The fundamentals of care

In my last blog I reflected on the fundamentals of a well-led organisation and the essential building blocks that we need to have in place to continue to be successful – including of course paying attention to delivering effective, high quality and safe care. That’s a theme I want to expand on today.

I recently visited ward 37, our critical care unit at the Freeman Hospital. When Matron, Lisa Digby, arrived to show me around, she was brimming with enthusiasm and keen to show me the work that her team was taking forward to go ‘back to basics’.

Lisa described what staff on the unit had experienced through COVID – a story which will be familiar to many of us. All of the staff were required to work very differently to respond to the pandemic, transforming the environment, supporting different areas of the trust and quickly learning about this new illness.

My visit took place during the week when the team had come back together again for the first time and this was an important milestone for them. The fact that many members of staff have had a similar experience doesn’t minimise the impact on each person or make it any easier to cope with those pressures.

As I met different members of the team, they reflected on the support they gave each other and felt themselves through those hard times. Several talked about feeling part of a ward family who genuinely cared for each other and shared joy and sadness together.

When I asked staff what made a difference to them, they were remarkably consistent in their answers – reliable and visible leadership and support, consistent and proactive communication and a shared sense of working together well to focus on the needs of their patients. The patients I spoke to certainly felt that they were in safe, caring and expert hands.

As some of the ‘fog of covid’ begins to lift, Lisa is asking her team to focus on the fundamentals of the clinical care they give. She is encouraging them to be rigorous about tissue viability, hand hygiene and infection control for example. The ward is working on the ‘Gloves off’ campaign (see below) to remove unnecessary gloves which were required during the pandemic but are not now needed for safe care.

As ever, good hand washing is so important and will have a positive impact both on infection control standards and also on our planet as we avoid the unnecessary use of plastic. I was impressed to hear that the team had invited the infection prevention and control team in to positively challenge them, and to ask for ideas and advice. Being open to this sort of review is a mark of a confident team who want to continue learning and challenging themselves to excel.

I also saw for myself the focus on the power of touch for healing and was delighted to meet complementary therapy team lead, Angela Jackson, who has been supporting both patients and staff for 20 years and is developing a team of therapists to extend the service further.

I also heard about some quality improvement projects the team had led; for example, by introducing an app to help communicate with patients who have a tracheotomy using a rigorous approach to QI methodology and measurement. They were passionate about involving patients and families by holding focus groups to understand other areas that could be improved.

I enjoyed my visit to ward 37 and (as is often the case with visits) it stayed with me. I often get out and about to visit wards and services – in fact, it’s usually the best part of my week.

It lets me clearly see the really important purpose of our job and hear both positive and challenging feedback directly from frontline clinicians, support teams, volunteers and of course patients. It is always a privilege to spend time with you in your workplaces and see the excellent support you provide.

One of the signature strengths of Newcastle Hospitals is the pride and sense of collective responsibility that we all feel for our services and the environments we work in. I see that everywhere I visit.

We are all members of a team with high standards. We go out of our way to help direct patients and relatives if they look lost or distressed, we pick up rubbish rather than walking past it, we take time to do those little things that make a difference because it matters. I think that one of the reasons why we are so successful is because of that sense of pride and it’s been very hard to not always be able to meet our high standards when we have been so pressured due to the pandemic.

I’ve asked Ian Joy, our Deputy Chief Nurse to share his thoughts on the importance of our fundamental standards of care. He said:

“At Newcastle Hospitals we have a long-standing reputation for the delivery of high quality and safe patient care. Patients are at the centre of all that we do. We want to ensure patients receive the highest standards and have excellent outcomes when in our care.

When patients experience avoidable harm, such as a fall or pressure damage, we know that the impact to them can be devastating. The foundation of high quality and safe patient care is ensuring we pay constant attention to the fundamentals of care and practice across the patient journey – both in hospital and in the community.

Following discussions with our matrons, ward sisters/charge nurses, and team leads and with senior medics across the Trust, the collective professional voice is clear that our priority continues to be the delivery of high quality and safe care and collectively we are committed to focusing our attention on fundamentals of practice in the year ahead.

We know that the essence of how we deliver care at the bedside, in the clinic or in a person’s home says so much about our personal and professional values and leaves a lasting impression on our patients and their families and this year we want to focus our collective time, effort and attention on those fundamental standards of care and practice which are the pride of Newcastle Hospitals.”

Matthew Shaw, who is our Clinical Director for Quality and Patient Safety and a consultant urological surgeon, also described what ‘basics of care’ meant to him:

“Here in Newcastle, we have always delivered care with the patient at the centre of what we do. There is little doubt that the last two and a half years have been the most demanding that we have faced within the NHS and there is no doubt that huge challenges persist.

Despite this, I see great examples of compassionate and innovative care to both patients and their loved ones every day. By doing the basics of care well we can create the foundations needed to obtain the best possible outcome for our patients.

“When we provide the basics of care reliably, not only does it allow the new technologies available to work to their best effect, but it also creates the confidence in the care that we provide that is so helpful to our patients. Recently, I have reflected on my own practice, and I have realised that offering the basics of care every time is what makes the biggest difference to our patient.”

NHS Confed Expo

Last week I was in Liverpool for the NHS Confed Expo Conference, the first held in person since 2019 which meant there was a real buzz as old connections were renewed, new relationships built, and ideas were shared between leaders.
It was good to hear directly from key figures such as the Secretary of State and Amanda Pritchard, the NHS Chief Executive. Amanda’s speech was excellent, focusing on four ‘r’s she wanted us all to have in mind as we work: recovery, reform, resilience and respect. These are themes I will return to in future weeks.

There were a range of strong contributions from Newcastle throughout the Conference which included:

• Dr Jen Townshend from The Great North Children’s Hospital talking about children and young people’s asthma services
• James Dixon, our Associate Director for Sustainability, speaking at the launch of the new clean air toolkit for ICSs that we have helped develop
• The commercial team’s stand which showcased our wide offer to other organisations, including the pioneering North East Innovation Lab.

I was pleased to speak at two events during the conference. In the first, on ‘performance management in an age of integration’, I stressed the need for us to continue to be directly accountable to the public for performance on reducing waiting times. However, I also noted that duplicate layers of performance management would hinder efforts to deliver improvements.

I also took part in a main-stage discussion on ‘NHS net-zero: what will it take?’ Next week marks three years since Newcastle Hospitals became the first healthcare organisation in the world to declare a climate emergency. I used this session to reflect on the progress we’ve made but also on the current key constraint to us making significant further cuts to our emissions – the availability of capital to spend on decarbonising our estate.

90% of the emissions we directly control are now from the heat and power we generate for our hospitals. We need capital to not only build pioneering carbon-neutral facilities such as the new Specialist Hospital wing at the RVI, but also to work towards replacing the gas-power plants that we have at both the Freeman and RVI with greener alternatives.

Celebrating Excellence Awards

Celebrating our success is so important and, while we often focus on the things we want to improve, we should also take time to reflect on the things we do so well.

Last month, we launched our Celebrating Excellence Awards which is a great opportunity to show appreciation for the outstanding work our staff do – day in and day out – in our hospitals and across the community.

There is now less than two weeks to go until nominations for our awards close, so please tell us who you think deserves to be recognised for the real difference they make to patients or the people they work with. You can submit a nomination here or if you need some paper nominations for your department or area, please email: [email protected]

Gloves off, wash your hands

We are launching a campaign called Gloves off, wash your hands this week. This aims to remind staff to wash their hands and only wear gloves when necessary – as the overuse of gloves carries risks of healthcare-acquired infection, skin irritation and is damaging to the environment.

Gloves have been a fundamental part of personal protective equipment throughout the COVID-19 pandemic for NHS staff. However, this has meant that the excess gloves used at Newcastle Hospitals throughout this time was equal to 21 tonnes in weight – the same as 16 Mini Coopers or one wind turbine.

As part of our commitment to reduce our impact on the environment, in line with our Climate Emergency Strategy, we want to significantly reduce this waste. We are supporting colleagues to change their practice and only use gloves when necessary – they are not a substitute for good and effective hand hygiene.

In the NHS we all have a key role in helping to make healthcare more sustainable and helping the environment. Using fewer gloves is better for staff, patients and the environment.

We know there are cases when gloves are needed, for more information about appropriate use of gloves, please click here.

Further details on hand hygiene and effective hand washing can be found here. For more information please contact [email protected].

Improvement case study

Our latest improvement case study is from Tyneside Integrated Musculoskeletal Service who have introduced virtual group consultations to help improve patient care. Read more here.

Community teams reconnect and celebrate

On Wednesday, our community teams joined together at a special event promoting staff wellbeing, inclusion and engagement. The event was organised by community staff after highlighting they wanted to feel more connected in their staff survey, other teams in their directorate and their What Matters to You work.

Regaining a sense of togetherness is especially important to our community teams – as we all know, the directorate is made up of a diverse workforce with geographically dispersed staff, with limited face to face contact. It’s also understandable that a sense of unity has been especially difficult over the past two years through the pandemic.

The event was made up of exhibition stalls and presentations – providing plenty of opportunities to share information, proud achievements and quality improvements. It provided everyone with the opportunity to all come back together, encouraging conversations between teams and services, have some cross-pollination of learning, share stories and to say thank you to colleagues.

Healthcare workers award

On Monday 13 June we celebrated our healthcare support workers with a very special event to say thank you for all that they do and show how much they are valued. Staff were asked to nominate their colleagues for an award with five categories to choose from, and over 140 submissions were received. It wasn’t an easy task but they were whittled down to five overall winners and some very special commendations.

Governors update from our lead Governor, Pam Yannez

The Council of Governors has enjoyed a busy few months. After agreeing the need for a new Non-Executive Director role with workforce expertise, we worked with Hunter Healthcare to ensure a wide range of candidates and undertook the usual appointments process before approving the appointment of our new Non-Executive Director, Liz Bromley.

We have also been working to increase our public and staff membership and broaden its reach by working with the trust and community groups including the Youth Forum, Disability North and representatives from ethnic minority communities in our region.

This important work is in its earliest stages but we are already benefiting from the collaborative approach. We want to ensure that our membership and our Council of Governors fully represents the community that we serve.

Finally, the latest Council of Governor elections ended on 30 May and we are happy to welcome back two experienced Governors and to meet our six newly elected and two appointed Governors.

You can contact Pam and the Governors by emailing [email protected].

Awards and achievements

NHS Parliamentary Awards

Congratulations to Jackie Thompson, our North East and Yorkshire regional champion for Lifetime Achievement in the NHS Parliamentary Awards.

Jackie was one of hundreds of NHS staff and volunteers nominated by their MP as part of the awards and her team at the RVI was the first in the UK to manage housekeeping for COVID patients at a time when infection prevention control was key.

The overall winners will be announced at a national awards ceremony on 6 July in Westminster – a day after the NHS’s 74th birthday. You can read more here.

Digital champion

Consultant anaesthetist Dr Adnaan Querishi was also a finalist in this year’s National BAME Health and Care Awards, which celebrate the unsung heroes of the NHS and specialist BAME services. He was recognised in the ‘Digital Champion’ category for his work on creating Newcastle PROMs – a custom online platform to collect, analyse and report patient-reported outcomes following surgery.

Financial rewards – It was great to see our finance team receive recognition at the HFMA Northern branch conference. Director of Finance, Angela Dragone, and Deputy Finance Director, David Reynolds, both ended their long and successful careers with lifetime achievement awards while the trust’s research finance team won ‘large finance team of the year.’

A special milestone

Emergency services from across the region came together this month to celebrate their 500th patient milestone for the North East and Cumbria’s lifesaving ‘Blood last on Board’ service.

The service – a collaboration between the trust, Great North Air Ambulance and volunteers from Blood Bikes Cumbria and Northumbria Blood Bike – was devised by Dr Rachel Hawes OBE, army reservist, consultant in anaesthesia / pre hospital emergency medicine at the RVI, and doctor at GNAAS.

It was introduced in 2015 and saw GNAAS begin to carry blood and plasma on board their aircraft and overnight cars. To celebrate treating 500 patients, a special reception was held at the RVI for patients who have received blood and their loved ones.

Happy anniversary

Congratulations to the Bubble Foundation who marked their 30th anniversary of becoming a registered charity and thank you for your tireless support to our specialist ‘bubble unit’ on ward 3 at The Great North Children’s Hospital