Thriving in our new environment

At the end of last month, I did something that has become quite unusual – travelling to London for a work meeting. It’s not my first recent trip but it was important because I was meeting with Chief Executives from around the country and the NHS England leadership team to talk about how we can make the elements of the NHS that we lead, fit for the future.

It was wonderful to reconnect with colleagues that I’ve only seen virtually for such a long time and as we came together, we clearly felt the shared responsibility that we have for the nation’s care and treatment.

It made me reflect on the enormity of what we have been through over the last two years. Everything has changed for the NHS, and we all need to take some time in our trusts and our teams, to refocus on what we need to achieve and how we can best work in this new environment.

With that in mind, I want to focus this blog on what the next year might look like for us here in Newcastle; the challenges we face, the opportunities we have and the positive progress we are making to support our patients.

I’ll start by setting out the context we’re working in.

We now find ourselves ‘Living with covid’ and it’s clear that this has created inherent pressures that we need to recognise. These pressures affect both our staff and also the flow of patients through the hospital and our ability to move them safely.

Both of these factors will continue to impact on our capacity and the way we use our resources and I know that all parts of the organisation have responded positively to review and re-engineer working arrangements to manage this complexity each day.

On top of this, we need to make inroads into the unintended consequences of the initial response to the pandemic. As hospitals paused non-urgent treatment, we were successfully able to focus on providing some of the best outcomes in the country for those suffering with COVID-19. This was at a time when there were no approved treatments or vaccines, and no real understanding of the severity of the infection.

This now means that large numbers of patients are waiting much longer for treatment and there is huge unmet need. The NHS is asking us to provide more treatments now than we did before the pandemic and we need to continue to challenge ourselves to achieve this aim.

As well as the increase in demand for planned procedures, we are also seeing significantly increased activity in both urgent and emergency care and also in referrals for cancer pathways which are unlikely to ease soon.

In the past, we would have looked to invest in services which were feeling these pressures – and we will still do that wherever we can – but another significant change has been to our funding arrangements.

Where we used to have a ‘payment by results’ or PBR system, this has now changed, and the majority of our services are funded on a ‘block’ contract. In this system we are paid a set amount for the care we provide each year, which is then supplemented by ‘Elective Recovery Fund’ payments if we reach certain thresholds for high activity.

The final major change will come into place formally in July when our Clinical Commissioning Groups are abolished and replaced with the Integrated Care Board, which is currently being set up. It is too soon to know exactly how this will affect us, but it is clear that working as a system, both in our city and as a wider NHS across the region, will be increasingly important.

This all means that there is pressure and uncertainty at a time when we have a lot of work to do. We will need to develop and adapt if we are to remain successful.

So how are we doing in meeting those challenges?

This week, we still have more than 40 patients in hospital with covid, and thankfully we are seeing many less people with severe illness due to the virus. We also have more than 150 staff who are away from work due to positive infection.

Our rates of hospital acquired covid infection remain low due to everyone’s hard work and attention to the essential basics of infection control.

The number of long waiters continues to reduce with 81 people waiting over 104 weeks, down from a total of 1,643 in November last year and we continue to anticipate that all 104-week waiters (except a small number of spinal deformity patients) will have been seen by 1 June.

The numbers of people waiting over 78 and over 52 weeks is also reducing steadily, and we expect to clear all of our 52 week waits ahead of the targets we have been given in the NHS planning guidance.

This is a remarkable position to be in and a testament to the hard work of our booking teams, schedulers, secretaries, ward and theatre colleagues across the organisation who are moving mountains to ensure that those with the longest waits are getting treatment as soon as possible.

Our ability to carry out more and more efficient surgical procedures will be enhanced further later this year when the new Day Treatment Centre at the Freeman Hospital opens. I’m grateful to the clinical, estates and support teams working on this project for their hard work in creating this new centre so quickly and I am looking forward to seeing the progress of this new centre for myself very soon.

Our urgent and emergency care services continue be exceptionally busy, and we are actively looking at ways to relieve pressure in this area. However, it’s important to recognise that we have some of the best ambulance handover times in the UK and waiting times are also among the best.

We are seeing more people who are very unwell attending the emergency department and although the reasons for this are not fully understood, we know that they are getting good care as our patient feedback and clinical outcomes from ED continue to be outstanding.

Similarly in cancer services, we are particularly pressured in the target to see at least 85% of patients start their first treatment for cancer within 62 days of GP referral. It’s important to remember that most of the people referred to us through 2-week wait pathways won’t have cancer, but they do have worrying symptoms which need to be investigated and have often been referred to us having been seen at another district general hospital first.

This year we have seen several successful awareness raising campaigns for cancer symptoms which are positively encouraging more people to seek help. The team are working hard across the region to streamline pathways for patients and make the most of all the clinical time we have available.

As I’m sure you can see, the picture I’m painting is a very consistent one. We are under pressure, everyone is working incredibly hard, and patients are receiving the best care we can provide. That hasn’t happened by accident, and I want to pay tribute to the innovation, flexibility and dedication of everyone who has contributed. This is a challenge we will only be successful in if we have everyone playing their part. You are all appreciated.

Our Breakthrough Objectives

Each year we set ourselves high level, challenging objectives which flow from, and help us to achieve the strategic ambitions which we set out in our trust strategy.

I want to share the ‘breakthrough objectives’ we have set ourselves for this year, and which we will come back to throughout the year.

We agreed these objectives through looking at the key areas that our patients, as well as colleagues in directorates and support services, have highlighted as important to them, and alongside that we considered our overall performance, the expectations of the wider NHS and the situation for the trust which I’ve set out above.

Each of these objectives has a named executive director responsible for making sure it is achieved, but each is also very much a whole team effort and I hope that everyone will be able to identify how they can contribute personally to these aims and also benefit from them.

You will see that having a laser focus on patient safety and quality, while providing the best environment for our whole staff team, runs through everything we hope to achieve.

I hope that they come over as practical and focussed, but also ambitious. It would be very easy to set ourselves lower expectations this year, given all of the challenges, but that’s not the Newcastle way. What drives us all is that clear focus on the best outcomes for our patients, and that will continue to be what sets us apart.

Announcements

I’m delighted to announce two new members of the Board have been appointed this week. Jackie Bilcliff has been appointed as Chief Finance Officer and will join us in the late summer.

Jackie is currently Group Director of Finance and Digital and Deputy Chief Executive at Gateshead Health NHS Foundation Trust where she has worked since 2014. She qualified as an accountant in 1996 and has held several senior finance positions within the private, health, and criminal justice sectors in the North East.

On her appointment, Jackie said: “I am really excited to be joining the team at Newcastle and to bring my skills and experience to such a leading organisation. This is an important time for the NHS as we seek out new opportunities to support patients and provide the very best care and I am enthusiastic about the potential I see throughout the organisation.”

Liz Bromley has also been appointed as a new Non-Executive Director to the Board. She is Chief Executive Officer of NCG (formerly Newcastle College Group), one of the UK’s largest national Further Education (FE) College Groups. Throughout her career, Liz has led on a number of significant change programmes and service restructures, and has a strong background in leadership and other professional development. She is a passionate advocate of education as the force behind genuine social mobility and cultural capital.

Liz is also a Non-Executive member of the Board of English Heritage, and has a number of board roles relating to her NCG work.

I am delighted that we have appointed two exceptional candidates to our Board and look forward to welcoming them to the team.

International Day of the Nurse and International Midwives Day

This month, we’ve been able to celebrate our nurses and midwives and the care that they provide through their international recognition days, firstly with International Day of the Midwife on 5 May and International Nurses Day yesterday (12 May). You can view a short video on the latter here.

How Maternity is supporting colleagues to understand ‘What matters to you?’

The Maternity department at Newcastle Hospitals is undertaking an improvement project that asks colleagues: “What matters to you?”

Working closely with the Institute for Health Improvement (IHI), a multi-disciplinary team within postnatal services are taking time with colleagues to have more meaningful conversations to understand and inspire change and service improvement. Together they have begun to develop pastoral care and support between peers, the ward environment, changes in postnatal service provision and how they communicate with each other.

A number of new ways of working have now been introduced, including regular huddles. You can hear more about this project with our new video. If you’d like to find out more about the What Matters to You Programme, you can access advice, support and tools on how to start and develop conversations with your teams by emailing: [email protected]

Celebrating our differences

May is all about celebrating diversity at Newcastle Hospitals. It’s an opportunity to learn about our diverse workforce, hear new perspectives and appreciate how our differences make us stronger together.

There is real benefit in providing an inclusive environment in which diverse employees can work together and feel valued and through our Flourish framework, we are therefore aiming to build on our programme of promoting equality and diversity by having a workforce that reflects our local community and is equipped to deliver the best service to our patients.

We have organised a number of events, in partnership with North East Ambulance Service (NEAS) to kick start Equality, Diversity and Human Rights Week (9-13 May). A full programme of events can be found here.

A highlight of the event programme is Let’s Talk Race next Friday (20 May), where a panel of experts by experience will provide a facilitated discussion on race. Please click here to register.

Additionally, a suite of resources have been developed to share throughout the month. For more information, please email [email protected]

Arts programme – Watchful Waiting

As part of our arts programme, Johannah Churchill – a photographer and nurse who trained at the Freeman Hospital between 2007 and 2010 – has kindly loaned Newcastle Hospitals Charity some images from her ‘Watchful Waiting’ works.

Watchful waiting is a medical term used when an illness or injury is observed intently but no immediate action is taken, and Johannah has captured a series of images which explores our relationship with compassion.

Our arts programme manager, Katie Hickman, has been working with the estates team to install these loaned photographic works on level 2 at the Freeman Hospital on the way to the Northern Centre for Cancer Care, and duplicate versions are also being produced for other parts of the trust.

Help us find our health care support worker ‘Stars’

Our healthcare support workers (HCSW) are much valued members of our clinical teams, providing essential support across our community and hospital site settings, every single day. To help us recognise the fantastic work they do, we will be holding a Celebration Event in the Summer presenting some very special awards. To help us find our HCSW Stars, we are looking for nominations for three award categories which you can make online HCSW Award Nomination Form. This is open for submissions until Friday 29 May so get your nominations in now.

Integrated Covid Hub North East

In 2020, we submitted an ambitious plan to the UK government based on a strong partnership involving the NHS, Newcastle University, public health teams and industry, which led to the north east becoming the first (and only) area in the country to create an integrated hub to tackle the pandemic.

This collaboration made a huge difference in our region and protected the lives of many thousands of people. I’d like to thank everyone involved in the incredible job of establishing the hub, processing eight million PCR tests at the Lighthouse lab, evaluating new diagnostics, providing valuable insight and supporting partners with additional capacity.

Recently, a huge reduction in mass testing requirements led to the closure of the Lighthouse lab. We have now sadly said goodbye to so many of the colleagues who worked there, who can be rightly proud of everything they achieved.

In creating the hub, one of our aims was to provide NHS jobs, with a chance for people to develop their skills and experience, and so I am heartened to know that around 100 of the team have been helped into alternative NHS roles, mostly at Newcastle Hospitals.

In addition, the ground-breaking diagnostics evaluation carried out by the hub’s innovation lab continues (at the newly named North East Innovation Lab) thanks to an investment of £1.4 million from the Academic Health Sciences Network for North East and North Cumbria.

And finally, some of the hub’s projects around pandemic preparedness, system resilience and Covid recovery will carry on for another year through the co-ordination and response team, providing important information for planning and learning as we move into the next phase of the response.

Council of Governors Elections

Voting is now open in the election to the Council of Governors. Elections are taking place for our public governors in both the Newcastle upon Tyne and Northumberland, Tyne and Wear (excluding Newcastle) public constituencies. There is also a vote being held in the medical and dental staff class.

Current members are only eligible to vote in their own staff class or public constituency and voting closes at 5pm on Monday 30 May, with results published on Tuesday 31 May so please use your vote. You can find further information here.

Achievements and awards

It was delighted to hear the news this week that head of occupational therapy, Odeth Richardson, has been elected as the new Chair of the British Association of Occupational Therapists/Royal College of Occupational Therapists. Odeth will become the 21st Chair of BAOT/RCOT Council when she takes over from Professor Diane Cox at the end of June.

Commenting on her election, Odeth said: “I couldn’t be prouder to be elected by my peers as Chair of RCOT/BAOT Council. I know this is a huge responsibility. I look forward to representing members and working with the Council to build on the fantastic work RCOT is doing and grow our future workforce. A membership body is only as strong as the sum of its members and my priority will be to promote equity and justice to ensure every member of RCOT feels heard and represented – and I mean every member. I will reengage with those who feel disengaged and help them regain their voices.”

Heart transplants – Our cardiothoracic team have been part of the Joint Innovative Fund (JIF) UK wide DCD (donation after circulatory death) heart pilot, which has resulted in 56 patients nationally (including 15 in Newcastle which had higher numbers than most centres) receiving a transplant after donor death within the time criteria. Prior to this trial, none of these donors could have – or would have – been used for transplantation for patients on the waiting list.

This is a remarkable achievement for the team and, of course, we must acknowledge those patients – and their families – who made the decision to give the gift of life to others.

VAD nursing team – Congratulations also to our VAD (ventricular assisted devices) nursing team who were runners up in the ‘Best Thoracic NAHP Team of the Year’ category of the Society for Cardiothoracic Surgery Awards.