Understanding our pressures – The Newcastle Plan

Previously I’ve written in my blog about ‘The Newcastle Plan’. Our plan sets out the strategic and operational steps we are taking to reset our organisation to tackle the unprecedented challenges that we’re facing in the wake of the covid pandemic. Over the last fortnight we’ve continued to respond to the challenges we face as well as we can.

Day to day, each of us will be seeing the pressures on our own teams and the impact for the patients we have direct contact with. In this blog, I want to take a step back and look at the ‘wicked wheel’ of demands that we are facing. This helps us to see the bigger picture – and to understand the areas where we have some control and can take steps to reduce the burden for both our patients and staff.

Urgent and Emergency Care

We could look at this wheel from any starting point, but I always try to begin with our patients at home. We know that many people are suffering from ill health at the moment, either from covid, which we know is at high levels locally, or from other complaints. We know that people may not have contacted the NHS about their symptoms as promptly due to the pandemic. This means that both GPs and our Emergency Department, Assessment Suite and same day emergency care services are seeing a significant rise in attendances. Primary care contacts in the city are up by around 16% and our Type 1 (Emergency Department) attendances have risen by 22% this year. This pressure isn’t in the main caused by people who are attending the Emergency Department inappropriately and it’s notable that the complexity and acuity of patients has increased.

Within the Emergency Department, the team has introduced a new system at the entrance to ensure that patients are directed to the right place for care, first time. This is a pilot project, and the results are being carefully reviewed to see how successful this proves to be.

I was very pleased to see the improvements that the Children’s ED team has made, by introducing a dedicated reception desk. They have also worked with Northumbria University to look at how they use space within the unit more effectively and have made some impressive changes. We also heard recently at our Board meeting about the improvements for those with orthopaedic problems who attend the ED, which have streamlined and improved the experience for patients and for staff. It’s positive to see the proactive approach that teams continue to take.

Inpatient areas

The next area to focus on is within our hospital wards. This has been another intense week where we have unfortunately needed to cancel planned operations to make sure that we have enough beds for those patients who urgently need them.

This week we have around 75 patients with covid in hospital, all of whom need a hospital bed and the staff to care for them. That’s about 7% of our beds and is higher than most other places in the country at the moment. This is reducing our usual capacity by about three wards.

About two thirds of those people haven’t had a full course of vaccination – which underlines the importance of the vaccination programme teams and volunteers who are making sure the region has comprehensive access to vaccination.

Elective care recovery

We’re also doing our best to tackle our waiting lists and care for the 5,000 plus people who have been waiting more than 52 weeks for an operation. It’s remarkable to think that this number has increased so dramatically – before covid just 18 people experienced that length of delay in Newcastle.

To tackle this, we’re expanding our facilities quickly and we’re innovating to maximise the volume of care we can provide. We’ve introduced a dedicated streamlined cataract centre where, to date, over 4,100 patients have received care. Work is now underway to build four new purpose built surgical daycase theatres at the Freeman Hospital. Each of these developments mean change for staff – many people are now working from a different location and I know that losing a car park at the Freeman has been inconvenient for some staff.

Please be assured that everyone is working to support people who are affected by these changes to resolve any issues as soon as possible, including creating additional car parking spaces at the Freeman.

Timely and effective discharge

Finally, discharge and getting people safely out of hospital, and preventing unnecessary admissions needs a clearer focus. Through Collaborative Newcastle we’re working hard to support local residents to leave hospital safely and quickly. A vital element of this is our community services who have seen their patient contacts rise by 16%. We do have some patients in hospital unnecessarily that live in other parts of the region and we are working hard with each local authority and trust involved to get them home as soon as possible.

I heard about the ‘Newcastle Frailty Prevention Force’ recently. A pilot project based at Westgate Community College who are working proactively with GP practices to deliver home-based physical activity to patients in their homes to help prevent falls, identify and address other health problems and thereby reduce ill health and admissions to hospital. It’s also helping to connect people to activities in their communities and reduce social isolation which has been so much a part of this pandemic. I’m looking forward to hearing more about this innovative service.

Our Workforce

Underpinning all of this of course is our workforce, and it is right that we maintain an unrelenting focus on supporting staff now and ensuring that we have a good supply of new recruits for the future.

Everyone has been affected by covid and this is continuing to cause absence due to illness and the need to isolate. We are observing that people are experiencing increasing levels of stress and anxiety – both from work related stress and the things happening in our home lives.

There is lots of support available from staff side, Chaplaincy, Occupational Health and line managers, as well as online resources such as Togetherall, our mental health support tool. I know that none of that support takes away the daily pressures and that having more staff available increases the likelihood of it being a good day. That is our highest priority and earlier this month we agreed to undertake further substantial international recruitment which is underway.

We have also successfully recruited just over 100 healthcare support workers this month who will be joining the Trust very soon.

For existing staff, you will be aware that we have introduced temporary enhanced overtime rates for some staff and are making sure that we can assist clinical teams with admin support at weekends, where possible, to relieve some of the pressure on our nurses.

I’m conscious that I’ve not mentioned every area of the organisation here, but hopefully each of you will be able to relate to this description of what we are collectively facing – because we all have an important role to play in continuing to provide the very best care we can for our patients in these circumstances.

Our focus for the coming weeks will clearly be on keeping our patients safe and well cared for, responding to the clinical demands placed upon us and looking after our workforce. I’m very grateful for everyone’s efforts in meeting these priorities.

This week we invited BBC health editor Hugh Pym into the Trust to talk about what we’re facing and the fantastic way that staff are responding. I’m grateful to the staff from the Emergency Department, Assessment Suite and same day emergency care, covid wards and those at the Westgate Cataract Centre who took part. We expect his special report to be broadcast on Tuesday next week when we will also have some additional media reports from the city. We’ve invited Hugh to return to the trust over the winter to tell our story and record the progress we make. Hopefully this will have a positive impact on the public – helping them to understand the bigger picture for the health service and encouraging them to do their bit to help – particularly by getting vaccinated against flu and covid.

Thank you once again for your unwavering efforts.

COP26

I was delighted to attend COP26 and interview Rosamund Adoo Kissi-Debrah, whose daughter Ella sadly died from a rare form of asthma, about her campaign for clean air. She spoke very movingly about the lack of awareness in the medical profession when her daughter presented at hospital and what might have been done for her.

I also spoke to a number of international leaders, including Dr Tedros Adhanom Ghebreyesus, WHO Director General about the work we are doing in Newcastle and what more we need to do.

This experience reinforced my resolve to tackle the climate emergency within our influence here, and to maximise the impact of the leadership position we have taken. You can read more about this in my article with the HSJ here. Associate Director – Sustainability, James Dixon also spoke to the HSJ about how climate emergency action became a fundamental part of Newcastle Hospitals’ DNA — and what he’s doing to spread the word. You can also watch this news piece from ITN Tyne Tees which includes an update on Rosie, the first baby in the UK born with assistance from climate friendly gas and air.

Plans for our New Specialist Hospital Building begin to take shape

November marks a milestone in our ambition to construct a new, iconic, purpose built home for many of our specialist services.

In the coming weeks we will submit planning and listed building consent applications to the City Council, asking for permission for the construction of our New Specialist Hospital Building on the RVI site and also share our plans with our immediate neighbours to give them the opportunity to give us their views on the proposed building. Alongside this, we have applied to the Government for funding for the project.

The proposed building will be home for many of the highly specialist services we provide each year to thousands of patients including adult critical care, burn care, North East Assisted Ventilation Service, high level isolation unit, out-patient elements of maternity and cystic fibrosis.  The building will also provide more ward and theatre space which means that we will be able to treat patients who have seen their planned care delayed because of the pandemic.

We have published a page on the Trust website about our plan, which includes more detailed information about the New Specialist Hospital Building including the configuration of the building and an opportunity to give feedback.

Mount Everest Challenge

Huge congratulations to the staff of ward 16 at the Freeman Hospital who have successfully completed a Mount Everest challenge in a bid to improve physical activity levels and general wellbeing. As a team they ‘ditched the lift’ and committed to using the stairs throughout their working day, aiming to accumulate 604 second to sixth floor climbs which would equal the height of Everest – it took them just over a month to complete this impressive challenge.

Alongside this staff are helping to encourage patients to achieve a weekly target of 150 minutes of moderate intensity physical activity, helping to support them while they’re in hospital but initiating conversations around health and physical activity when they return home. Well done to everyone on ward 16.

OFSTED

This week OFSTED have spent some time in the Trust to inspect our apprenticeship service, while we await the final report I want to thank everyone involved for all of their hard work.

NHS Staff survey

Over the last month everyone has been invited to take part in this year’s NHS Staff Survey, there’s now only two weeks left for you to share your views about working at Newcastle Hospitals. Your feedback is so important and will help us to continue to develop staff experience. Here you can view a short video where I explain just why what matters to you really does matter to us.

Awards and celebrations

Congratulations to our finalists in the Bright Ideas in Health Awards demonstrating how we continue to push the boundaries in the provision of innovative health services by harnessing the latest digital technology. The Trust was shortlisted in four categories and you can read more about these innovative projects here.

The HSJ Awards will be held next week and after one of the most demanding and challenging years on record for the NHS, I’m delighted that the organisation is a finalist for the acute or specialist Trust of the Year Award. We were also shortlisted in a number of other categories including;

• Health and Local Government Partnership Award– Collaborative Newcastle
• Connecting Services and Information / Provider Collaboration of the Year – The Great North Care Record (on behalf of North East and North Cumbria ICS)

Good luck to everyone involved.

Congratulations also to Dr Karen Marshall who has been named as the next President of the North of England Thoracic Society. Her internationally recognised expertise around Cognitive Behavioural Therapy (CBT) for Chronic Pulmonary Disease (COPD) has benefitted hundreds of patients.

Finally, good luck to our HR team who have been shortlisted in two categories in the HR Excellence Awards. The team are finalists in the Best recruitment and workforce planning team of the year award and the HR Team of the Year award. Winners will be announced on Wednesday 1 December.