My executive colleagues are carrying out staff briefing sessions at the moment and will be providing an update on progress with our CQC Improvement Plan (action plan), however I am conscious that not everyone will be able to find the time to attend these sessions and I would like to let you know what we’ve been doing as a team of directors.

Working with your divisional management teams we have created a draft Improvement Plan, clearly stating how we will address the “must do” and “should do” actions shown in our Hospital Inspection reports.

We are, and sadly for the wrong reasons, an organisation that has experience of delivering against regulatory actions plans. Such plans can feel very transactional and a little soulless – it is really important that we don’t see this latest plan as simply going through the motions, we will only be in a worse position in six months time if we do. Any changes we make need to be permanent; therefore we have undertaken a number of additional actions.

We have been developing a three year Quality Improvement Plan for our Trust, creating a framework for making lasting and measurable change, the CQC Improvement Plan will form part of it in year one. I want to ensure that together with the support of our partners, we are all able to make changes that can be sustained well beyond a year and deliver real and meaningful improvements for the benefit of everyone who uses our hospitals.

To support the CQC Improvement Plan, we have created an Improvement Board, who over the next year will have the responsibility of overseeing and contributing to progress and will report directly to our Trust Board.  This has been designed to be an inclusive process and we have asked many of our partners such as the Clinical Commissioning Groups, NHS England, the patients champion Healthwatch and local authorities to be part of the Improvement Board.

The CQC Improvement Plan is time limited, it has to be, as we need to deliver the improvements at a greater pace and before our next Inspection. To ensure the improvements can be sustained and to tackle some of the long standing issues such as culture, we will also be establishing an Improvement Academy within our Trust.  The Academy will provide support and assistance, helping everyone to fully understand what ‘good’ and ‘outstanding’ looks like and providing staff with the tools to achieve it.  This approach will assist with using tried and tested techniques for delivering consistent change.

It was said to me this week that we haven’t chosen the easiest approach to tackling issues, but we have chosen the right approach, and I believe that too. 

The CQC are being very supportive, as are Monitor, but quite rightly, they are also challenging our plans and providing objective input. Over the coming year we will be asked if we feel we are ready to be re-inspected, which I would imagine would be at least another six months away, probably more. It is critical that we do not aim or aspire to come out of special measures to receive a rating of “requires improvement”, the only aspiration we can have is to achieve “good” as a minimum and have a plan to achieve a rating of “outstanding” in time. Even if we achieved “good” we should not be content, as all we will be achieving is a minimum standard.  Therefore, I don’t feel we should look to try to come out of special measures until we are confident our improvements can be fully evidenced and sustained.

 

MANAGER CONFERENCE

I will be writing to all managers in the organisation very shortly to invite them to a Leadership Conference in September. I want to ensure that all leaders are brought up to date on performance, that they understand our priorities for the next two years and are clear on the next stage of our overall clinical strategy, better care together.

I believe this further clarity will assist all staff. I want your leaders to be able to come back and brief you, so we are all be “on the same page” in respect of where we are going and how we are going to get there.

Space is always limited at such events, and not all managers will be able to make it I know, however managers should pencil in Monday 22 September into their diaries, further details will follow.

 

COMMUNICATIONS GROUP

Thank you to everyone that responded to Phil regarding my request to join a Trust wide communications group. I am not sure if it was the offer of cake or not, but we have been very pleased at the response! We have good representation from many areas of the Trust, with a lot of new names, but we would like to see an even wider membership, especially from our clinical staff.  This is your opportunity to get involved, influence and shape how we communicate with you all.  Please drop Phil a line (phil.woodford@mbht.nhs.uk) if you would like to join the groups. You don’t have to attend every meeting, but any input, even if it is by email will be very much appreciated and welcomed.

 

AND FINALLY

It has been really pleasing to receive emails from a number of departments inviting me to come and spend time with them. I am now planning my diary with my team to fit them all in and look forward to spending even more time out and about in our departments and wards.

Thank you again for your continued efforts and support.

 

Jackie Daniel

Chief Executive

Friday Message - 18 July

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Posted by corinnekemp

The Friday Message

Jackie is taking a well-earned break this week, so I hope I don’t let her down with my thoughts for the Friday message!

We have seen a lot of speculation and talk in the last couple of weeks about the hospital’s development plans, and I want to use my message this week to discuss our proposals for pharmacy improvement.

Our early-stage plans for changing the way we do things have led to concerns that we plan a major outsourcing and privatisation of the whole service. Let me reassure you that this couldn’t be further from the truth. We are not proposing any “sell-off” of these services, nor would the proposals mean any job losses among our existing pharmacy staff. 

In fact, this is a really exciting, positive and important piece of work, focussed entirely on patients.

We are indeed proposing to work with a commercial pharmacy partner, but they would only co-ordinate dispensing of medicines to patients from outpatients, day case and A&E during daytime hours. But the benefit they would bring by taking on this small amount of work would, we think, be felt right across the Trust, and make a huge difference to our patients.

No-one in pharmacy would lose their job – they would instead be able to concentrate on their core priority – providing medication and expert information on medicines prescribing for inpatients and patients who are being discharged. We know that good patient flow and timely discharge are key challenges for us as we continue to see increasing activity, and these proposals would, if implemented, be designed to improve those processes.

Freedom for pharmacists to spend more time on wards will also help reduce prescribing and medication errors. Their on-the-scene expertise will help make sure each patient gets the most appropriate medicine for their own unique needs, first time, every time, reducing their risk of harm and speeding up their recovery.

A large number of NHS Trusts work with commercial pharmacy partners to provide outpatient dispensing services. Evidence from neighbouring trusts suggests the change could halve waiting times for outpatient medications, as well as significantly speeding up take-at-home medicines provided by the Trust for inpatients leaving hospital.

It’s all good stuff, but it is still in its earliest stages - so far, we have begun to establish a list of potential providers, who, in principle, could improve the current outpatients dispensing service, improve patient experience and provide value for money. We are not yet even at the stage of publishing a formal tender, but we will keep you informed of our progress.

We are in the midst of a time of great change, for NHS services right across England as well as in the Morecambe Bay area. Our continuing journey of improvement is set against a background of a drive for modernisation and change across the whole of the NHS, based on better technology, better organisation and integration between different types of health service, and more preventative care outside hospital.

We have a great deal of work going on, much of it involving a number of different NHS organisations with projects set to last a number of years. Against this background, it is inevitable that misinformation and speculation reach the public domain.

For example, in the last two years we have seen:

  • Headlines claiming plans to close A&E at the Royal Lancaster Infirmary, and campaigns to block those plans, despite the Chief Executive’s personal written assurances that no such proposal had ever been made.
  • Speculation that the Trust intended to build a new “super-hospital” in Kendal. Again, no such proposal had been made.
  • A large-scale campaign against closure of Westmorland General Hospital, despite constant, official statements from the hospital that there have never been any plans to close the site.

 

Such rumours and headlines do have a real effect on our patients, who can easily be confused or frightened by misleading or simply false information. We owe it to those people to ensure they hear the real story, and we as an executive team owe it to you to ensure you are kept fully up to date with all the latest, and that we are here to answer any questions you may have.

 

Aaron Cummins
Deputy Chief Executive/ Director of Finance

Friday Message - 4 July

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Posted by corinnekemp

This is a copy of my “Friday Message”. As well as visiting wards and departments most weeks, I also provide a written update each week to our staff, governors and volunteers.

Last week was quite intense for the Trust following the publication of our hospital inspection reports. I know from the many conversations I’ve had with staff that there are a lot of mixed feelings across the organisation. It is important that we now dust ourselves down, pick each other up and move on. Our concentration now needs to be on continuing our journey of improvement, finalising the action plan for the reports and making the sustained change that needs to be made.

Thank you to everyone who was able to attend the CQC report discussion sessions this week. We are collecting all of the questions and will arrange for a Q&A to be shared with you all.

Since the publication of the reports a lot has happened and it is important that we maintain the pace and momentum that we have built up this year. The draft Improvement Action Plan for the reports is just about ready to be shared with our regulators and partners. Divisional teams have been involved in the creation of the plan and will now start the planning to implement them. Once finalised, they will be shared with you all and published on our website.

As previously outlined, on the 30 June the Trust submitted a summary of its five year plans to Monitor, together with the high level strategy detail of better care together. The better care together strategy will now be examined by NHS England and Monitor and we expect that discussions will continue over the summer. In the meantime it is our intention, starting with the staff briefings at the end of the month to begin to outline to you all the elements of the strategy and the possible next steps.

It is critical that we don’t take our foot off the gas with our existing plans as summarised on our Plan on a Page (http://www.uhmb.nhs.uk/about-us/our-plan/plan-on-a-page/). We need to maintain confidence with the public, partners and regulators that we can deliver on our existing promises. As a result of your hard work, we finished last year with a number of key indicators being met, such as achieving the cost improvement targets, through to the A&E 4 hour standard. As a result, there are a lot of expectations on the organisation to continue to achieve this level of improvement.

We will not be able to deliver this year’s plans without the input of everyone pulling in the same direction. I am currently concerned as I feel we have slipped back in the area of staff feeling empowered to make change. When I joined our Trust I detected early on that there was a deep desire amongst the workforce to change and improve, but for whatever historical reason, many of you felt that you didn’t have the authority or permission to act. I am starting to detect this feeling again – a culture of looking to the most senior person in a division, sometimes an executive director to agree certain changes that will benefit patients and staff. Of course, there are occasions where the Board does need to be involved, and divisional management teams are well aware when this is necessary.

We employ a lot of talented and experienced people in a wide range of roles at all levels. With each role comes a clear set of responsibilities, it is important now that we shake off the feeling of not being empowered to make change, you are.

I am not naïve enough to think it is just that simple and tomorrow, everyone will go forward and change an area that has frustrated them, there are many good reasons why some change isn’t yet possible – however you should challenge back if you are not satisfied with the reasons you are given for not being able to do so.   I met this week with the Clinical Leadership Team and I know that they want to support you and will be behind you to deliver these improvements.

Please let me know if you feel you are unable to make change where it is needed, and likewise, I would also be very pleased to hear about the improvements you have made, however small – they are all important.

A number of you will have already been involved in the weekly Wednesday morning patient summits where current, live incidents are discussed, together with learning points and further action taken where needed. This a great example of a change in culture taking place across the organisation. It is led by Sue Smith, our Executive Chief Nurse and George Nasmyth, Medical Director. The summits bring together clinicians from right across the Trust, with those that can’t attend in person are able to dial in and take part.

The weekly summit allows for immediate change to take place when needed. I would like to thank everyone who takes part in this; it is a good example of how we are working as a team across the Trust for the benefit of our patients. I will arrange for one of the summit meetings to be written up as an article and shared with everyone (patient details removed).

I wanted to share this good practice with you all as an exemplar of how each week a group of colleagues come together for the benefit of patients and staff, review incidents and ensure we learn from them. No manager has the answer to all of the questions or problems within an area, but they do have the authority and ability to pull their teams together, from right across the Trust to review an issue and make the changes needed. “Two heads are better than one”, clichéd I know, but in some departments we employ hundreds of people who together, can make the improvements needed.

Remember, within your teams you do have the power to make the changes needed. There are people within the organisation who are employed to support you and provide advice and guidance.

 

Drop me a line, what are you going to change this month?

Jackie Daniel

Chief Executive

Friday Message - 27 June

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Posted by corinnekemp

This is a copy of my “Friday Message”. As well as visiting wards and departments most weeks, I also provide a written update each week to our staff, governors and volunteers.

Firstly, I would like to offer my sincere thanks to the incredible messages of support that many members of the team received yesterday and over the last couple of weeks. It doesn’t matter what your title is, it is nice to be recognised and supported, thank you. It has also been incredibly touching to have members of the public ring up and pass on their positive experiences and messages of support following articles they have read in the press.

Over the course of yesterday, members of the executive team have provided interviews to the media and I am sure this will continue for a little while longer, I do hope that you feel we are coming across ok and representing you well?

I was pleased yesterday morning to be able to spend some time with a number of our nurses and other staff and I can sense the uncertainty as to what’s next in terms of the leadership for our Trust and what exactly special measures means.

Let me get the question about my future out of the way. I came to this job, as did my other Board colleagues with our eyes open to the challenges we faced. We have all come a long way together with making improvements for everyone who uses our hospitals, and there is still much more to do. I intend to stay and see the job through with you all as part of my team – I do believe that we are all making a difference and I am incredibly proud to work alongside such talented people who quite rightly, have been praised by the CQC as being caring.

It is important to let you know that Cumbria and Lancashire North CCGs are behind us as our commissioners. I have shared a copy of their public responses to the reports below. The relationship that has been built up with the CCGs, local GPs and many other partners has not come about by chance. It is as a result of all us working much more collaboratively and open with them and I know this approach is appreciated by them all.

I also want to clarify our position with Monitor, the regulator of NHS Foundation Trusts.  Monitor, like our CCGs must hold the Trust to account for the safe delivery of services, that is absolutely correct. Monitor has been clear with the Trust that they want us to succeed, with the current Trust Board in place. This message was also shared with the CQC and other health partners at the Quality Summit we attended last Friday.

Special measures means that Monitor will now work the Trust on a package of support, helping us to move at a pace which will see a number of improvements come about quicker than we might normally expect. This will include the appointment of an Improvement Director by Monitor, whose role will be to provide support and expertise, but also to hold the Trust to account. In addition, there are opportunities for the Trust to potentially buddy with another, more successful Acute Trust. Working together with Monitor, the CQC and our partners, we will develop our action plan which will also be published and shared with all staff, governors and the public.  As I have more information on special measures, I will of course share it with you all as soon as I can. Please don’t see this action as a punitive measure, it isn’t meant to be, it is to assist us.

You will have read in the communication this week from the Chair and myself that we have been developing plans for an Improvement Board and also an Improvement Academy and I look forward to discussing this with you over the coming weeks in further detail.

Some areas of our Trust have been rated as good and others less so. To be a high performing trust, we need to work as one large team and harness a collective responsibility for change, in all areas.  Looking at the reports, we clearly have best practice of our own taking place, it is important that we share this learning across the organisation too.

I remain confident that with your help, we can continue to work together and finish what we’ve started. I know from the many conversations I’ve had this week that many staff feel low, especially after the recent speculation and then receiving the reports, it can feel exhausting. Keep supporting each other – it is at times like this when we need each other and right now, my Board and I feel supported by you all and recognise the trust you have put in us, thank you.

Please keep in touch with me, I do read and respond to your emails and messages.

 

Kind regards

Jackie Daniel

Chief Executive

 

Dr Alex Gaw, Chair, NHS Lancashire North Clinical Commissioning Group (CCG): 

"As a local GP, I know that aspects of the report will, for many of our patients, be unsettling but I wish to assure them that we are working closely with the Trust to continually enhance the safety and experience of hospital services, recognising that clinical involvement and leadership is key to sustaining this improvement. We should not lose sight of the vast amount of work that has been undertaken to improve hospital ratings - this work reflects the good progress that is being made at the Trust but we aren't complacent and recognise that there is still more work needed.

“Doctors, nurses and staff from across the hospital trust have been working incredibly hard, together with the CCG and GPs, to develop a clear plan for the future of health and care across Morecambe Bay. This commitment has come with clear support and direction from the leadership of the hospitals, showing a real change in culture from a number of years ago.

Dr Hugh Reeve, Chair, Cumbria Clinical Commissioning Group (CCG): 

"Whilst everyone is disappointed at the overall rating, I do believe that the individual hospital ratings reflect the good progress made to improve services over the last two years. Both CCGs have been working in partnership with the Trust to develop a clear strategy for the future, today's report from the CQC highlights the urgent need for this work to continue to ensure patients receive the very best standards of care for generations to come.

"I believe it is important that we recognise the good progress made by the hardworking, professional staff and leadership in our local hospitals. I believe that there is still a lot to do to ensure we have hospital services up there with the best in the country and the CCG is committed to working with the hospital Trust to achieve this. We now have a hospital Trust that works in partnership with its local GPs and has put doctors and nurses in charge of services, demonstrating a much improved culture of putting the patient first."

CQC Hospital Inspection Quality Report

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Posted by corinnekemp

Responses to the Care Quality Commission's findings following its publication on 26 June 2014 of the Trust's Hospital Inspection Reports.

Jackie Daniel, Chief Executive, University Hospitals of Morecambe Bay NHS Foundation Trust:

We are all incredibly disappointed to receive the overall rating for the Trust. The reports reflect the fact that we are part-way through a process of significant improvement which is still going to take a number of years to complete. It isn’t an overnight job to change the culture of a large complex organisation but through the hard work and commitment of our staff, governors and partners, our hospitals are now much safer, with improved standards of care in a number of areas from two years ago when we started to turn them around.

I believe that ‘special measures’ will provide the Trust with focused support to make further change in a number of core areas, and we welcome this assistance. We will use these reports as the spring board for further, positive improvement. I believe it is essential that we address the issues we face as a local health community for the benefit of our patients, collaborating with each other across the NHS in an even more determined and targeted way, something we’ve done to good effect already with maternity and A&E services.

Over the last two years we have seen significant improvements in areas such as mortality, staffing levels, A&E, complaints management, maternity, record keeping and appointments, many of which are recognised in these reports. It isn’t all fixed and there is much more to do but I am confident that we have progressed, although at times not at the pace needed.

There are a number areas highlighted that need urgent attention, particularly in our medicine division. It is clear that some aspects of safety and quality within this division were not meeting acceptable standards. It isn’t good enough; the CQC standards should be seen as the minimum standard of achievement. Our priority must always be the safety of everyone who uses our hospitals; therefore it is alarming to receive such a poor rating in these areas.

It is important that we recognise the positives aspects of the reports, such as the dedication, care and compassion for patients demonstrated by staff right across our hospitals. I’m not surprised Hospital Inspectors witnessed such good levels of care - I see this too when I visit our wards and departments. I am pleased that the CQC has reported this level of caring and I would like to praise staff for having this high standard of care recognised.

The CQC has reported that overall, risks to patient safety and quality were often as a result of staffing and recruitment difficulties. This is an area that has seen good improvement over the last year, with over 130 direct front line staff now in post. Nursing vacancy levels across our hospitals have also been below the regional average for a number of months now. We have recently introduced cohort recruitment, rather than waiting for people to leave, we are now proactively recruiting for future vacancies. We’ve also committed to over recruiting when needed. If we have vacancies for five new nurses and we interview seven suitable candidates then where we can, we will take on all seven of them.

As a leadership team, we are committed to seeing this journey through. We have rebuilt the leadership team which has taken time but I felt it was important that we got the right people. We only wanted the best people who will see us through to the next stage and I believe we now have this. I am personally determined to ensure we take this report and learn from it. I am confident that together with our partners, we have an emerging strategy through the ‘better care together’ programme to transform health and care services across Morecambe Bay.”

 

Friday Message -19 June

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Posted by corinnekemp

This is a copy of my “Friday Message”. As well as visiting wards and departments most weeks, I also provide a written update each week to our staff, governors and volunteers.

As weeks go, this has certainly been a lively one.  I’ve thought long and hard about what to say this week over the comments in the media. I think a lot has already been said and written and I feel my messages last Friday and earlier this week on the matter of the forthcoming Hospital Inspection report still stand and nothing has really changed, despite what has been reported. 

On Monday this week somebody decided to share with the media a draft copy of one of the Hospital reports. I don’t know who did it, or which organisation they work for, but I believe what they did was wrong. Not to me, but to the thousands of staff we employ, our hundreds of volunteers who give up their time every day and also the public. Everyone connected with our hospitals has had to endure a week of speculation and rumour about the future of our hospitals without having the information for themselves to read and ask questions.  This isn’t whistleblowing, this isn’t the action of someone who is concerned about protecting the safety of patients or staff – what they’ve done is the opposite, they’ve caused unnecessary stress and worry.

I said last week that if you feel your story of improvement isn’t being told, then let me know and we will support you. I didn’t have to wait long! This week we’ve seen a number of nurses and doctors step up to the plate and undertake interviews with the TV. I know from personal experience when work is pressured and your back is up against the wall, the easiest thing to do is retreat and close the door, when in fact, the best thing to do is get out there and calmly and professionally join together and tell people your side of the story.  

Being interviewed for the media can be really intrusive, that isn’t the fault of the media, it is just because of what is involved.  It can take many hours to film for a 30 second slot on the news and then it isn’t even the 30 seconds you hoped would be played!  However it does allow staff to show how open they are and get over their messages, yes there is always a risk and it doesn’t always go to plan. I would like to say thank you to everyone involved in the filming this week, I feel very proud that you chose to represent us all, well done.

MBE FOR MEMBER OF THE TRUST

Sunday morning brought some very welcome news, Professor Anne Garden, one of our Non-Executive Directors was honoured by the Queen with an MBE for her services to medical education. Anne, who is also Head of the Medical School at Lancaster University, has been a member of the Trust Board for two years. 

On behalf of the Trust Board, I would like to congratulate Anne on her much deserved honour, we are all very proud of her. I know how committed and passionate she is about the provision of high quality medical education and her crucial role in establishing the Lancaster Medical School.

YOUR VIEWS

Each year the NHS undertakes a staff survey.  This involves random groups of NHS staff receiving a questionnaire, which can also be quite long. The national survey provides a very useful snap shot of the views and feelings of staff at a point in time, in a similar way the annual in-patient survey does.

The Trust is seeing really good improvement in patient satisfaction levels and through the many initiatives that we’ve implemented, such as ‘I want great care’ we can measure them on a regular basis and take improvement action when needed.  We now want to adopt a similar approach for staff.

We can’t afford to wait a year to find out if your experiences of being a staff member have approved. Nothing replaces managers and supervisors sitting down with their colleague and taking the time to talk to them. However it is very useful to capture staff views and experiences across the Trust on a regular basis, providing a much broader picture.  Using questionnaires helps us to better understand where we need to concentrate our efforts to make improvements for the benefit of us all.

I would be very grateful if you could take a few minutes to complete a short survey to help us understand your views today. You can access the survey via the straff intranet: http://uhmb/cd/commsmarketing/public.

Hard copies of the survey are also being sent to those members of staff who cannot easily access a computer.

AND FINALLY

I will leave you all with a thought this week about acceptable standards, as it is an area that we will need to constantly revisit if we truly believe we can be one of the best providers of healthcare in the country. Have you ever walked past a piece of litter in our hospitals without picking it up? Ever found a hand gel dispenser empty and not arranged to have it filled? Ever found a bin overflowing outside the hospital on a Saturday night? Ever walked past a visitor unsure where a department is and didn’t stop and offer help? There is an old saying “the standard you walk past is the standard you accept”, what standards do you accept at work?

While the press continue to speculate about our future because of a leaked draft report, I would be interested in your views on a particular question. As you know the CQC now issue ratings to hospitals. The ratings range from outstanding, through to good, requires improvement and inadequate. The press has ran stories saying that we may be rated as inadequate and I will respond to you all and share my views once a final report is published and a formal rating issued. If that proves to be the case, I am not satisfied with the Trust working towards a ‘requires improvement’ rating.  Surely ‘good’ must be the minimum level to aim for.  So my question to you is, in your areas, do you all know what ‘good’ or ‘outstanding’ looks like?  

Do you think you provide it now, and if so why?  Over the coming weeks and months we will be building on our vision and values and I believe it is crucial that individually as employees, departments and divisions, you have your own vision of what it would mean to be outstanding, and how you are going to achieve it?

Please drop me a line, I am extremely interested in hearing your views. 

Jackie Daniel

Chief Executive

Friday Message - 13 June

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Posted by corinnekemp

This is a copy of my “Friday Message”. As well as visiting wards and departments most weeks, I also provide a written update each week to our staff, governors and volunteers.

You will know from previous communications that we are expecting the publication of the CQC Hospital Inspection Report in the next few weeks. The announcement of the Chairman standing down and the fact that we are currently recruiting for George Nasmyth’s replacement have been linked to a negative CQC Inspection report and this has led to a number of speculative stories about a whole range of things.

It is interesting how quickly the issues of the past and wave of negativity gain momentum. We featured on regional TV news this week, it was all very factual, but nothing about any current failure or issues, just ‘what might be’. This will give you all an idea of the scrutiny we all remain under. We are at an important point – we have made demonstrable improvements in safety, quality, financially and against our required operational performance. However we have much further to go.

We have been working hard with our commissioners and partners to design a health and social care model across the Morecambe Bay area which will deliver high quality, efficient care. Better care together, the strategic plan will be complete by the end of this month. However this signals the beginning to what I think will be a three to five year plan to transform acute, community and primary care across the Bay. It has the potential to radically improve the experience and outcome from the services delivered. It also has the potential to secure the delivery of health care provision for the future. However it relies on a number of things – these include great leadership which is sustained over the medium to longer term, it will require the right culture and staff at all levels buying into this, it will require all of us, MPs, partners and the general public supporting our local services.

The Chairman, for those of you who know him, is indeed his own person and it was his decision (I suspect his wife had more than a small influence!) to step down. He has made a huge contribution over the Last 17 months and I am very grateful for that. However he recognised that right now we need a chair who can fully commit to leading the organisation to deliver the ambitions of better care together.

George Nasmyth and I have been having similar conversations. George committed to leading the Trust through a remarkably difficult period, but for a fixed period. He and I agree that we should appoint a Medical Director who will lead better care together for the next period and George has agreed to support the incoming Medical Director recruitment process and stay with us a little while after to assist with a smooth handover. Essentially it is just good succession planning.

So my request of you, as we enter what may feel like a turbulent couple of weeks at times is:

1. Understand that others may put 2 and 2 together and get 6. 

2. If you are unsure use the rumour line and ask, you can always speak to any member of the executive team too.

3. Support your leaders – it is important when things are going well, but even more important in tough times. And all remember, leadership comes at all levels, it isn’t based on pay band or job titles.

4. Take the time to read the reports fully when they are published, look beyond the headlines and make your own mind up

5. If you feel your journey of improvement isn’t being heard, tell me. We will assist you to share your story with the wider world, including speaking to the press.

6. Let’s get behind our vision and values to make our hospitals great places to be cared for; and great places to work.

The improvements you are all making are growing in number and depth – but this scale of change does take many years and it is important that we continue our efforts.

It is all too easy to jettison the plan and switch leader – all the evidence points to the fact that stable leadership and setting and delivering strategies are all key.

I am continuing to receive feedback about how we could best share the Hospital Inspection Report and our response to it once it is published. I aim next week to share dates and times for staff to meet with their clinical leaders to discuss the reports, by site in greater detail. These sessions will be a week or so after the report has been published to allow everyone time to digest them and review diaries to attend a session. In addition, the executive team will ensure we remain out and about around our hospitals to support you and discuss any aspects of the reports.

I’ve been asked is there a way we can share the reports before they are published, unfortunately we will not see the final report and ratings until the CQC has held their Quality Summit in the coming weeks.

SOCIAL MEDIA

I am noticing a growing number of staff ‘talking’ in their personal capacity on social media about the Trust. Yes we have a duty not to discuss or share personal and private details of patients and staff, but what I have noticed is the pride so many staff are taking in sharing positive examples of improvement and engagement in their areas. This week we’ve seen a live web chat with the public on diabetes by our clinicians – this is great progress and compliments the health seminars now taking place throughout the year.  Well done to you all, it can be difficult at times, especially on twitter with only 140 characters, but I do feel immensely proud to read your posts.

Jackie Daniel

Chief Executive

Friday Message - 6 June

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Posted by corinnekemp

This is a copy of my “Friday Message”. As well as visiting wards and departments most weeks, I also provide a written update each week to our staff, governors and volunteers.

MEDICAL DIRECTOR

I wanted to let you all know that George Nasmyth, our Medical Director has decided to step down from his role and as a result, we will shortly start to advertise for his replacement.  
As many of you will know, George joined the Board as the Interim Medical Director whilst we made important changes to ensure services were safe, and then joined the Board as a permanent member a little while after.

George is a valued and respected member of the team and I would like to put on record my thanks for his support and contribution over the last two years. It hasn’t been an easy time and George, like a lot of others has given up a good deal of his personal time to help us move forward, particularly with the better care together programme which has taken up many an evening and weekend.
I am pleased that George will be staying in post whilst we recruit his successor and assist with a smooth handover to the new Medical Director.

In line with our vision, it is essential that clinicians and governors have the opportunity to influence our recruitment decision and I am planning to hold a stakeholder event as part of the selection process, which looks likely to be at the end of July. Details will be circulated once they are confirmed, but I wanted to give you an early ‘heads-up’.  If you would like to discuss this, please feel free to contact me.

For those of you that know George, you will know he is a passionate and talented photographer, I am hoping that once he has handed over the reins he will be able to spend more time getting out and about around our stunning counties with his camera.


NHS CONFEDERATION CONFERENCE 2014

Like any large institution, the National Health Service has a national gathering where staff from all parts of the NHS, right across the country can get together each year to discuss issues and share best practice. This year the conference is in Liverpool and has been taking place Wednesday to Friday of this week. The conference is organised by the NHS Confederation, an independent body which represents all organisations that commission and provide NHS services.

I had the pleasure of attending the opening talks which were given by Simon Stevens, the new NHS England Chief Executive, Rob Webster, Chief Executive of the NHS Confederation, and Sir Stuart Rose, NHS Advisor and former Chief Executive of Marks and Spencer.

Sir Stuart Rose has been asked by the Secretary of State to advise later this year on how the leadership in the NHS can be better supported, especially for those trusts that need it most. I was personally very energized to listen to them all talk.

Rob quoted a poem by a blogger called Adam Bojelian, which brought a round of applause and a real focus on what leadership really is. Rob’s overall theme was the need for hope and positivity within the NHS.

I wanted to share Adam’s poem with you, which you can also find on his blog site: http://intheblinkofaneyepoemsbyadambojelian.blogspot.co.uk

poem.jpg

Rob’s speech recognised that the 2015 Challenge Declaration from the NHS Confederation is the base-line assessment of where we are. The future will require engaged local leadership and some freedoms from above. You can find out more about the 2015 Challenge from their website: http://www.nhsconfed.org/resources/2014/05/2015-challenge-declaration.

In his speech, Rob set out a vision for the future and some possible ‘asks’ to get us there. He suggested we might ask for:

•    a 10 year funding settlement for health to take money off the table, so we can focus on change;
•    £2bn for a transition fund, to help the NHS move to new, more sustainable models of care;
•    a commitment to parity of esteem for physical and mental health;
•    speeding up of payment reform;
•    bringing clarity to the FT pipeline timescales and purpose;
•    a genuine focus on seeing people as assets with a sector led programme.
 
There was a ‘call for action’ from Rob and a request for the NHS to let him know what the Confederation should be asking of politicians and policy makers.

It was my first time to listen to Simon Stevens live since he took up post in April this year.  I know I’ve said it before, but the more I read and listen to the new NHS England Chief Executive, the more reassured I am that our plans for better care together is following national thinking.

Simon was clear in that he wants to speed up the redesign of care delivery and also provide “far greater local flexibility” in services, structure and system rules. He went onto say that the NHS needed to stop working in silos between primary, secondary and community services and work much more collaboratively.  This is important, as our future transformational plans will require a lot of energy and pace and as I’ve previously said, we will need to start to relook at the ‘rule book’ as a lot of what we are doing is on a new scale and we can’t be precious about traditional, organisational barriers.

You may have read recently about his message regarding district general hospitals and this was reiterated at the conference, stating there will be times when services needed to be brought together, but there would also be times when a redesign is required to make DGHs more feasible as an offering.
It was clear from his speech that there is still a lot more to come this year.  There will be a more “hard-nosed review” of incentive schemes, such as quality and innovation, a five year forward look published in the Autumn outlining the sort of models of care that could succeed and also greater involvement of the third sector.

The annual conference is an effective opportunity for me as a Chief Executive to be able to meet my peers from across the NHS and discuss with them their successes and challenges, I have to say that this year, despite the difficulties that we all face, there was a buzz about the place and a sense of optimism.

CQC HOSPITAL INSPECTION REPORT

Thank you to the feedback that I received following the email I sent earlier in the week regarding the forthcoming CQC report and how we can best share and discuss the report once it is published.  Please do not hesitate to drop me a line; I have received comments around creating a Q&A through to how we might share the key messages from the reports. I do read them all.

BETTER CARE TOGETHER

We are nearing the end of June 2014, our target for creating the Strategic Outline Case (SOC) for better care together. The SOC is our headline proposal as a local health economy as to how we propose to change healthcare across South Cumbria and North Lancashire, ensuring the local population have safe, high quality services which can be sustained well into the future.

Before this take place, there will be a further stakeholder event on Saturday 21 June 2014, 10am – 1.30pm in Kendal. This is an event by invite, which will also include governor, volunteer and patient representation.

The event seeks to help attendees:

•    Understand in broad terms why change is needed and how an options development and evaluation process works for health services reconfiguration;
•    Find out why certain healthcare options may be unviable;
•    See the feedback from our engagement to date and how this has influenced the thinking of our clinicians ;
•    Look at the possible scenarios for future healthcare in and out of hospitals;
•    Find out more about health service reconfiguration and provide a patient and public a “sense check” on our work to date;
•    Ask questions to the clinicians who have been developing proposals.  

This event will be facilitated by an independent company called Participate who will produce a report capturing the feedback from the day.

I have requested that a similar opportunity is also made available for our staff and the better care together team is looking at how they can facilitate this.  However if as a staff member you would like to attend, then please contact Sophy Stewart (sophy.stewart@mbht.nhs.uk) who will be happy to assist. This is another good opportunity to receive up to date information on the programme and to share it with your colleagues.


Jackie Daniel
Chief Executive

Friday Message - 30 May

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Posted by corinnekemp

This is a copy of my “Friday Message”. As well as visiting wards and departments most weeks, I also provide a written update each week to our staff, governors and volunteers.

A GREAT PLACE TO BE CARED FOR; A GREAT PLACE TO WORK

As promised last week, I am now pleased to update everyone on our new vision and values. As a relatively new Board of Directors, we felt that the time was right last year to review our vision and values, enabling the Board to be clear on the direction of the Trust.

As a Board we designed a draft vision and set of values to take into account comments we picked up from staff as we visited wards and departments as to what they wanted for the future too. Between January and March this year we gave all staff, governors and volunteers the opportunity to further shape and comment on this draft work. I want to say thank you to everyone who took part, such as attending one of the workshops, completing a reply card from the ‘value stands’ that were in each of our hospitals, or by responding to the many articles in Weekly News.

All of the comments were read and as a result, the Trust Board this week approved a new vision and set of values.  We were very pleased, but not surprised that many people expressed that they wanted the vision and values to be more ambitious and specific. In addition, a comment we have heard before and during this process is that many staff would like the Trust to adopt a short strap line that encompasses our vision and values, we have therefore also approved the strap line of “A great place to be cared for; a great place to work.”  We can never forget that we are here for our patients, and they must be central to everything we do, however it is equally important that our staff and volunteers are recognised and I believe that the vision, values and strap line put patients and staff at the heart of everything we do.

On behalf of the Trusts Board, I am proud to present to you, OUR vision and values:

Our vision

We will constantly provide the highest possible standards of compassionate care and the very best patient and staff experience. We will listen to and involve our patients, staff and partners.

Our values

Patients: Our patients will be treated with compassion, dignity and respect. Their experience is our most important measure of achievement.

People: Our staff and volunteers are the ones who make a difference. They understand and share our values and this is reflected in their work.

Partnerships: Our partnerships make us strong. By investing in them, we will deliver the best possible care to our communities.

Performance: Our performance drives our organisation. Providing consistently safe, high quality care is how we define ourselves and our success.

Progress: Our progress will be improved through innovation, education, research and technology to meet the challenges of the future.

Words are all very good, and we can pat ourselves on the back for a job well done, but they won’t mean much unless we actually live and uphold them in our work.  It is easy to be cynical about such work; I recently received comments from a small number of staff, unsigned, as to what a waste of money and time this sort of work is, as they do this already. As a reply, I believe the vast of majority of our staff do fantastic work every day, in some really challenging and emotional circumstances. However, as the Chief Executive I still have to read and sign off responses to complaints from patients where we have failed them and we haven’t provided high standards of compassionate care, I also still have to challenge colleagues as to why some staff feel the non-negotiable rules around hand hygiene do not apply to them? I would say to those staff members that have objected to our recent sharing of the 6Cs and developing these values that it is incumbent on us all to lead by example, rather than sniping and commenting from the side-lines. 

As well as arranging for the vision and values over the coming weeks to be displayed across our five sites, we will also be making other important changes such as ensuring the values form part of our recruitment and appraisal process.  As always, we will keep you updated as to progress and involve you in this work.

OUR PLAN

The vision and values essentially serves two key purposes:

o    To provide a clear direction for the organisation, what we are trying to achieve; and
o    To state how we should behave towards each other, patients and others.
What it doesn’t do is provide the detail of how we are going to get there! To help you all, we have created a “Plan on a Page”.  The aim was to try to put in one place, the following:

•    Where we are going (Our vision)
•    How we will behave and act (Our values)
•    The goals we want to achieve (Our corporate objectives)
•    How we are going to achieve our objectives (Our plans, such as the Annual Plan)
If you follow these weekly messages, or attend the staff briefings, many of the items on the Plan on a Page will not be a surprise to you.  The top of the page is our vision, values and objectives, and below them our headline priorities. That’s not to say there are not more, but these are the ones we want to bring to everyone’s attention, as they often form part of our weekly discussions. Behind the headline priorities sit a number of plans and strategies which provides further detail.  For example we have shared with everyone on a number of occasions our intentions towards improving our estates and a strategy is being developed to support this.

The challenge with producing such a document is someone in the Trust will be disappointed that their area isn’t mentioned, please look again! We are all responsible for the actions, for example 7 day working, infection prevention and cost improvement I would argue impact on us all. As we start to work 24 x 7 across a wider range of services, how are departments getting ready to gear up and support them? Our clinicians will need supplies, records, cleaning, food, IT support etc., at all times of the day. Essentially ensuring services are based around the needs of the patient. It isn’t going to be easy, but it will be immensely satisfying as we start to see improvements to patient outcomes as a result, we must hold that in our minds.

The plan on the page, vision and values are currently all being printed and will start to appear right across our hospitals.

We have created a webpage (http://www.uhmb.nhs.uk/about-us/our-plan/) where you can download a copy of the plan on a page and we will start to add any supporting documentation to this page too.

We will update the Plan on a Page later this year to represent a 5 year period, and at that time discuss with you all in greater detail.

Jackie Daniel
Chief Executive

Friday Message - 23 May

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Posted by corinnekemp

This is a copy of my “Friday Message”. As well as visiting wards and departments most weeks, I also provide a written update each week to our staff, governors and volunteers.

As with many large complex organisations, it is all too easy to concentrate on our own areas and not regularly think about some of the work that goes on behind the scenes to keep our hospitals functioning 24/7. I am quite sure that this isn’t intentional, probably more a testament to the high standard of work that ensures our support services work away ‘quietly’ in the background. I spent some time this week in our switchboard at WGH. If in the future anyone ever says to me that all this team do is “answer calls” then I would challenge them to take the time to also understand these important roles a bit more. I would never take any of our staff for granted, but collectively, we do possibly take this service a little for granted at times. They are the virtual “face” of the Trust, for many of our patients and visitors they will be the first voice they hear when they call us and therefore have a crucial role to play in the experience of our patients.

It was an interesting and welcoming visit, and I’ve come away with a number of areas that need to be explored further. Firstly their accommodation at WGH isn’t good enough, there are plans for them to move into a much more modern and welcoming environment and I look forward to this taking place in weeks, not months. The team also explained to me the challenge they and patients face when changes are made to clinics and the switchboard are not updated, particularly at weekends. It is really important that this team are considered in departmental communication activities, ensuring they are kept in the loop and informed as to any changes that may affect them. I am quite sure they would welcome departments calling in to see them to ensure we are all working as one large team with the patient at the centre. I am looking forward to next week as I want to spend a bit more time with them including taking some of the calls and trying out the technology first hand.

Thank you to the switchboard team – your work is very much appreciated.

ALWAYS HERE
Staying on the theme of 24×7, I’ve mentioned a few times via these emails of developments around 7 day working. At the heart of the 7 day agenda is patients, in some cases they may be receiving a reduced level of care at the weekends. This subject featured on the executive directors meeting agenda this week.  We spent a good deal of time on Tuesday discussing plans for an initial solution to 7 day working in acute medicine at the RLI and FGH.  The plans centre around shortfalls in weekend consultant provision and to provide staffing levels consistent with the Society for Acute Medicine guidelines. Such a change will see patients reviewed at weekends and decisions about their care made. This is something that needs to take place to ensure outcomes are improved for our patients. The divisional leadership team are going to finalise these initial plans for further consideration and I hope to be able to formally confirm them in a matter of weeks.

VISION AND VALUES
Last year the Trust Board started to review the vision and values of the organisation.  We believe that it is important that everyone who works in our hospitals, as well as our stakeholders are clear about our direction of travel, what we stand for and the types of behaviours and actions we should all display. Between January and March this year, together with the Staff Side Chair, we invited all staff, governors and volunteers to take part in a number of activities and provide feedback and comment on the proposed new vision and values.  The activities ranged from completing reply cards to attending discussion groups with a member of the Trust Board. I am delighted that so many of you, from all different parts of the Trust voted with your feet and pens and got involved, thank you!  The feedback and suggestions have been incredibly helpful; we have read every single comment. As a result, I hope you will be pleased to know that we have now created a revised vision, which is much shorter, as well as revising the values where appropriate.  The vision and values will be presented to next week’s Trust Board for final approval and I will update you following this.

FRIENDS AND FAMILY
The experience of our patients is one of our most important measures of achievement. For those of you not familiar, the NHS friends and family test gives patients further opportunity to provide feedback on the care and treatment they receive whilst in our hospitals. It was introduced in 2013 and asks patients whether they would recommend hospital wards, A&E departments and maternity services to their friends and family if they needed similar care or treatment. This means every patient in these wards and departments is able to give feedback on the quality of the care they receive, giving hospitals a better understanding of the needs of their patients and enabling improvements. Going forward the test will be open to everyone using any NHS services, including staff.

The data I want to share with you today represents the feedback from over 9000 of our patients between October and May 2014.  Thank you to everyone involved in achieving this.  I see the hard work and professionalism from all of our staff every day and feel confident we will continue to see it improve.

Friends and Family Test Results

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

AND FINALLY

Next Wednesday is the Trust Board meeting and is being held at WGH. As always, members of the public and staff are very welcome to attend, further information can be found on the Trust website (www.uhmb.nhs.uk), or by contacting our Company Secretary, Paul Jones (ext. 46684).  For those of us who are off work for the long weekend, I am sure you will all join me in paying tribute to all of our staff who will be hard at work in our hospitals caring for patients, answering phones, cleaning wards and cooking meals and so on…you are all doing a fantastic job, thank you.

Jackie Daniel
Chief Executive

Friday Message 16th May

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Posted by woodfordp

Many of you will know that Jackie is on leave this week; however I wanted to share with you a number of key items. A little shorter than normal, however the videos I want to share with you will make up for it.

SPEAKING OUT

Jackie has talked recently about bullying and harassment and how it must not be tolerated, in whatever form across our organisation and I would like to echo this message. The support the Trust can provide isn’t just about such instances between staff, but also where members of the public may verbally abuse or physically assault anyone working in our hospitals.

This week, with the approval of the member of staff involved, we have shared with the media details regarding an abusive member of the public who has now been found guilty of using threatening, homophobic and abusive language towards a member of our staff.

It must have been incredibly difficult for the member of staff to speak out and I would like to praise them for doing so.  I am aware they were unsure about involving the police after the incident which left them feeling anxious and upset.

The case was dealt with by the Magistrates court where the member of public received a 180 hour community order, £100 court cost and £100 compensation.

If you need any help in raising the alarm where you believe anyone’s safety is compromised, please do not hesitate to let your manager know. In addition, I know that any of my executive colleagues would also be pleased to assist you.

 

STAFF BRIEFINGS

Thank you to everyone who recently attended the executive director led staff briefings.
The staff briefings are designed for members of the executive team to update staff on performance, but with a focus on the future, together with the opportunity for staff to ask questions. They are a supplement to the monthly team briefings which focus on current issues and performance.

As Jackie mentioned some weeks ago, at each quarterly briefing we will now record one of them and share it with you as we all appreciate how busy you all are. I was chosen as the first director to feature on this round of recordings, like most people I don’t like to see myself on camera, I am convinced it has put at least 10lbs on me, I will let you be the judge of that!

We aim to have the video on the staff intranet by Monday and will share the link in Weekly News. In the meantime, you can watch it on our YouTube channel: http://www.youtube.com/watch?v=8UD434BXDiI.

We appreciate that it is a long video and the sound in places needs to be improved, please see it as work in progress as we get used to the technology and further develop it.  The aim very quickly is to ‘chunk’ future videos into bite size segments.  This will allow staff and the public to watch the parts that most interest them, or the whole recording in one go.

 

APPRAISAL

We’re now well into the new business year and therefore the next round of appraisal and development reviews.  Appraisals provide a valuable opportunity for each of us to have a one-to-one meeting with our manager / appraiser to reflect on how we are doing, discussing progress and performance along with our role and priorities for the coming year, as well as discussing our development needs to support current role and future aspirations.   The process has been changed slightly for 2014-15 particularly with regards to the timeframe within which appraisal should be completed.

Further information will be in the next edition of Weekly News, however it is important to note that the process does include Clinical Directors and Speciality Leads.  If you have any queries regarding the process, please in the first instance contact your HR Business Partner who can provide further guidance and support.

 

YOUR HEALTH HEROES

The year is moving along quite quickly and we have now started to plan the next Your Health Heroes awards.  They were held in Barrow for the first time this year, previously they have always been in Kendal, the next awards will be held in Lancaster and continue to rotate around the Bay thereafter.


The awards were another great opportunity to formally recognise the hard work and commitment of our staff, volunteers and governors. You can now watch a short film of the awards here:https://www.youtube.com/watch?v=xravcGT2Cro.

Again, I will ensure that this film is also placed on the staff intranet as I am aware that some staff members may have difficulty accessing YouTube.

Aaron Cummins

Director of Finance and Deputy Chief Executive

Friday Message - 2 May 2014

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Posted by woodfordp

This is a copy of my "Friday Message". As well as visiting wards and departments most weeks, I also provide a written update each week to our staff, governors and volunteers

BETTER CARE TOGETHER ACHIEVES A KEY MILESTONE

On Tuesday I attended a ‘clinical summit’, with over 200 people in Kendal as part of the better care together programme.

I felt the summit was a real milestone for us all; it was an opportunity for the Trust, along with its two Clinical Commissioning Groups to stand side by side, together with partners from social care, mental health, community services and other NHS providers to share and seek feedback on early thoughts as to how future services may look.

It wasn’t about the detail of how individual services might look, but how hospital, primary, social and community care could be better configured in the future – providing a more joined up and seamless way of working.

The format for the summit consisted of clinicians from hospital and primary care providing updates from their respective workgroups of unplanned and planned care, maternity, paediatrics and out of hospital services. There was also an opportunity for delegates, who included patient groups, local GPs, practice managers, third sector representatives etc to break out into smaller groups and provide feedback on what they had heard.

Professor Chris Ham, Chief Executive of the Kings Fund provided the keynote speech which included a number of notable points from his observations on the day. Chris spoke about the American Health Care provider, Kaiser Permanente and the lessons that can be learned from other providers of healthcare both home and abroad. Kaiser operates 38 hospitals and employ over 170,000 staff. Chris spoke of two observations on their services for us to take away and think about; 1) that they treat each emergency admission into hospital as a failure and 2) they diagnose for admission, rather than admit to diagnose – of course they don’t get it right every time, but these two points provided good insight into their way of working and values.

These two observations are really important I feel as part of the future success of better care together, and while we may not have expressed them in the same way, the principles underpin some of our aims and aspirations. Especially around creating a system which is sustainable for future generations, both clinically and financially – to achieve this will require a change in thinking from us all.

It has always been clear that the unique geography and population of Morecambe Bay means that we have to think especially carefully about how we build sustainable, high-quality services that everyone we serve can access. There is clinical evidence that some “crisis” services like stroke and major trauma get the best outcomes when they  are delivered through larger, centralised units led by the country’s most specialised and experienced clinicians.

But we also know, not least through the interim reports from Sir Bruce Keogh’s Urgent and Emergency Care Review, that these larger, centralised units must be underpinned by ensuring the day-to-day care is carried out as close to home as possible, that all parts of the health service work together to make sure people avoid having to go to hospital at all in the majority of cases, and that patients are able to get to the services they need quickly and conveniently if a trip to a hospital or clinic is needed.

It is positive that these views were echoed by NHS England’s new Chief Executive, Simon Stevens, in his first update to the Health Select Committee this week. He told MPs that while centralisation was “unarguable” for some services, a more “creative” view would be needed to ensure the different needs of urban and rural populations are met, and that merging or closing smaller hospitals was not always the right way forward. He reiterated that local services should be developed in partnership with local communities, so we are confident that our collaborative, inclusive approach to Better Care Together is the right one.

Integration I believe is the way forward for our health and care services in South Cumbria and North Lancashire.  In my opinion, the next challenge for the better care together programme is to start to re-examine traditional organisational barriers and start to talk about how these services will be led. This isn’t the time to be precious about job titles and roles, but to remain true to our central aims of delivering really high quality, safe care for the local population. I was really encouraged at the clinical summit to listen to one of the lead GPs in Cumbria talk this way, about pooling resources and combining structures to remove the delays that exist for patients. It will take a lot of courage and we will need to test and stretch the current rules to allow such radical change to take place, but surely it makes sense that we strip as much bureaucracy as possible out of the system and look to make it as safe, efficient and accessible as possible for every patient?

What are the next steps?  We’ve reached the target of creating a ‘long list’ of ideas around how healthcare might look in the future, the plan now is to review them, alongside all of the feedback and evidence available to create by the end of June 2014, a high level plan. This plan is called the Strategic Outline Case (SoC) and will detail how over the next five years, in partnership with the local health economy, we will start to deliver the transformational work required.

 

SUPPORTING EACH OTHER – ENGAGEMENT

The Trust Board received an update this week on the continued work to improve engagement across the Trust. An important part of staff engagement is ensuring that everyone who works in our hospitals feels supported and respected.

As part of this positive work there will be a renewed focus on wiping out bullying and harassment across our Trust. Bullying and harassment, in all its forms, must not, and will not be tolerated. In the same way we proactively ask all staff to speak out when they have safety concerns, we also want anyone who works in our hospitals to raise the alarm, and take action should they witness, suspect or fall victim to any form of bullying or harassment.

When a person is bullied or harassed it can have a profound and long lasting effect not just on those immediately involved, but also for those around them. It can also have a negative effect on the care we provide for our patients, through staff experiencing reduced morale and confidence and in some cases absences.

The recent staff survey highlighted that around a quarter of staff who responded raised bullying and harassment amongst staff as an issue. The only target of improvement that we can have with regards to anyone working in our hospitals, not being the subject of bullying or harassment is to stamp it out altogether.

Over the coming weeks the HR teams, led by David Wilkinson, Director of Workforce and OD, will be sharing will all staff via weekly news and divisional meetings further information on the actions the Trust is taking and the support and advice available.

On behalf of the Trust Board, I want to call on all staff to support the work that is underway to drive this out of our organisation and to adopt a zero tolerance approach to bullying and harassment.

 

STAFFING

As you would expect the Trust Board spend a good deal of time discussing and working on this area with divisional leaders. At this week’s Board meeting Sue Smith, Executive Chief Nurse and David Wilkinson presented the paper I referred to in my Friday message last week, regarding Nurse and Midwifery staffing and recruitment.

Our HR experts, together with divisions are seeing their hard work pay off. International recruitment has made a positive and valuable contribution to our hospitals. Twenty six appointments have been made from Spain, Romania and Italy, of which nine candidates have now taken up their posts within the medical and surgical divisions.

A further seventeen candidates are going through pre-employment clearances, with the majority expected to commence on 8 May. The Divisions are currently working closely with the international recruits to address any pastoral or professional support issues. In addition, keep-in-touch days for the new staff are being arranged in conjunction with the HR team and the Divisions. Provision of accommodation continues to be the most problematic aspect of international recruitment, with a number of options currently being explored.

I’ve talked previously about how different and strange it can feel when joining a new employer, please take a moment to consider the extra challenges for a new member of our team who might not be used to our cultures, and idiosyncrasies of which we have many!  I am sure you will all join me in taking a few extra moments of time with them to assist and make them feel welcomed.

I’ve previously updated that ward 39 is now fully staffed to the funded establishment, and has been for some time, an additional supervisory band 7 nurse has also been appointed on the ward to support newly recruited registered nurses to achieve their competency assessments.

We remain committed to publishing nurse staffing levels to meet the requirements of the ‘Hard Truths Commitments’ – the senior nursing and midwifery team have been working to ensure that information relating to funded and in-post staffing detail is displayed publically this month in all inpatient wards.

Jackie Daniel
Chief Executive

Friday Message - 25 April 2014

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Posted by louisefleming

This is a copy of my "Friday Message". As well as visiting wards and departments most weeks, I also provide a written update each week to our staff, governors and volunteers

We are anticipating the outcome of the recent CQC inspection of our hospitals in the next few weeks, and whilst we have not yet received a draft of the report, it is likely that staffing will feature.  As soon as we have further details on the report, we will take the time to sit down and share it with you all.

The recruitment and retention of professional staff is one of our key strategic risks, at next week’s Trust Board meeting (Wednesday 30th), we will receive a paper regarding nursing and midwifery staffing and the positive recruitment efforts that are underway, including confirmation that Ward 39 at the RLI is fully staffed to the funded establishment. In fact, this has been the position on the ward for some weeks.

You will know from my previous briefings that good progress has been made with the recruitment of registered nurses and midwives over the last year and more needs to be done to close the gap for unregistered positions.

I am sure that you will be pleased, as I am, that as an executive team we have agreed a strategy to over-recruit with an understanding that efficiencies will be released through a reduction in temporary staffing costs and through reducing cost associated with harm. As I’ve previously mentioned, we know that each year a certain percentage of staff will leave the organisation – therefore as leaders of the organisation, we are now working through the detail to ensure you have the support required to allow you to operate this way.  Clearly it can’t be an open book and controls need to be in place, but we do want to give you the freedoms to operate within a clear set of parameters.

A recruitment campaign is currently underway for over 20 whole time equivalent staff to join our Children’s and Young people’s team – promotion is underway with assessment centres planned in May. Early interest is encouraging and it’s good to see the leadership of the teams showing real innovation through the use of a Q&A this morning on Twitter.

If you have the time, please take a moment to visit the Trust website where all Board papers are published (www.uhmb.nhs.uk).

 

Patient and staff experience

The experience of everyone who uses our hospitals is critical.  We all want people to be treated in the same way we would like our loved ones to be. This month I received two sets of information relating to the experience of our patients and staff - I know statistics can turn many people off, but these stood out and I would like to share the headlines with you.

The first is as a result of a piece of work that took place in March across our three hospitals as part of Intentional Rounding.  Five staff and five patients from each in-patient ward were asked a series of short questions.

Patient experience

% that replied Yes

Were you involved as much as you wanted to be in decisions about your care and treatment?

90%

When you had important questions to ask a nurse, did you get answers that you could understand?

95%

Were given enough privacy when being examined or treated?

98%

Did you have confidence and trust in the nurses treating you?

97%

If you were ever in pain, do you think the hospital staff did everything they could to help control your pain?

96%

Did you get enough help from staff to eat your meals?

99%

On reflection, did you get the nursing care that mattered to you?

95%

If a friend or relative needed treatment, would you be happy with the standard of care provided on the ward?

95%

 

Staff experience

% that replied Yes

I am satisfied with the quality of care I give to patients/ service users

91%

If a friend or relative needed treatment, I would be happy with the standard of care provided by this ward

89%

I would recommend the ward as a place to work

86%

 

I would like to thank all of the patients and staff that took part. These are an encouraging and positive set of results. This survey will now be carried out each month, across all wards in our hospitals and we will ensure they are shared with all staff, volunteers, governors and the public.

If you would like to know more about this work, I am quite sure that Joann Morse, Deputy Chief Nurse at the RLI and her team would be happy to discuss the findings and approach with you.

Patient experience - chemotherapy

The second set of experience results that I received concerned patients undergoing chemotherapy at our hospitals.

Of those surveyed, 100% of patients rated the service as good or better – with 97% saying the service was very good or excellent.

The survey was conducted by Quality Health nationally and when broken down local patients said their service was responsive to their needs.

The Trust performed as well as – or better than average – in 46 of the 52 questions asked in the survey.

I have recently spent time on two of our units which provide chemotherapy and know how passionate and caring you all are, well done to everyone involved – we have shared these excellent results with the press and local partners.  I will arrange for a copy of the survey to be placed on the intranet.

Safety seminar – 2 May

I have the privilege on the 2 May of attending and delivering the opening talk at a national patient safety seminar being held at Lancaster University.

The seminar has been organised by the British Association of Physicians of Indian Origin (BAPIO). BAPIO is a national voluntary organisation representing the interests of over 50,000 doctors and 15,000 dentists working in the NHS. 

I am pleased to support BAPIO, as I am other organisations, in the important pursuit of continually raising standards to ensure the services we all provide are the safest they can be.

Better care together – 29 April

On Tuesday next week, over 200 people will be gathering in Kendal to receive the latest update on the work of better care together.  The aim of the event is for those people who have been closely involved in the programme, including many of our clinicians and staff, to gain a clearer understanding on progress to date and next steps. 

We are also planning to look at how some of the possible models of care are taking shape. This is very much an early look and it is important to remember that no decisions have yet been taken as to how future services may be configured in the future. If you do hear any rumours that decisions have been taken, you can always make use of the rumour line, speak to your line manager, myself or any member of the executive team for clarification – we don’t want people worrying unnecessarily and we will do our best to provide a quick reply.

Following the event we will be collating the information and providing an update to all staff, stakeholders and the public.

Jackie Daniel
Chief Executive

Friday Message - 18 April 2014

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Posted by louisefleming

This is a copy of my "Friday Message". As well as visiting wards and departments most weeks, I also provide a written update each week to our staff, governors and volunteers.

As an executive team and a Trust Board, we have recently taken the time to look forward and plan for some of the key events that we expect to take place this year, and I will summarise some of them in today’s message.

But before I do, I am conscious that whilst I am thinking about a break over the bank holiday weekend, for many of our staff it is ‘business as usual’, working around the clock to care for our patients.  In my opinion hospitals are like many of our public services, we hope we never need them, but sleep sounder knowing they are there if we do.

Whilst my team and I visit wards and departments at all different times of the day and night, we should never forget those staff who are still here when we have turned the lights out and gone home – I wanted this week to say thank you to those staff who work what we often think of as ‘unsociable’ hours, I really don’t take your contribution for granted.  But thinking ahead, this surely needs to become the norm for our hospitals?  After all, patients do not choose when to become ill.

Nationally, hospitals, ours included, will need to move to true seven day working – there is evidence that limiting services over weekends can have a detrimental effect on the outcomes for our patients, including increasing the risk of mortality. I do believe that we will look back in the future and wonder how services were ever planned this way.  Our forthcoming staff briefings will touch on this important area, you can also read more about the NHS plan for “NHS everyday” on line: http://www.england.nhs.uk/ourwork/qual-clin-lead/7-day-week/7ds/.

LOOKING FORWARD

I want to share with you all a number of key activities taking place in this year. We will also circulate a more complete ‘map’ of the year in due course, and talk to you all as these events approach.

ITEMS

POSSIBLE DATE

COMMENT

CQC Hospital Inspection Report

April / May

We will likely receive a draft copy of the report at the end of April / early May.  Following this the Trust has an opportunity to comment before the report is published.

Prior to publication, the CQC will hold a quality summit for the Trust and other relevant bodies to meet and discuss the outcome and next steps.


Better care together – clinical summit


29 April


Around 200 representatives from the organisations that have input into the process have been invited to a half day event.

The intention is that this will be the first look at a long-list of potential models for how healthcare may be provided in the future, both in and out of hospital across the Morecambe Bay area.

It will not be the final recommendations and will require further work.

 

Five Year strategic plan

 

 

June

The Trust will be submitting to Monitor its plan for continuing to transform services.

Safety, quality and the patient experience will be at the heart of the plan and detail how the Trust will be able to deliver high standards of care with the resources available to it.


Better care together – ‘strategic outline case’


June


This will inform our 5 year plan and include the recommendations for how the local health economy could deliver healthcare in the future, both in and out of hospital for the population of the Morecambe Bay area.

It will then require further, formal scrutiny and examination before submission to NHS England.  Major, substantial service change will require formal consultation.


NHS staff survey


Sept


The views of our staff are critical if we are to improve.

The staff survey provides a useful method, amongst others, to understand how our staff feel when working in our hospitals.


Morecambe Bay Investigation

 


Autumn


Whilst we don’t have an exact date, the Chair of the Investigation Team has indicated that he expects to conclude and report the findings in the Autumn. 

AND FINALLY

I started by saying that I was thinking about the long weekend – it is very important that we all look after ourselves. As an employer we take our responsibility for your health and well-being really important.

I want all of our staff to feel supported when you come to work and good health and wellbeing plays a key role in preventing a wide range of major health conditions. It can also improve mental health by reducing stress and anxiety, as well as having a positive effect on self-esteem.

Your management team and Human Resources are here to provide you support when you need it. We also have a number of services available to you provided by our dedicated team of specialist Occupational Health nurses and doctors, should you need support if you are experiencing anxiety, or stress, or would like some advice regarding your health and wellbeing such as stopping smoking or how to lead a healthier lifestyle. 

We also have the Employee Assistance Programme, an independent, impartial and confidential service; please speak to your line manager or HR Business Partner for details.

One of our workforce priorities this year is to ensure our employees are healthy, happy and safe in their working environment. If you have any suggestions for how we can improve your life at work, or would like to get involved in the project please do not hesitate to contact Karmini Willmot, HR Business Partner on 07760 426250.

How do I relax? I am currently in training for the Edinburgh Marathon at the end of May and most of my spare time is spent preparing for it. I find it a great opportunity to spend a few hours clearing my mind and concentrating on something completely different – I say relax, my body is often saying something different the morning after!  Whatever you are doing at the weekend, I do hope that you are able to find some time to safely unwind and relax.

Have a very happy Easter.

Jackie Daniel
Chief Executive

Friday Message - 11 April 2014

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Posted by JackieDaniel

This is a copy of my "Friday Message". As well as visiting wards and departments most weeks, I also provide a written update each week to our staff, governors and volunteers.

WELCOME TO NEW COLLEAGUES

The first day of joining any new job is arguably one of the most important in your time with the new employer. It is our opportunity, as a Trust, to share and discuss our vision and values – where we are heading and the standards of behaviour expected by patients and colleagues.

We have now amended our corporate induction to be a one day programme taking place twice a month, with an introduction at each session from an executive director.

I would like to personally send a warm welcome to everyone that has joined the Trust this week. I know how it feels to start a new job, from excitement through to confusion – especially if you are new to the NHS and the myriad of jargon that comes with it! Good luck and welcome to the team. 

I welcome all feedback, but I would be especially interested to hear from new staff as to their initial experience when joining us. 

NEW NON-EXECUTIVE DIRECTOR

One of the new members of team this week is Jacqueline Pratt, - our new Non-Executive Director.

Jacqueline started her career 30 years ago as a Social Worker. Her career has continued to progress with experience of health and social care leadership at Board level, including leadership and governance roles within an NHS Foundation Trust and the Police Service.

I am sure you will join me in welcoming Jacqueline to the Trust and I know she is looking forward to working with the Board, governors, staff and volunteers to continually improve standards of safety, quality and experience for our patients and staff.

Non-Executive Directors play a crucial role in the leadership of the NHS, ensuring its strategic direction is in line with government policy, while also providing a voice for local communities.

RUMOUR LINE
Last week I launched the Rumour Line – a chance for us to answer your questions and ‘myth bust’ those rumours. I will be looking at these on a weekly basis and responding to them via the Weekly News. If you have any questions or hear a rumour you’d like answering, please let us know. 

I don’t plan to respond to these via the Friday Message each week, but I thought I’d start of by answering what I have received to date below:

Q. The RLI is to merge with Preston and Blackpool Hospital. RLI is going to be demolished and re-built with a multi-story car park.  FGH will stand alone.

A. We have no plans to merge with Preston or Blackpool hospitals.  Our strategy, better care together, is reviewing services in partnership with our two clinical commissioning groups of Cumbria and North Lancashire to create, within the existing geography, a new way of delivering safe, high quality care which can be sustained for generations to come. Whilst we do not yet know the outcome of the review, I have not attended any meetings to discuss such a merger.

We have no plans to demolish the RLI. As I have put in writing recently to all staff, we have started to develop plans, following initial meetings with the City Council, to develop the existing visitor and staff parking at the RLI, which is likely to include a multi-story car park for hospital use.

In terms of Furness General Hospital being stand alone, it is a difficult question to answer as I am not clear on whether this means we have plans for it not to be part of the Trust? I have been very open in that we cannot go on providing services as we do, in the way we do across the three sites moving forward, it isn’t viable - clinically or financially. However, I do feel that we are stronger as a network, and the current discussion is focussing on how we develop pathways of care across primary, community and acute care in order to improve the way we deliver care as a ‘whole system’ but how we operate and manage the hospital sites in the future is likely to change, especially as we look to implement essential changes for the benefit of our patients such as seven day working.

Q. Is it true WGH will close?  Porters and domestics have been told this may happen.

A. We have no plans to close WGH.  Whilst services may change in the future following the review, it would be premature to speculate at this stage.  As soon as we have any plans, for any of our hospitals that indicate change, I will let all staff know.  It is important to remember that change does not always mean reducing services.

 BETTER CARE TOGETHER

For over eighteen months now, the better care together programme has been looking in great detail at the best ways of ensuring that we can provide safe, long-lasting, high quality and affordable health care services for the people of Morecambe Bay. The Trust and its two Clinical Commissioning Groups remain committed to this aim.

What is important, we believe, is not who owns our hospitals, but the quality and range of services available for local people. That isn’t code for closing, downgrading or selling off any of the hospitals; on the contrary, having this as a principle allows us to think beyond traditional organisational boundaries and focus on people, rather than the buildings. 

As you all know, if we don’t get this process right and sort out the long standing issues facing our hospitals, the matter could be taken out of our hands by the regulators, in which case, the future ownership of any of our hospitals could be in doubt as we have now seen elsewhere in the country.

We have been clear that as soon as we have any specific proposals for service changes these will be shared with staff, partners and the public. We have not yet reached that stage and there is still much more detailed work to do on key issues before we make any formal recommendations about the best way forward.  

We have a number of key dates approaching starting with 29 April.  On 29 April, we will brief around 200 clinicians and other colleagues from the organisations that have been involved in the better care together process, providing them a ‘first look’ at possible future models of care. We have held a number of workshops/ information sessions this year for staff across our hospitals, together with CCG colleagues and we are now in the process of planning further opportunities for staff, governors and volunteers to be updated on progress.

I would like to repeat my previous requests to you all, I know how busy you all are, but given the importance of the information we have to share and discuss with you, if you could do your very best to attend, or perhaps arrange in teams for a colleague to attend and feedback, it would be appreciated – this really is too important to miss the opportunity to get involved.

UNDERSTANDING THE NEEDS OF OUR COMMUNITIES

I spent the evening yesterday at a Community Forum in Barrow-In-Furness.  Around 40 women from across the community attended.  I met many inspirational women who were engaged in work across the community and who were changing the experience and lives of those around them.  It reminded me how important it is to listen and understand the needs of the population we serve.

 

Jackie Daniel
Chief Executive

Friday Message - 4 April 2014

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Posted by woodfordp

This is a copy of my "Friday Message". As well as visiting wards and departments most weeks, I also provide a written update each week to our staff, governors and volunteers.

 

The Friday Message

SIMON STEVENS – NEW NHS CHIEF EXECUTIVE

On Tuesday, 1 April, Simon Stevens took up post as the new Chief Executive of the NHS, I look forward to working with him and wish him every success. Simon delivered a speech on his first day in the job and you can read it in full here: http://www.england.nhs.uk/2014/04/01/simon-stevens-speech/.

As part of the speech he was clear that he wants to take a bit more time assessing what needs to change within the NHS, but also recognising that for the majority, the quality of NHS care is very high. He did however make a number of headline observations which I feel resonate with what we are aiming to achieve through better care together and greater partnership working.

Within his speech he talks about the need to find ways of better blending health and social care for people with high needs and for those high performing Clinical Commissioning Groups, considering bringing some services together within primary, community, and specialist care.

To quote from his speech, ‘If you’re going to get to a sustainable and future-proofed local health system, what are some of the longstanding assumptions and constraints we’d need to say goodbye to?’

Simon also talked about three elements that I feel are forming part of the discussions and planning within the work of better care together:

  • Boosting the critical role that patients play in their own health and care;
  • Supporting the amazing commitment of carers and volunteers and communities to sustaining their health and social care services;
  • And unleashing the passion and drive of the million+ frontline NHS staff who are devoting their professional lives to caring.

I am sure we will see more information over the coming weeks as he works with the wider NHS, public and third sector to meet the future challenges and I will share these with you as they are released.

I would be grateful if you could take a few moments over the coming week to read the speech, as I do feel it provides a good deal of context as to why we created better care together, and that in some ways, we are ahead of the curve in this thinking.

OUR FUTURE AND RUMOURS CIRCULATING

My aim when I started the Friday message was to be as open as I could be on matters concerning the Trust without causing unnecessary worry or alarm. Therefore I was disappointed this week to be discussing via the press, details of a meeting with staff which has in my opinion, brought unnecessary concern to many of our staff, patients and local residents.  I don’t doubt the intentions were well meant and I do respect the views put forward.

When we started on our journey with better care together, we agreed at the outset, with our partners, that we would not work in secret and that as and when thoughts and plans started to take shape or we faced matters we needed assistance with, we would discuss them with our staff, the public and stakeholders. The aim remains that this feedback will help inform the clinical design process ahead of the recommendations we expect to receive in June this year. What we didn’t want to do was wait until the summer and announce the details of a consultation that none of you had any knowledge of.

I am sure you are all aware of better care together, however, as with any large complex organisation, there will be a lot of people in our Trust who will be new, therefore I would like to remind ourselves why we created this plan.  Better care together is a programme of work which was formed by the Trust and its two Clinical Commissioning Groups to review services across the Trust. More recently this was expanded to reviewing ‘out of hospital’ services.  Together, we want to design a new health care service for South Cumbria and North Lancashire, which is not only safe, but offers high standards of care and experience for patients and staff. We cannot sustain our hospitals as they are currently configured, clinically or financially. Through better care together, we want to transform the services to ensure they can be sustained for generations to come.  Whilst I can’t second guess the outcome of the work that is taking place, any substantial change would be subject to formal consultation. What I am clear about is that it is very unlikely the outcome of better care together will be to stay as we are and ‘tinker’ around the edges – the public, staff and stakeholders deserve much more than that. I do believe that if we work together we can create a system that we can all be proud of, but we do have to think beyond bricks and mortar, this isn’t the time to be protective about traditional organisational boundaries.

The difficulty with a process such as better care together is who do you tell first? We decided, and I believe rightly, that we should discuss our thoughts with some of our most senior clinicians in the organisation as well as with you all. We have also arranged and publicised staff briefings for the coming year – we do trust our staff and our intention remains to brief you in this way, rather than via the media first, we hope you will continue to be supportive of this approach.

 

Disposal of Westmorland general hospital

I would like to address the main crux of the claims, regarding the sale or disposal of Westmorland General Hospital and the Trust Board’s approval of over £150m of capital expenditure at our other two main sites. The Trust Board has not approved such an investment, nor have any decisions been taken over the long term future of our hospitals, other than to commission, and be part of better care together.

We remain absolutely committed to better care together and continue to work in partnership with our two clinical commissioning groups to see through the plan of reviewing healthcare services that take place both in, and out of hospital. The aim is to ensure future health care in South Cumbria and North Lancashire remains safe, is of a consistently high standard and can be provided within the resources available for generations to come.

 

Estates planning

 I recently wrote to all staff regarding the progress of our draft estates strategy via the Friday Message. We are very mindful that better care together has not yet provided any recommendations on what future healthcare may look like, but we do have sight of some of the commissioning intentions from our commissioners, such as the aim to retain consultant led maternity services at Furness General Hospital.

In addition, we are aware of some of the immediate pressures that remain if any of our sites are to be further developed over a long period of time, such as car parking at the Royal Lancaster Infirmary. Car parking at Lancaster causes our patients and staff additional anxiety on a daily basis. A significant amount of preparatory work would be required if this situation was to be drastically improved, and we have held initial talks with the City Council around this possibility – an improvement which could benefit the majority of patients that need to travel to the Royal Lancaster Infirmary.

Clinical modelling work: what might things be like in the future

We have also been discussing with staff, the public and stakeholders via engagement events how services may look in the future. Helping each other to think differently in anticipation of the recommendations that will emerge in the summer. We have been very open about how this is coming together, enabling these conversations and activities to take place. I wrote to our stakeholders, staff and Governors in January this year, together with my colleagues from our two Clinical Commissioning Groups and we were clear about some of the thinking at that time around ‘in hospital’ services, which included a number of potential scenarios - following which, you may have seen the headlines of a “super hospital” to serve the whole of Morecambe Bay. 

When talking specifically about Westmorland General Hospital (WGH) we have been discussing whether or not it should be our Trust that owns the site in the future. We only occupy part of the hospital, two other NHS Trusts also operate a number of services from here. For example, the Primary Care Assessment Service (PCAS) is available 24x7, treats in excess of 20,000 patients a year and is provided by Cumbria Partnership NHS Foundation Trust.  We have also been discussing how the hospital could be further developed, with open questions for discussion – such as bringing other services onto the site. But again, no decisions have been made.  We are proud of the services that are provided at WGH and know how valued they are to the public, but that isn’t a reason not to review them and consider how they may be best delivered in the longer term to meet the changing health needs of our local population.

Trust Headquarters

We have been doing a lot of work recently not just as an executive team, but across the organisation to ensure we are more visible to our staff – I know from feedback from my colleagues and personally that this is starting to make a difference, but I feel we can still do much more to ensure we are better connected with you all. As part of this work we are considering the location of the executive team and some support staff, and the opportunity to be located across our sites.  Essentially, being based where the majority of activity is taking place and staff employed, be that in Barrow or Lancaster. Do you agree?  I welcome your thoughts.

When we started the important work of better care together we saw headlines stating the A&E at the Royal Lancaster Infirmary was to close, in January there was to be a “super hospital” to be built and this week it is the possible closure or sale of Westmorland General Hospital.

 

As we go through the process of reviewing services there will naturally be a lot of questions and supposition. If you are hearing rumours about the future of a service or have concerns you do not feel are being addressed, then please do not hesitate to let me know and together with my colleagues, we will try to answer them as best we can.

However, let me be absolutely clear – if you see practice that you feel falls below the standards we expect for our patients or staff, then please raise the alarm, you will be supported, the safety of everyone who uses our hospitals is our priority.

I don’t want to let a rumour get in the way of a few good facts, Starting next week, we will publicise via Weekly News each week an email address for any rumours that you hear and share the responses via the staff intranet for you all.

CARE QUALITY COMMISSION REPORT – PUBLISHED TODAY, 4 APRIL 2014

A report from the Care Quality Commission (CQC) following an unannounced inspection at Royal Lancaster Hospital in October last year is being published today. The report shows that the Trust was already acting on the findings of the unannounced visit, and since the report, more progress has been made.

My executive colleagues and I spend time each week on our wards and in departments, and we know first-hand that our staff are working hard day-in, day-out to ensure services are safe, and standards of care continue to be improved for the benefit of all of our patients.

Staffing on ward 39 is now up to establishment, and we continue to monitor staffing levels, not just on this ward, but across the Trust. The ward also has additional leadership support.

I would like to thank all of the ward staff for working together to make further improvements, and welcome the support of one our local MPs who recently visited the ward to meet staff and patients and see first-hand the progress being made.

Over the last year, the Trust has been successful in increasing the number of registered nurses at the Trust, seeing over 130 new nurses join our hospitals. We still have work to do, but have significantly reduced the vacancy levels in these areas. The Trust is committed to being open and transparent and will shortly be publishing, on a monthly basis staffing levels for all of its wards as part of providing further reassurance to the public.

THANK YOU

Last weekend, like many of us I was enjoying the first really warm days of the year, sadly, I also became one of the first people to arrive at the scene of a serious traffic incident and stayed to assist.

I don’t want to go into details of the incident, other than to publicly say thank you to the doctors, paramedics, police and other people who assisted – I will place this message on my blog too. I may be a nurse by background and at heart, but it still takes moments like that to remind you how precious life is, and to remember what an incredible and vital role our NHS plays at such times. I will contact those people separately who I can recall from the incident.

Jackie Daniel
Chief Executive

Friday Message - 28 March 2014

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Posted by JackieDaniel

This is a copy of my "Friday Message". As well as visiting wards and departments most weeks, I also provide a written update each week to our staff, governors and volunteers.

 

BetterCareTogether-Blue.jpg

Better care together – developing our strategy

It continues to be an exciting but very busy time in developing our strategy - better care together. 

This week, I had the pleasure, together with George Nasmyth, Medical Director and Juliet Walters, Chief Operating Officer, to meet a large number of our consultant colleagues from across the Trust. This was an opportunity to discuss how we are progressing with better care together, and as I recently mentioned, to discuss the draft estates strategy.

We don’t have all the answers yet as we are still working with our partners on developing the possible options for how future services both in, and out of hospital, could look but it was a further occasion to provide an early look at thoughts and receive comments.

I always welcome feedback and suggestions about what’s working and what isn’t and discussing how we can improve on things. While we received a lot of feedback about the longer term plans, certainly about how the different hospitals and services could be developed, we also discussed a number of other areas, such as the impact of getting the staffing levels right. This wasn’t just focused on patient facing staffing but also the administrative and support services, along with the importance of retaining staff once we have recruited them.

I would like to thank everyone that was able to make the meeting, especially as it was in the evening and many of you have other commitments.

It is essential, as we do in other areas of the Trust, to keep these sessions as a regular calendar item throughout the year, and I will work with George Nasmyth and our consultants to ensure this happens.

Staff Survey

As you will be aware, the results from the Staff Survey 2013 have recently been released. These results are your way of letting us know what we are doing well and what areas we need to improve. We want to give you the opportunity to talk through these results with us, feeding back what is working and what isn’t, so we have arranged some feedback sessions. These sessions start on Monday and more details can be found in the link at the end of today’s message and in this week’s Weekly News. 

We really hope you will join us at one of the sessions and take part in making any changes which will go towards improving your experience at work.

Nursing and Midwifery recruitment

As an executive team, we have been leading the work to review the recruitment for the nursing and midwifery (registered and unregistered) workforce.

Sue Smith, Executive Chief Nurse, and the team are aware, particularly from the time we spend each week on our wards, the importance of getting this right to allow you all to do your jobs to the best of your ability.  Getting the staffing right – not just in terms of numbers, is vital as part of continually improving standards of quality and safety.

Over the last year, efforts have been increased to improve the recruitment success in these areas. We have been targeting our efforts, such as making use of social media, attending recruitment fairs, improving the quality of recruitment information, and undertaking overseas recruitment.

In addition, the teams have also looked at ways of improving the process for recruitment and to reduce the time it takes, such as the introduction of the online system (TRAC).

It was reported at the Board meeting this week that the Trust currently has an overall vacancy figure for the nursing and midwifery (registered and unregistered) workforce of 5.6%, against a budgeted establishment figure. However, as with most statistics, you need to look further.  For registered posts, efforts have paid off and we currently have a vacancy factor of 3.5%, however for unregistered staff, this currently stands at 10.3%. 

Clearly there is more to do to improve the figures, particularly for unregistered staff.

Based on previous data, it is reasonable to anticipate that the current turnover rate of approximately 8% in these areas will continue for the foreseeable future. It is unlikely, therefore, that the current pressure on nursing recruitment will stop in the coming years, and as such it is necessary to continually identify more innovative, streamlined, approaches to meeting this rising demand.

If we know 8% of this staff group are potentially going to leave this year, it then makes sense to start recruitment efforts in advance, recruiting in cohorts and anticipating the demand.  This will also help to reduce the issue we face where we have to say “no” to suitable candidates. For those people who may want to join our Trust, it allows them to plan, knowing when throughout the year we are recruiting.

This simple change will lead to a more efficient, streamlined approach to the recruitment process which will be more responsive to the Trust’s needs. Cohort recruitment would be managed through assessment centres where the selection would focus on the Trust values in addition to clinical skills. Site-specific recruitment cohort days on a monthly basis will be held with a two stage recruitment process.

Moving forward, plans are also being developed to look at the role of Modern Apprenticeships for unregistered roles.  An apprenticeship would allow recruits to receive paid, on the job training, as well as a formal certificate. At the end of the course, the apprentices would have the opportunity of staying with the Trust in paid employment, or furthering their career development by undertaking study to gain registered status. This is an exciting development and will, in time, reduce our reliance on agency and temporary staff and help to develop the workforce at the beginning of their career. 

David Wilkinson, Director of Workforce and Organisational Development, and his team will be in direct contact with all divisions to discuss these improvements and to work with you on implementing them.

We all have a role to play in the experience of our patients

Arguably the most important part of our monthly Board meetings is the first agenda item which is always a story about the experience of one our patients.

As a Board, we always feel privileged that patients share their experiences with us. We receive the information in a number of different ways, such as being read out by a clinician involved in the care of the patient, via a video, or by the patient themselves.

Not all of the experiences we hear about are positive. This opportunity allows the Board to question and examine the improvements that have taken place and lessons have been learned and shared.

If you are not aware, the monthly Trust Board meeting is held in public, hence we provide different options for patients, including whether or not they want their name disclosed. 

What is important is that, as a Board, we never lose focus as to what is important – the safety of everyone who uses our hospitals, the quality and standard of care being provided, and the experience of our patients.

This week, Lynne Wyre, Assistant Chief Nurse – Surgery and Critical Care, presented a story of a patient who after a fall at home, spent around 32 days in hospital, with spells in both the RLI and Royal Preston Hospital (RPH).  We heard many positives and I will talk about one of those, but sadly we also heard the patient had a poor experience in a number of areas. Before I mention more, I would like to say thank you on behalf of the Board to the patient for sharing their experiences.

The details of this patient’s experience have been shared with the staff involved and the plan for improvement shared and discussed with the patient.

What came through listening to the story, and I hope this won’t be a surprise to any of you, is the difference the little things make to a patient whilst they lie in their beds.

I would like to share with you two particular items from this particular story. Firstly, an example of where small things can have unexpected consequences for a patient. The patient was told over the course of a week that they would be transferred to RPH for further treatment and that the ward was ‘waiting for the call’. The patient, who was immobile, complained that the phone on the ward would often ring without being answered.  The consequence of this is that the patient felt more and more anxious each time, thinking this could be the call confirming the transfer, especially as we had raised and lowered expectations each day.

A real positive from the story was the patient’s impression of a member of our staff. The staff member’s name is Henrik Wagner, and he is a Domestic at RLI. Henrik was praised by the patient for taking the time to talk to them - just a pleasant “morning” and “how are you?” made all the difference. I know a number of nursing staff were also praised but Henrik was specifically mentioned as making a difference.

I would like to put on record my thanks to Henrik, and look forward to meeting him when I am next on the wards at the RLI.

The minutes of the Board meeting will be published prior to the next meeting, which will include further detail of this patient’s experience, and be available on the Trust website (www.uhmb.nhs.uk). In the meantime, I am quite sure that Sue Smith’s team would be pleased to share the details and learning with you.

#hellomynameis Jackie

I want to stay on the theme of the experience of our patients. I do believe that we can all make a difference, every day, to improving the experience of everyone who uses our hospitals - the previous story clearly demonstrates this.

Dr Kate Granger, an Elderly Medicine Registrar working in Yorkshire, is terminally ill with a rare form of cancer and her experience of being a patient led her to start a campaign to raise levels of compassion among NHS staff.

Through social media and a personal blog, she has started a campaign, #hellomynameis, in order to raise awareness of how simple things can dramatically improve the dignity, respect and experience afforded to service users.

I want to quote direct from Kate’s blog as it explains her campaign:   http://drkategranger.wordpress.com/2013/09/04/hellomynameis,

I was recently a hospital in-patient with post-operative sepsis following a stent exchange procedure. During this admission I made some observations on the quality of my care. Perhaps the starkest of these was that not every member of staff who approached me introduced themselves. We have it drilled into us on day 1 of Clinical Medicine learning that starting the relationship with a patient begins with an introduction. It was easy marks in our exams. I’m sure it is the same for nursing and other healthcare professionals too. But something has failed…

As a healthcare professional you know so much about your patient. You know their name, their personal details, their health conditions, who they live with and much more. What do we as patients know about our healthcare professionals? The answer is often absolutely nothing, sometimes it seems not even their names. The balance of power is very one-sided in favour of the healthcare professional.

 

I have always been a strong believer in getting to know people’s names as part of building good working relationships with both patients and other colleagues. I think it is the first rung on the ladder to providing compassionate care and often getting the simple things right, means the more complex things will follow more easily and naturally.

 

So here the idea of #hellomynameis is born. If you support this idea please leave a comment below with your introduction to a patient. By doing this you are pledging to introduce yourself to every patient you meet. Please share this page with as many healthcare professionals as possible and let’s make things better… The NHS employs 1.7 million people. The majority of these people will interact with patients on some level. Let’s see how many pledges we can get!

Here is mine to get us started:

“Hello. My name is Dr Kate Granger. I’m one of the senior doctors who will be looking after you on the ward while you’re with us. How are you feeling today?”

Why am I sharing this particular campaign with you?  Following information prepared by one of our Specialist Bereavement Nurses, as an executive team we want to support this campaign as best we can, and support you all to do the same.  We will shortly share with you all how we intend to best to do this.  In the meantime, and I am sure many of you already do, but when you next meet a patient, please remember to take the time and let them know who you are and the role you will be playing in their care.

 

Jackie Daniel
Chief Executive

 

Friday Message - 21 March 2014

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Posted by JackieDaniel

This is a copy of my "Friday Message". As well as visiting wards and departments most weeks, I also provide a written update each week to our staff, governors and volunteers.

BetterCareTogether-Blue.jpgWith the budget grabbing the headlines earlier this week, I wanted to stay on a financial theme and talk about the efficiency gains that we have achieved together over the last two years.

As the Trust started to make plans for recovery in 2012, there were a number of headline figures as we started to understand the scale of the financial challenge – largely as a result of having to reinvest to ensure the safety of everyone who uses our hospitals. As you will all know this investment continues, particularly in the area of staffing where we have seen around 130 new nurses join our hospitals over the last year, this is in addition to those that have left, but there is still work to be done in some areas to get the staffing levels to where we want them to be.

As we got a grip on the finances, we were able to clarify that for the financial years 2012/13 and 2013/14 we needed to make efficiency savings of £18m, excluding additional financial support from our commissioners and the Department of Health.

While this has proven to be challenging, I am pleased to inform you all that as we finalise the accounts, it does look like we will be have achieved the £18m efficiency target. 

Personally and on behalf of the Board, I would like to say thank you to all – it hasn’t been easy, but by all working as a team we have improved services for the benefit of our patients.

We shared with staff a long time ago that we can’t carry on as we are, spending more than we earn, it doesn’t work at home and it doesn’t work in business. It is a priority to ensure our services remain safe and that standards of care and patient experience continue to improve, that was one of the fundamental reasons for establishing our better care together strategy, - ensuring that future generations of people have hospitals in South Cumbria and North Lancashire which are of a standard the public and regulators expect and deserve, and that can be provided within the money available.

NHS Hospitals are required each year to deliver efficiency savings and work has been underway across divisions for some time now to plan how we will achieve the targets in 2014/15 and 2015/16. We will share the final details of these and the planned schemes with you all shortly, but once again, thank you for your continued hard work and commitment to achieving these efficiency gains.

If you are not yet been involved in the planning within your areas for cost improvement schemes, please do not hesitate to contact your line manager. If you do not feel that you have sufficient opportunities to be involved, please contact myself, or any of the executive directors for support.

Better care together and the Annual Plan

It is really important that all staff have the opportunity to understand our strategy, better care together, and our supporting plans, as well as to ask questions and feedback.

To assist, we have established a series of executive director led staff briefing sessions for 2014 which will provide a regular update on our strategy, governance and quality – including patient experience, engagement and partnerships, finance and how we are performing overall.

These have always been well attended in the past and we hope that this will continue, especially by sharing dates now to help you all plan.  Starting with the April sessions, we will also be filming one of them (not the staff Q&A element) so they can be shared with you all via the Intranet.

At the April briefings, we aim to update you on the latest round of planning documents that we have submitted to Monitor. Each year, Monitor requires foundation trusts to produce realistic plans (based on discussions with their commissioners) to help them identify any potential issues and make sure patients’ needs are met. The plans consist of a financial forecast and an assessment of governance risk, which reflects the overall effectiveness of an NHS foundation trust’s leadership – our Operational Plan will be presented at the public Board meeting next Wednesday, copies of the papers will soon be available from the Trust website (www.uhmbt.nhs.uk).  We will also place a copy of the plan on the staff intranet and share the link with you all.

As I mentioned recently, we are refreshing a number of communication activities, we started with increasing the visibility of the Board and leaders on the wards and departments, introduced the Friday Message and this new approach to briefings I am sure, will assist to provide you all a consistent, clear message on progress throughout the year.  I will over the next week or so also share with you our plans for re-launching Team Brief.

And finally

It is always one of the highlights of my job to attend our awards events.  I was delighted to attend and present at this year’s Your Health Heroes Awards last night, where the commitment, passion and dedication of our staff, volunteers, fundraisers and governors were all recognised. 

It has been an incredibly busy last 12 months and I don’t expect the next 12 to be any quieter, especially with the small matter of a general election to take place in 2015!  However, it is important to step back and take this time out to celebrate and formally recognise the achievements of you all. What makes these awards really extra special is that they are nominated by the public and your colleagues – that in itself is a great accolade for the work that goes on every day, right across our hospitals.

Well done to everyone who was nominated, regardless of whether or not you received the winner’s award – all very much deserved.

Traditionally we have held these events in Kendal each year, starting this year they will be rotating, last night they were held in Barrow, next year it will be in Lancaster.

I have mentioned a lot lately about the importance of volunteers in our hospitals; I will ensure the Friday message is also shared with them from now on – volunteers, like our governors, are also very welcome to attend our staff briefing sessions.

 

Jackie Daniel
Chief Executive

 

 

STAFF BRIEFING DATES 2014


Date

Time

Location

17th April 2014

12-1pm

Boardrooms, WGH

24th April 2014

12-1pm

Lecture Theatre, RLI

25th April 2014

1-2pm

Lecture Theatre, FGH

 

 

 

24th July 2014

12-1pm

Boardrooms, WGH

28th July 2014

12-1pm

Lecture Theatre, RLI

31st July 2014

12-1pm

Lecture Theatre, FGH

 

 

 

24th October 2014

12-1pm

Lecture Theatre, FGH

27th October 2014

12-1pm

Lecture Theatre, RLI

30th October 2014

12-1pm

Boardrooms, WGH

 

 

Friday Message - 14 March 2014

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Posted by JackieDaniel

This is a copy of my "Friday Message". As well as visiting wards and departments most weeks, I also provide a written update each week to our staff, governors and volunteers.

 

Education, Training, Research and Development

I wanted to start this week’s message by updating you all regarding the important role that education, training and research and development will play in transforming our services.

As you know, under our strategy for better care together, we are in the transition phase, reviewing services in partnership with our Clinical Commissioning Groups. I believe that in order to make the transformational change needed we must ensure that we have a clear plan as to how we will train and educate not just our existing workforce, but the clinicians and support staff of the future.  We must also ensure that along with this, we have a clear vision and plan as to how research and development can help us to achieve our goals and to develop best practice.

It has been some time since we last commissioned a review of these services and we possibly haven’t made the progress that we would have all liked. However this week, following discussion with the University of Lancaster, I wish to restate our commitment to this agenda, and how R&D, education and training is very much part of our strategy going forward.   There are of course other education providers, and we will continue to engage and involve them.

We are now working on a paper for the Trust Board, which will start to lay out the proposed direction of travel.  This work will require input from our leaders in these areas as to how we now bring them to the fore and give the functions a real sense of identity. I discussed a number of initiatives this week with the University, one of which includes the possible recruitment of a number of joint academic posts.  These new posts, and some funding has already been identified, would concentrate on areas where we can design and deliver new models of care as part of enabling better care together.

Clearly there is much to discuss and to be excited about and I look forward to your involvement as this work starts to take shape.

Our hospitals – making them fit for purpose

I recently wrote about the practical difficulties that patients and many staff face on a daily basis due to the layout of our estates. We have for a short while now developed the outline of what an estates strategy could look like as we move forward with our plans to transform services.

We now have the beginning of a 10 year vision for our estates, essentially how our hospitals could develop throughout this time, together with an indication of what work we could complete in the next 2 – 3 years.  To get to this stage, we have been speaking with staff across all divisions, as well as our commissioners and other partners – trying to get a clearer understanding on national and local priorities for the longer term.

This isn’t about prejudging any outcomes of the work that we are doing as part of better care together around future models of care, as some of that is already known. What we have yet to fully decide, is how in the future they could be provided within the resources available.  For example, Cumbria Clinical Commissioning Group has already said that it sees the retention of consultant led maternity services at Furness General Hospital as a core commissioning priority for the foreseeable future – therefore we can start to plan and think about the type of environment and location within the hospital for these services. At RLI, with the buildings being so disjointed there is the opportunity to look at how services could be brought closer together on the site.  This would assist patients to move through the hospital in a logical way, with support and diagnostic services located where they are most needed, not where they fit to suit the building. We already know at RLI we need to significantly invest in our Blood Sciences to achieve the relevant accreditation. Blood Sciences are a real critical part of our hospitals – we do not need to wait for the results of better care together to start to think about and plan for such developments.

It is difficult to mention RLI without talking about the car parking issues. Day in, day out, many patients and staff suffer the frustration of trying to find a parking space across the site.  Parking at RLI has been an issue for some time, and it won’t get any better without decisive action and investment.  It isn’t easy to solve and it isn’t cheap, if it was it would have been sorted by now, however it needs to be tackled – part of the plans we are developing include looking at how we can drastically improve the situation, probably through different measures, such as a multi-story car park and better use of alternative travel options.

As plans develop, I will ensure we speak to you all and seek your feedback and continued input.

Reputation

Understandably we receive a lot of press coverage, not just when we don’t get it right for our patients, but also about the good work that you all do.  Of late, we have been featured on day time TV due to the innovative work of our catering teams, in the local press as a result of the positive increase in nurses joining our hospitals, through to the success of apprenticeships and recognition of being award winners – well done to everyone who promotes our hospitals, it really does make a big difference.

I know great things happen every day throughout our hospitals, and in fairness, the press is not here to publicise what we should be doing well, but what they will do, and do often, is publicise where we have gone the extra mile for our patients. Did you know for example, that over the last six months we have had around 130 positive articles published about the Trust?

But the way people commentate and report on everyday life has changed – not least with the introduction of social media, and its rapid pace of change. 

This week I want to share with you some personal thoughts and observations concerning the reputation of the Trust and the impact being in the spotlight can have for each of us individually, for our colleagues and for the patients who use our services.

I am a great believer in being open and, whereas my social media skills may not be as good as some of my colleagues, I do appreciate how it helps us communicate and get the message across to a wider audience.

Like many of you, I chose to come to work in Morecambe Bay because I wanted to be part of a good organisation aiming to being a great one, where the safety of patients and excellent care is at the heart of everything we do.

I am very aware of the impact and distress when individuals are singled out, especially on social media. We only used to talk about Facebook, now it is Twitter, Pinterest, Snapchat and so on, with the list growing each year. However with the best will in the world, messages on Twitter of a 140 characters or less do not always allow the whole story to be told and can often appear to misrepresent a situation.  Once the message is out there, as many of you know, it can be reproduced many times over in a matter of minutes, before we are even aware.

I have broad shoulders and expect to get criticised and held to account, be that in the press, or now via social media - it's part of the job description of a Chief Executive! Normally I accept and move on, but when the personal attacks begin to impact on the reputation of the Trust and potentially create a lack of confidence from staff or patients, I then believe it is my responsibility to do everything I can to ‘put the record straight’. That can be difficult sometimes to do in public, mainly because when we respond, we must make sure that we do not breach the privacy of anyone involved – which can sometimes put us in an almost impossible position. But, we will do everything we can to respect the views of others. I say this as often staff sometimes ask why we haven’t said more to the press, sometimes we have and it isn’t fully stated, or there may be on-going private matters.

I knew when I started here that there were high profile concerns and reviews especially about our maternity and neonatal services, but very early on I was able to see for myself the commitment to improve, led by highly committed clinical and support staff.

Also from the beginning I have met and regularly communicated with the families who have bravely and resolutely campaigned to find out why a number of mothers and babies died in our maternity and neonatal services.  Concerns have been heard, and the Independent Investigation chaired by Dr Kirkup is due to report its findings later this year. 

I am far from complacent but believe we are heading in the right direction. However sometimes despite best efforts, it can feel the Trust is 'under siege' and I know some individual members of staff are feeling the pressure of repeated and constant reviews and investigation. On some days this is how I too feel.

Recently you may have seen comments that we are not prepared to answer questions relating to past failings in maternity services – this is not an accurate reflection. We remain fully committed to supporting the Independent Investigation and the on-going Police investigation.  We will continue to meet families affected by the past failures, but we hope you understand that we will not be seeking ‘media’ or public acknowledgment for doing so.

I don’t want to single them out by name, this week I met with a senior clinical member of staff who told me about the impact on them personally through the intense scrutiny they have experienced over the last few years. This is a real concern to me, as was hearing about new staff joining who have commented on already being affected by past issues.

Yesterday, I met again with a parent of one of the babies whose death will be looked at as part of the investigation being led by Dr Kirkup.  His continued and focussed drive to get at the truth is clear to see and I and the Trust will continue to do all we can to support efforts to give him and the other families the answers they want and deserve.

Equally I am clear that I also need to ensure that our staff feel accurately informed and when necessary supported by the Trust – I am continuing to discuss with colleagues how we can ensure, during what will continue to be an intense period of activity for the Trust, that we fully support you all as well as continuing to celebrate, recognise and share your many successes.

If as a staff member you are ever unsure as to what lies behind a headline or comment, or hear a rumour and you are concerned, please do not hesitate to contact me. Together with my team, we will do our very best wherever we can to share details with you.

Public engagement – better care together takes to the road

As a final reminder, tomorrow sees the start of further engagement with the public as part of our better care together strategy. Clinicians and staff from the Trust and our two Clinical Commissioning Groups (CCGs) will be at Lancaster Town Hall, between 10am – 12:30 and 2.30pm – 5pm. 

As we did at the recent drop in sessions for staff, further details on the progress being made to review services will be shared, together with discussing the next steps to transform local health care.

Thank you to those colleagues giving up their personal time this weekend to deliver these events, both from the Trust and the CCGs.

You can find out more information on the dates, times and venues from the better care together website: www.bettercaretogether.co.uk.

 

Jackie Daniel
Chief Executive

Friday Message - 7 March 2014

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Posted by JackieDaniel

This is a copy of my "Friday Message". As well as visiting wards and departments most weeks, I also provide a written update each week to our staff, governors and volunteers.

 

As you will know from last week’s Friday message, Jackie is on leave this week therefore I am very pleased to write today’s message.

Further improving services

Every Tuesday, the Executive Directors meet to discuss a wide range of matters, ranging from the long term strategy, through to operational matters, feedback from our visits to wards and departments, and reviewing and commenting on proposals from staff.

As part of this week’s meeting, we were able to discuss proposals to further improve our Stroke services with clinical and managerial colleagues. The national statistics for Stroke is quite shocking. According to the Stroke Association, there are approximately 152,000 strokes in the UK every year. That is more than one every five minutes. With this in mind, it is pleasing to receive business cases from our Divisions about further improving such vital services for our communities. This particular service development is focusing on how we can continue to improve the care and outcomes for our patients through the introduction of seven-day working.

The business case was approved, including the recruitment of additional Clinical Nurse Specialists (CNS) to enable the seven-day service to be embedded.

I know the Division will now be working hard to implement these plans and will share the details of these positive changes with you all.

Better care together – it’s our strategy

In recent Friday messages, Jackie has talked about better care together, our strategy for transforming services, ensuring the people of South Cumbria and North Lancashire have the very best health care services, not just now, but well into the future.  I thought it would be useful to comment further on this, especially as I am still relatively new to the Trust – ten weeks in!  Better care together has, for some time, been seen as another entity or body but it isn’t.  Better care together is very much part the Trust.

My request to you all, especially those leaders that hold team meetings with their staff, is to keep better care together on your agendas. More and more information is coming out on how plans are evolving, not least through these updates, staff briefings, team brief, etc, and it’s important that this information gets to all staff. If you need more information, or someone to assist at a meeting, please let me know. We are here to help.

This week, we started another series of briefing sessions for staff to find out more about better care together. I know you are all really busy people but I would recommend that even if you can only spare 30 minutes to try to make the sessions. It’s ok to bring your lunch along! If you haven’t seen them, the details of the dates and times of the sessions can be accessed by clicking here. We have a number of drop-in sessions today, 12-3pm in the Boardroom at WGH, starting each hour, and another session on Monday at RLI, again 12-3pm in the lecture theatre.

We look forward to seeing you there.

Patient and public feedback

In January this year, in partnership with local GPs, we held a listening event in Barrow. The purpose was to give the public the opportunity to come along in an evening, outside of a healthcare setting, and meet some of the local people who provide their health services and share their own experiences of health care in Barrow.

Together with GPs from Barrow, we are holding our second listening event on Monday 24 March, at 6pm at Forum 28 in Barrow’s town centre. 

As a Board, we have already committed attendance at the next event and we would be very pleased if a number of staff from FGH, or our other hospitals, could join us and take part. The format allows the public to sit with staff in small groups, rather in one big gathering, and spend the hour listening to their experiences. At the end of the hour, the groups can then provide feedback.

What’s key is what we do with this information. At the next event we will be asking the public how they would like to receive feedback on any action taken as a result of what we heard.

We have also started to discuss how we can deliver similar events right across our area, and again will be asking for support from those staff based at our other hospitals.

This is a great opportunity, outside of your normal workplace, to receive feedback on the services we provide and together, further develop and improve them.

If you feel that you can spare an hour or two and would like to take part, together with our GP colleagues, please email Rachael.Whitaker@mbht.nhs.uk who will confirm details.

As a final note, I wanted to pass on my thanks for everyone that got involved with NHS Change Day. It is easy to be cynical about such activities, however the purpose of NHS Change Day is to take a look at ourselves, whatever our roles and say: “What can I do better?” – and sometimes, it is the smallest things that make the biggest difference to our patients and colleagues. Well done to you all.

 

Aaron Cummins
Director of Finance and Deputy Chief Executive

Friday Message - 28 February 2014

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Posted by JackieDaniel

Firstly, thank you for the feedback I’ve been receiving on the Friday message, I really do appreciate it. I’m taking it all on board and welcome your comments.  Just drop me a line with your thoughts.

Better care together - our plan for transforming services together

We meet with Monitor, our regulator on a regular basis, and this week we were pleased to welcome them to WGH, together with leaders from the NHS England Local Area Team and our local commissioners.  We talked about a number of key areas such as quality, our performance and our strategy for improvement and transformation, better care together.

Better care together is our plan, our strategy for the future. It is our strategy for transforming services, ensuring the people of South Cumbria and North Lancashire have the very best health care services, not just now, but well into the future.  Better care together is progressing well and taking good shape.  We are still working towards having solutions available for you all to look at around June this year.

Right now we are in the process of working with our partners to look at those services that take place outside of our hospitals, such as primary and community care – looking at how in the future, we can all work together as a local health economy in a much more effective and integrated way. We want you all to know how this work is coming along and there a number of activities planned to do this.  Over the coming weeks, starting Monday, we have a series of drop in sessions across our hospitals.  Details have been shared with divisions, and you can also find out more from the link at the end of this email.

I know everyone is busy, but please try to find the time to come along, even if you can only spare 30 minutes. It is your chance to find out more and put your comments and questions to some of the people involved.  It is an exciting time and we want as many people as possible to get involved.

Recent feedback and experience from staff and patients

As you know, I visit as many areas of the hospital as possible each week.  After recently spending time on the Grizedale unit at WGH, it was good to do the same at oncology at RLI and speak to the team and patients.  Someone in the department said to me that “we have a first class crew, but a tired old ship” – and I would agree.  It was clear we have a professional and dedicated team, but the facility is no longer suitable and must be improved.  I will take this forward and discuss with my executive colleagues. 

Whilst at Lancaster I was also able to spend time on Ward 39, which has recently been subject to scrutiny by the CQC.  I was able to meet with some patients, who told me about how busy the unit is, but they felt it was calm and that they were receiving good care.  Mary Shimwell and her team are making good progress on the ward, staffing is now up to the full establishment and relieving some the recent pressure experienced.

I also spent time in the day unit at WGH with Wendy and her team.  I had the opportunity to have a good look around, talk to Wendy and members of her team about experiences in the unit and how they would like to further improve things. The day unit if you don’t know it is tucked away in one of the side corridors at WGH, but with good patient access. The unit sees some of our most frail and elderly patients and not a surprise, provides an extremely welcoming experience.  But the unit looks tired. I’ve listened to the comments made and I wanted to let the team know that I have requested details on replacing the 20 year old carpet and the seating improvements they asked about.  I will ensure they are updated on progress.

Recognising excellence

This week we celebrated achievements of many of our staff.  We held two events, at the RLI and FGH.  The events recognised the dedication and commitment of our colleagues who have worked in the NHS for 25, 35 and 40 years, as well as those from across the Trust that have completed some form of formal training over the last year.

These events are important, we don’t take the work of our staff for granted, I know people are working extremely hard across all areas of the Trust. And I know that it does feel extremely pressured at the moment. These events are an opportunity to step back for a moment and express our sincere appreciation – well done to everyone.

Every time I visit the RLI it is clear how difficult the configuration of the site makes delivering services.  It clear to us all, that the issues around parking, the disparity in the quality of the buildings, the difficulty of travelling and communicating effectively across the sites makes the job so much harder. This makes the case for better care together, our reason for transforming services even more compelling to me.

Engagement – involving not just informing

I don’t want to embarrass anyone, but thank you to Dr Karnad, Consultant Anaesthetist and Vice Chair of the Medical Staffing Committee for his feedback and suggestions on communications and engagement. Great to see this leadership in action with suggestions on how we can all work together to improve our culture.

Whilst I have been involved in regular conversations with our consultants, we haven’t had a formal schedule of events planned, I am pleased that we now have a series of meetings for the next 12 months, where we can get together and discuss a number of extremely important issues such as our Patient Safety and Quality Strategy and our clinical strategy, better care together.  I am looking forward to meeting our consultants again on Tuesday 25 March.

Ombudsman report

You will be aware from the email I sent to all staff yesterday, the Parliamentary Health Service Ombudsman (PHSO) has published a report, concerning four historical complaints about the Trust.

You can access our full statement in response to this report from the link at the end of this email.

I thought it would be helpful to explain who the PHSO is. The PHSO is there to help anyone who is unhappy with how the NHS in England, a government department or another public service has dealt with their complaint. The service is free to use, open to everyone and completely independent. They are not part of Government or any of the organisations they investigate complaints about.

The PHSO are a complaint handler, not an inspector or a regulator. However, they do make sure that regulators (such as the Care Quality Commission) and professional bodies are informed about its work.

Finally, thank you for taking the time to read this week’s Friday message and I look forward to your feedback. You can email me direct on Jackie.Daniel@mbht.nhs.uk.  I am on leave next week; however you will still receive a Friday message from Aaron Cummins, Director of Finance and Deputy Chief Executive.


Regards

 

Jackie Daniel
Chief Executive

Friday Message - 21 February 2014

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This is a copy of my "Friday Message". As well as visiting wards and departments most weeks, I also provide a written update each week to our staff, governors and volunteers.

As I mentioned last week, the idea of the ‘Friday Message’ is for me to share with you important matters from the last week, as well as helping to reduce the number of ‘all user emails’ you have all been receiving. The ‘Friday Message’ will vary each week and could range from good news stories, to important information about the Trust I would like to share with you.  

Flu Fighter awards

This week, we attended the National Flu Fighter awards as finalists in the ‘Most Improved flu fighter campaign’ category. Our nomination for this award came after the Flu Fighter team found new ways of engaging with staff, which led to an outstanding increase in uptake of the vaccination amongst frontline staff by over a third – from 40.9 per cent in 2012/13 to 64.1 per cent.

Members of the Occupational Health team and a couple of our link nurses went along to the awards ceremony to find out the result. Unfortunately, we didn’t win the award but just being nominated for a national award is a fantastic achievement.

I’ll look forward to seeing what new ideas we come up with next year to ensure we vaccinate even more staff!

Trust Board meeting

The next public Trust Board meeting is taking place at 10am, on Wednesday 26 February, in the Boardrooms at WGH. Agenda items include an update report from the Chair and I, a Better Care Together update and an update regarding the Independent Investigation into Maternity and Neonatal Services. All staff are invited to attend and observe the meeting.

NHS Change Day

NHS Change day is a fantastic initiative, which started only last year, and looks to harness the collective energy, creativity and ideas of thousands of people, with the aim of improving the care and wellbeing of everyone who uses our healthcare services.

This year, NHS Change Day is taking place on 3 March, and we are aiming to get 1,000 pledges from across the Trust. This is something we can all be involved in and I would encourage you all to make a pledge which describes what you can do to ensure you always provide the highest standards of safety and quality for our patients.

The Trust Board and I will certainly be getting involved and making our pledges. Make sure you look out for the pledge cards which will be circulated across the Trust over the next week.

Jackie Daniel
Chief Executive

Friday Message - 14 February 2014

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From Jackie Daniel, Chief Executive

Welcome to our first “Friday message” – a replacement to the growing number of ‘all user’ emails that are sent across the Trust, often as ‘corporate communication’ or ‘Trust notification’ messages. Many of you have told me that there are too many of these, therefore, as from today, we will be combining all of these emails into one update, with links to the individual messages.

There will be exceptions to the rule; however, we will look to ensure these are kept to an absolute minimum.  We are counting on everyone’s support with this and ensuring that other established methods of communicating are used first wherever possible, such as weekly news, team briefs, team meetings, notice boards etc.

As part of the Friday message emails, I will whenever appropriate use it as an opportunity to update you all on relevant issues of the day, as the first Friday message, I would like to take a bit more of your time than normal by email, and share with you all an update and my thoughts on a number of important areas.

Commitment of staff

Whether you work direct with patients, or provide one of our essential support services, I am clear that you are all doing an incredible job day in, day out.  I know we have a committed workforce, and I would never take this commitment for granted. We know that staffing levels need further improvement in several areas of our hospitals, Sue Smith, our Executive Chief Nurse, has reviewed this across our Trust and is very clear about the need for safe minimum levels of staffing.

At our Board meeting last month, we made the commitment to publish the staffing levels of all of our wards by 1 April 2014. We believe it is important that we are as open and transparent as we can be with staff, patients and the public, to help everyone feel confident that that we are fulfilling this essential requirement. It is also important that where we are not meeting the required staffing levels, to share with you all what we are doing about it.

I fully respect and support the role of our regulators, they are an essential part of providing assurance to everyone who uses our hospitals on the standards of safety and quality being provided – but our first line of assurance is you, our staff, volunteers and governors.  I want all staff to feel they can raise concerns at any time and without fear, in the first instance to their manager, or with Sue or I directly. 

Role of senior leaders and the Board

Senior managers, leaders and the Board of Directors are here to support all staff, volunteers and governors, and to create the right environment so that we can all give our best.

We have done a lot of work to improve any disconnect that previously existed between the ‘ward and the board room’ – such as the introduction of clinicians to lead our clinical services.  But there is much more we can do to ensure we are connected and in touch with staff and patients. Over the last 12 months or so the Board has been engaged in regular leadership walks, visiting wards and departments across the Trust to find out about the pressures and issues staff are facing, and also to hear first-hand from patients and relatives about their experience in our hospitals. This week, I have agreed with the executive team how we will increase this activity to ensure that each week we are all spending time with staff and patients around our hospitals.  I will also be asking for the same commitment of all our senior leaders at Ward Manager level and above. 

This action will mean that each week, around 450 hours of time from the Board, senior managers and leaders across our organisation will be spent concentrating on the experience of our patients and colleagues.  Some of you will already be doing it and that’s great, you now need to assist your colleagues to do the same, perhaps visiting new departments and areas you are unfamiliar with.

Future plans

Thank you to everyone who attended the recent staff and team briefings. Many of you will have heard more about the future plans for the organisation, for those of that couldn’t make these, your Managers will be delivering divisional Team Briefings over the coming days, however I felt it would beneficial to also share a summary here.

What will the future of our clinical services look like? As you might imagine designing clinical services which will be robust for years to come and which we can deliver within the finances we have is not an easy job. The fact that we have three main sites serving populations with different needs and some distance apart presents us with a fairly unique challenge!

We began the work of reviewing and redesigning our future clinical services under the “better care Together” (BCT) programme over a year ago. As we started the work we also began to understand that in order to design the right hospital services for the future, we would also need to review what services we would need to have in place in the community and in primary care (out of hospital). Patients do not think about their healthcare needs in terms of different NHS organisations, why should they. What we know, is that when a patient visits a GP, they want any care that follows it such as referral to a hospital to be joined up and seamless, enabling them to access the right care, at the right time and place for them.

Over the last few months we have been working with our Commissioners (Clinical Commissioning Groups / CCGs) to extend the design process to ‘out of hospital’. This will mean that by the early summer of this year we will have a set of proposals for care for our populations of South Cumbria and North Lancashire.

The detail of those proposals isn’t yet clear. However there are a number of important principles which will drive the justification for change:

  • The NHS payment system is based on an average price, based on an “average” hospital. For several reasons, I am sure many of you will agree, we do not fall into the average category. We have twice the number of hospital sites than the “average”; we have about half the number of patients being seen and treated at those sites compared with the “average”, finally the distance between the hospital sites is around double the “average”. So you can see we are far from “average” – and we aspire, not to be “average”.
  • What this means is that we currently run services with the income for an average hospital, but in reality we are required to provide at least two sets of emergency care staffing rotas – we have two or three sets of boilers and heat, light and building costs to pay for. Consequently our staffing, infrastructure costs etc. are all stretched beyond those in the “average” hospital.
  • There are a number of ways this can be resolved – including being paid more to provide our services which better reflects our circumstances, or bringing services together on fewer sites. We can of course also continue to look for more effective and efficient ways to deliver care – something all hospitals even those “average” ones will have to continue to do.

 

This last point is not new, following the last update from better care together you will have read articles in the press suggesting a “super hospital” could now be built in Kendal. No decisions have been made; we simply want to be as clear and as open as we can be as we progress, however in doing so we know people may get carried away!  I wish to echo the comments of other colleagues, it is not about providing a ‘super’ hospital in the future, it is about providing super care for all – how we achieve that is yet to be decided, and you will all have the opportunity to have a say.

There are no quick fixes to this conundrum. The structural problems though must be resolved once and for all. They have existed for a long time – but we cannot keep simply stretching the elastic, as there comes a point where it snaps.

We are improving but still have a way to go

I see and hear the evidence of improvement most days I come into work. The majority of the indicators and things we use to measure ourselves against are improving. Whilst this is great, I am not complacent and I know there is much more we need to do. Our staff survey for last year would appear to be improving with a much more positive response, we have more nurses and doctors employed across our hospitals this year compared to last, complaints are fewer and we are responding more quickly.

Change of the scale we require doesn’t happen overnight and it will take a little longer before we are comparing our performance with the best hospitals in the country. To help us continue to improve it is vital that we set ourselves a number of goals to aim for over the next couple of years.

We will publish our Quality Improvement Strategy in April this year – this will set out our trajectory for improvement and be very clear where our focus will be over the next few years. We want to improve not only day to day experience of care in our hospitals but also outcomes of that care.

We will at the same time roll out a patient experience feedback system called “I want great care” across all our wards and departments. In time this will allow patients and visitors to our hospitals to rate their experience and provide real time feedback which we will publish. This will give us the best indication of how we are doing and give us the feedback we need to continue to improve.

I appreciate that this is a long message and future emails will not be as long!

Jackie Daniel

Chief Executive

November video blog

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Sorry, posted a little later than we would have liked. Video from our Chief Executive, one year on.

Regards
Phil, Communications team


 

 

Christmas time blog

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Jackie at WGHI want to take this opportunity to wish all of our staff a very happy and healthy Christmas.  I hope that whether you are working over the festive period or not, you will find the time and space to enjoy this time with family and friends. 

Thank you for all your efforts and support over the last 12 months.  There is no doubt that we have strengthened our performance and delivered higher standards of care and that is down to you.  It has been a challenging year as we continue to rebuild our reputation and set out our strategy for the future in a context of a difficult economic climate and rising expectations of our healthcare system.

Whilst developing our future strategy – “Better Care Together”, I have been struck by the overwhelming support for the NHS and our services.  The anxiety over access to high quality services is palpable as both the Health Service professionals and the public as taxpayers and patients have very difficult questions about a sustainable model of healthcare and the changes we need to make. 

“Better Care Together” continues and will enter its final phase during 2014.  Although the potential solutions are not worked through in detail, I think that they will offer a vibrant and much more sustainable model of services as we look at developing primary, community and hospital services together.  The services need to be much more joined up in order to prevent the patients we serve suffering as they fall between parts of the services.

Staff often talk to me about their anxieties about the future.  What is clear to me is that our services will continue to thrive into the future.  As we look at joining together hospital and community services, the way we provide services will change.  The same is true as we start to deliver 7 day working in our hospitals.  There are so many positives to embrace as we shape services to give the best possible care to our populations.

It is vital that you feel part of that change and play a full role in shaping it.  There will be opportunities in the early part of 2014 for you to contribute so please get involved and attend the sessions and workshops that will be announced in the New Year.

I begin 2014 with a complete Executive Team and both the team and I want to be as visible as possible.  I have absolutely no doubt that people have not seen me around enough and I have spent too much time in meetings but I also have a sense through my conversations with colleagues that all our organisations are experiencing the same in every respect.  It is a time of uncertainty and personal responsibility for us all.  It is daunting, it is challenging, it is rewarding – it is the NHS. 

I can say with honesty that I look forward to next year as we continue to improve what we do, build stronger relationships together and with our partners, with a view to being the best that we can possibly be.

In February 2014 we will be one of the ‘second wave’ of hospital trusts to be visited by the new CQC Hospital Inspection Teams.  Am I worried?  Of course, however hard one works and however committed to doing the right things, it is always anxiety provoking to be scrutinised by others.  We are on a journey in our Trust; currently we are a middling performer overall but with aspirations to keep moving forward.  We think we are doing the right things, choosing the right priorities and operating in the right way but we are open to learning how to be better. 

Managed correctly, the findings of the visit will help us to support our Trust to become even better.  The importance of the 5 domains (well led / responsive / caring / effective / safe) is unarguable and a balanced assessment of our performance against these will be difficult for even the most hardened opponent of change to resist. 

Have a happy Christmas and I look forward to working with you to be the best that we can be in 2014.

Jackie Daniel
Chief Executive

Flu Fighters

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Jackie Daniel, Chief Executive getting her Flu JabWe 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!

Kind regards

Jackie Daniel
Chief Executive

Supporting staff to raise concerns

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Jackie Daniel Cheif ExecutiveIn 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.

Poster Campaign for safety.jpgIt 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.

Regards

Jackie Daniel
Chief Executive

Speak out Safely

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SOSlogo.jpgI 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/.

 

Jackie Daniel
Chief Executive

Blog - 3 June 2013

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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.

Regards

 

Jackie Daniel
Chief Executive

A thank you to Molly

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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:

http://www.youtube.com/watch?v=XOCda6OiYpg

 

Regards

Jackie

Easter 2013

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Posted by JackieDaniel

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.

Jackie Daniel
Chief Executive

February 2013

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Posted by louisefleming

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:

  1. 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.
  2. 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. 
  3. 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.

December 2012 - Four months in

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Posted by JackieDaniel

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.

 

Jackie Daniel
Chief Executive

 

First blog post

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Posted by woodfordp

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. 

Kind regards

 

Jackie Daniel
Chief Executive

 

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