Recovering and rest

I’m writing this week’s blog as I prepare to head off for a few days annual leave. I’ve been trying to get my to-do list clear and beginning to think about what I need to focus on when I return. My hope for the next week though, is to take some time to unwind and try to ‘switch off’ so I can return feeling refreshed and re-energised.

It can be difficult for many of us to ‘switch off’ at the best of times, but even more so when we have been working so hard, and at such a fast pace for most of this year.

Turning on the ‘out of office’ message and leaving the hospital physically is much easier than convincing an active brain to relax. Often we can feel a bit guilty for not being at work and worry about the impact that has on our colleagues. I know that many of you will be familiar with that feeling, but rest is something that we all need and has huge benefits for our mental health and wellbeing.

Coming back refreshed from holiday often gives a different perspective on some of the challenges that have proved tricky to address. It also helps us re-remember the importance of family and friends, and assess the balance between our working and home lives.

I very much hope that everyone will be able to get some downtime over the next few days and thank you to those who are keeping our services running 24/7 to support our patients over the bank holiday weekend.

Let’s also support our colleagues to ‘switch off’ both before and during their leave as much as possible and encourage – and enable – those who could use a break to take some time.

But before I head off on leave I wanted to be as clear as possible on the task ahead of us. At the moment we don’t have the certainty we had pre-covid. I am being asked questions about what to expect over the coming months and the honest answer is we don’t have the certainty we would have under normal circumstances. However we can make assumptions based on a range of scenarios and that is what we are doing in order to continue to deliver care and treatment to our patients and to protect our staff.

I’m sure that every part of the Trust will be starting to feel that activity is returning to a more familiar level, despite the restrictions caused by social distancing and PPE, and the continued disruption of the pandemic in its current stage. We shouldn’t underestimate the huge amount of work that everyone has contributed to enable us to provide safe services at the scale we will require.

I want to thank you for the work carried out across teams within each directorate and service area. Your planning and hard work has enabled us to resume as much care and treatment as possible under the new arrangements.

It was back on 17 March that we significantly reduced and cancelled much of our non-urgent elective work. Our activity in these services is now up to over 80% of our pre-covid levels, having increased from around 20-30% in March and April.

Despite continuing with our urgent work and cancer care, we also saw a significant reduction in these areas. For a brief period in late March our non-elective activity was around 50% of what it usually would be, before increasing steadily to between 80-90% at the moment.

Alongside this we also saw referrals for urgent, routine and two-week cancer pathways fall significantly – in one week being 40% the usual level. Thankfully for those patients who need our urgent care, referrals are now back to 90%, but there is still some way to go for two-week cancer referrals which are sitting at around 70-80% of what we would expect.

We are actively working with our primary care colleagues and other partners to make clear that we are ready to receive and treat these referrals. We are picking up locally and nationally that due to covid people are reluctant to come forward for treatment.

We will continue to share the safety measures we have in place and to reassure the public.

Overall, the increases in activity to levels which are getting closer to what we were doing pre-covid – and over such a short period of time – is an incredible achievement. Other trusts across the country will not be in as fortunate a position, but I think this is yet another example of our fantastic teams and their outstanding abilities here in Newcastle Hospitals. We are, however, being asked to go further.

On 31 July, Sir Simon Stevens and Amanda Pritchard, Chief Executive and Chief Operating Officer of the NHS wrote to trusts setting out the way that the NHS as a whole will be expected to operate for the rest of the year to ensure maximum services can be achieved.

This letter set out a stretching but clear set of expectations on returning to near-normal levels of non-covid health services. A theme running through this was making the most of the ‘window
of opportunity’ between now and winter.

Meeting the expectations of not just central NHS organisations and Government, but of our patients and the North East public, will be challenging and require us to dig deep at a time when many of us have been doing so for months. However, having spoken to many of you over the last few months in smaller groups of staff I am convinced that if anyone can do it it will be us.

For us all here in Newcastle, we need to steer a course that not only delivers the quantity of services needed, but ensures they are of the same outstanding quality that we have always achieved.

That’s a matter of pride for us, and it’s hugely important to our patients, especially those experiencing the greatest health inequalities.

With the reduction in referrals, it reinforces what we already know about the importance of working
with our colleagues in primary and community
care to support patients who need our services.

There are some fantastic examples of how we are responding to these challenges with innovation and imagination:

• In ophthalmology, patients are being booked in for digital imaging and diagnostics at the weekends, so that the whole capacity of the eye department can be used to facilitate social distancing. Surgeons can then review results digitally and discuss a treatment plan with patients by video or phone. This has also made the hospital visit much quicker for patients, who would previously need to wait for some time to see the consultant;
• A huge number of our teams have been holding video consultations for hundreds of patients using the “Attend Anywhere”. This has allowed clinicians to assess their patients visually, ask questions and check on their general wellbeing. In total, 215 ‘waiting room’ clinics are now available online and, to date, 3,250 consultations have taken place with patients which equates to around 1,150 hours but I do know there is an appetite to continue to roll this out. Feedback from the clinical teams involved suggests the ‘waiting rooms’ are working really well with the same patient outcome and experience as face-to-face appointments.
• Patients whose hearing aids we provide no longer have to attend a booked appointment and then wait for their hearing aids to be repaired. Instead, huge numbers are simply popping their hearing aids in the post and sending them in for repair. The number of face-to-face repairs has reduced by 80%, whilst the number of postal repairs has increased threefold, from around 550 to over 2,400.
  Several services, including MSU, endoscopy and some women’s services, are reviewing their referral pathways to triage as early as possible so that, where appropriate, patients can go straight to diagnostic tests without an additional face-to-face clinic appointment.

Just as everyone needed to change the way they worked to tackle COVID-19, everyone will need to change the way they work if we are to be successful in the recovery and bridge back to our pre-covid levels of activity. We need to keep seizing the opportunity to be bold and keep on thinking in new and different ways.

At the heart of all of this, needs to be the experience of our patients and their families.

Our Executive Chief Nurse, Maurya Cushlow, and the patient experience team have developed a range of patient experience ambitions which can be used as a guide when considering new service developments, to ensure that they are in line with the standards we aspire to. These are as follows:

I  am sure you agree that these ambitions are exactly what ground and motivate us as health and care workers as part of the Newcastle Hospitals team.

We need to approach the autumn and winter with precisely this clear focus on supporting our patients and ensuring that we continue to provide them with the very best services and experiences.

Of course throughout this we will need to remain alert to the importance of social distancing, and the inevitable rise of coughs, colds and other winter bugs, and possible increases in covid admissions.
However, as ever for Newcastle Hospitals, it will be by remembering what is at our heart: working together, supporting each other, and focussing on providing our patients with the very best services and experiences that we will get through it.

Understanding that during this pandemic things do, and will, change we will step up the communications – particularly as we approach the winter months. For now though I ask for your support in providing the highest levels of patient care and treatment in the context of covid-related restrictions. Thank you very much for your continued efforts and support.

Recognising our staff – 5,000th Greatix award

Since the launch of Greatix in November 2016, staff and patients across the Trust have shown their appreciation for colleagues and teams who have demonstrated excellence and to share the learning from what we do well.

Earlier this summer, the Greatix team received their 5,000th Greatix nomination from Sister Lynn Watson on ward 16 at the RVI, who put forward staff nurses Gwen Arthur and Helen Todd after the pair were redeployed there as part of our COVID preparations.

Sister Watson told how both nurses straightaway became part of the team and helped to support their colleagues during a difficult couple of months.
She described both nurses as “excellent caring nurses
who were a pleasure to have in our team.”

To mark this milestone, the nurses were paid a surprise visit by Executive Chief Nurse, Maurya Cushlow, alongside members of the Greatix team to say thank you.

This award is just one of many the Trust has received over the past five months relating to redeployment to different wards and departments during the pandemic and the team said what has shone through in every nomination is the ‘can do’ attitude of adapting to new surroundings and colleagues getting stuck in. A true testament to team working.