IMPACT December 2023 Issue 11
Partnering Ambitious Caring Trusted
Providing high quality emergency care
How our Planned Care Hub will improve care
Growing our own talent
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FOREWORD Louise Barnett Chief Executive
Dear colleague, The last few weeks have undoubtedly been challenging, which is why I am so proud of the quality improvements you all continue to make and your kindness and compassion for those we provide care for. This was recognised and commented on during the visits to our hospitals by colleagues from the Care Quality Commission (CQC).
just like the wider NHS, but your dedication to patients is so evident, particularly through the improvements that you are making.
They spent several days on our hospital sites inspecting a number of our key services and also conducted a well-led inspection. We really welcomed this inspection. It gave us the opportunity to show how far we have come and present our plans for the future, whilst being open and honest about the challenges we continue to face.
We know that we are on a journey with much more to do, which is why we are following our Getting to Good framework. Impact enables us to keep you up-to-date on our progress, how we are managing those challenges and how we are making improvements through innovation in your areas to improve quality of care.
I was incredibly proud to hear some of the early feedback they shared with us especially recognising our long-term commitment to improving care. Our patients and their voices are at the heart of the improvements we are making together.
In this edition, you can read about how our financial teams are championing a culture of good financial health on page 14. As a Trust, and a system, we are in a significant financial deficit, so it is absolutely crucial for us all to become more efficient and reduce waste where we can. We all have a part to play to make sure every pound we spend is put to best use, and through Impact give tangible examples of how our teams are doing this.
It will be early in the New Year that we hear the outcome of the CQC inspection, but I wanted to take this opportunity to say thank you for your support during this process. We are facing many challenges as an organisation, 2
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One area where we are starting to see success is within our recruitment and retention programme. We are committed to making our organisation a great place to work which will be better and safer for our patients, providing them with continuity of care. This is led by innovation driven by our teams. One area is in Theatres where our fantastic colleagues are successfully ‘growing their own’, having developed their own Theatres Academy. You can read more about this and how it has helped colleagues on page 10. If you have an improvement idea and would like help to bring it to fruition, then please contact our brilliant improvement colleagues via sath.improvementhub@ nhs.net. Thank you.
MESSAGE
Dear colleague,
Mary Aubrey Getting to Good Programme Director
Thanks to the drive and dedication of our teams to make a difference for patients, we are continuing to make substantial progress on our Getting to Good improvement journey. As you will be aware, the programme is the key enabler for the organisation’s priorities this year to help us to achieve our vision which is to provide excellent care for the communities we serve.
part of the internationally-educated nurse project, and there has been a reduction in the number of healthcare assistant (HCA) vacancies. This will have a positive impact on the quality and continuity of patient care and a reduction in the usage of agency staff.
To date: • There are 71 current and outstanding milestones • 98% are not yet delivered Whilst we continue to make progress there is still • 63% of those are on track for delivery much more to do, particularly around elective recovery and ensuring we are doing all we can to Programme highlights include the rollout of phase optimise the use of our theatres. one of the quality dashboard which provides performance reporting for all metrics in the Trust. It is fantastic to learn about the improvements that This will enable us to make our services more are being made from colleagues, and hear from effective. colleagues involved about the improvements that they are working on and the difference they will We have also seen a sustained improvement in make to our patients and colleagues. performance, particularly in the number of simple discharges happening each day (68 per day in Thank you for all your continued hard work. August 2023 compared to 60 per day in August 2022). This improvement will contribute to the improvement of the flow of patients through our hospitals, so they are in the right place for their care. We continue to see improvements in recruitment too. A further 28 nurses have joined the Trust as
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TRANSFORMING OUR EMERGENCY DEPARTMENTS Improving the time it takes for patients requiring urgent and emergency care to be seen by a clinician at the start of their hospital journey is a key priority. We want to ensure our patients are seen as quickly as possible in the right place, and by the right clinician. It will not only improve health outcomes, but also their experience of our hospitals. Under national guidance, patients should be seen and assessed within 15 minutes of arriving at an emergency department or urgent treatment centre. This ensures the sickest patients are identified, helping effective patient flow through the
department to reduce waiting times. As part of our Emergency Care Transformation Programme (ECTP), our teams have been focused on improving triage time - those crucial first steps in the patient journey. A task and finish group is now in place and is already achieving results. RSH is showing significant improvement and in September, 54% of people attending RSH ED were seen within 15 minutes –
There are five workstreams as part of ECTP which are: Clinical quality outcomes and co-ordination of care; Staff culture, resilience and health and wellbeing; Governance and risk; Communications and engaging with communities, and Environment, pathways and flow.
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The transformation programme, which has been running for 12 months, is made up of five workstreams, each focused on a key area for improvement. Despite ongoing high demand for services, good progress is being made.
The ECTP action plan contains 134 total actions of which: • 31 (23.1%) are delivered, not yet evidenced • 36 (26.9%) are evidenced and assured
Clare Walsgrove, Quality Matron 4
higher than the England average. Challenges remain at PRH due to the nature of the estate, and colleagues undertook a focused ‘Perfect Week’ event to improve current performance and they achieved 68%.
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Saskia JonesPerrott, Medical Director for Medicine and Emergency Care, said: “It is a tribute to colleagues working in emergency care that they have continued to make progress on our transformation journey despite the challenges
faced over the last few months, including high demand and industrial action. This shouldn’t be underestimated, and we thank them for their ongoing support and valuable contribution. “We still have more work to do to further improve our performance, but I am very proud of our teams for the improvements they are making for our patients and each other. We are also continuing to work alongside our system partners to improve waiting times and flow through the department as this is not something that we, as an organisation, can tackle alone.”
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Laura Graham, Divisional Director of Operations for Medicine & Emergency Care said: “It has been a really challenging 12 months, but despite this, the teams have managed to deliver a wide range of transformational improvements which is truly testament to them and their dedication. “A big thank you to our teams who have shown incredible commitment, drive and enthusiasm in designing and progressing this important programme. Our patients and colleagues are starting to feel the benefits, so a huge thank you to them. We recognise we have more do, but we have established a solid foundation to build upon over the next 12 months.” 6
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Key highlights: •
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A review of rostering practices and implementation of a process to ensure rostering is managed fairly Launch of department communications including ED colleague newsletter Rollout of ImproveWell engagement app for colleagues to submit their improvement ideas. More than 100 colleagues have signed up with more than 40 ideas to date Task and Finish groups have been set up to support workstreams including Initial Assessment and the 4-hour target ECTP has reached its first anniversary, with plans underway to celebrate successes to date
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Next steps: • • • • •
ED Metrics dashboard developed, and launched in early December ‘Perfect Week’ for initial assessment undertaken at PRH Launch of a new live coding model ahead of rollout of CareFlow as part of Electronic Patient Record to enhance patient safety Task and Finish group set up to support four-hour treatment national target Presentation of certificates for successful improvement ideas submitted via ImproveWell
“The input and enthusiasm from our teams to make tangible improvements for our patients and for colleagues is fantastic. The uptake of the ImproveWell app demonstrates how keen colleagues are to share their ideas.This will really help us to improve the quality of care we provide and make our emergency departments a great place to work, with a real sense of belonging.”
Donna Hadley, DirectorHead of Nursing for Medicine Emergency Care Matthew Dimmock, of Medical People and Services Impact Magazine - Issue 11
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FOCUS ON PLANNED CARE Thousands of additional operations will take place each year with the opening of the new Planned Care Hub early in 2024. The new facility will consist of four dedicated operating theatres and more recovery beds, meaning a further 3,600 day case procedures will be undertaken each year. This is fantastic news for our patients who will have reduced waiting times for operations, and for colleagues who will be working with state-of-theart technology in a modern environment they have helped to create. Clare Marsh, Matron for Surgery and Preassessment, said: “Colleagues are really excited about moving into the new Planned Care Hub as it will provide a dedicated purpose-built unit for our patients requiring surgery. “It will support the communities of Shropshire, Telford and Wrekin and mid Wales to have their planned surgery in a dedicated facility operating 52 weeks of the year, which is fantastic.” The opening of the new hub will support our elective recovery programme. Increasing our elective recovery activity is a key focus of our Getting to Good improvement journey. It will lead to improved health outcomes and a better hospital experience for our communities.
our patients.
To date, we have eradicated 104 and 78 week waits, and we are making good progress in reducing 65 week waits. NHS England has been placing the NHS trusts it views as the most at risk of not achieving their recovery trajectories into tiers since last summer, with those most at risk (Tier One) receiving additional support. Our organisation was in Tier One, however, thanks to the commitment of colleagues, we have now moved into Tier Three, which recognises the significantly improved of our Trust for our patients. Making a difference for our communities • £24 million investment • 3,600 extra day cases a year • Dedicated admissions area • Four dedicated operating theatres - two of which are ultra clean and two of which are laser proof allowing for a more varied case mix • 24 recovery beds • Muti specialty facility - gynae, vascular, ophthalmology, breast, upper GI, ENT, maxillofacial and general surgery • Dedicated paediatric day case lists
We still have more to do but we are making fantastic progress in recovering our performance and reducing the impact of long waiting times on
“As part of the elective hub development, the new administration hub has now been handed over to the Trust. This is a fantastic new workspace offering an improved and modern environment for clinical and non-clinical colleagues. Thank you for your patience during the planning stages and ongoing support as we start to use the new environment and works are being completed.” Sheila Fryer, Deputy Chief Operating Officer 8
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“Colleagues are also looking forward to utilising their skills as dedicated day surgery nurses. Currently, the day surgery unit is sometimes used for escalation to support capacity. The new hub will improve theatre efficiency and utilisation which will in turn improve patient experience.” Clare Marsh, Matron for Surgery and Pre-assessment
The hub is located over two floors, expanding the current theatres into the former administration corridor. A new administration hub has been created as part of the upgrade of the main entrance and the first staff have started to move in this week.
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HOW WE ARE ‘GROWING OUR OWN’ Our ambition is to make our organisation a great place to work and receive care. Our recruitment work is aligned to our workforce needs and we are delivering innovative recruitment practices including: •
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We have grown bank usage by 20% this year. We auto-enrol new medical, nursing and healthcare support workers to the bank Recruitment from overseas, particularly within nursing, which is in line with the NHS People Plan. We have recruited more than 700 internationally-educated nurses since the end of 2019, which is in line with the NHS People Plan We have engaged with academic institutions including schools, colleges and universities We continously undertake public engagement at careers events and job fairs We offer apprenticeships from entry-level jobs through to senior clinical, scientific and managerial roles
The impact from these intiatives are working; • • •
Our vacancy position is at 2.5% (192 WTE) which has reduced by 64% since April We have 90 new healthcare support workers starting with us We have reduced high-cost agency usage including reducing the most expensive agency tier by 92% since April
As well as providing the right career development opportunities, we want to create a sense of belonging in our organisation and ensure we are looking after everyone who works here. This includes: •
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An increased health and wellbeing offer with over 2,500 colleagues accessing support last winter Staff networks which engage with colleagues to drive diversity and inclusion and improve the work experience of LGBTQ+, BAME and disabled colleagues A focus on listening to feedback through our regular Making a Difference Together conversations and the NHS Staff Survey, including flexible working and increasing our career offer
Our retention practices are succeeding. The NHS Staff Survey results from 2022 show that we are one of the Trusts that has shown improvement in all seven elements of the People Promise and the themes of employee engagement and morale.
“Without our valued colleagues and their incredible contribution and compassion, providing care to our communities would be impossible. It has never been more important to ensure we have the right staff in the right roles, but also to provide exemplary support and staff engagement to make our Trust a great place to work. “What is so fantastic is the commitment of our colleagues to drive improvements in their areas by developing career progression opportunities within their own teams and a brilliant example of this is within Theatres.”
Rhia Boyode, Director of People and Organisational Development 10
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SPOTLIGHT ON THEATRES By supporting and investing in growing our workforce, we will be able to provide excellent care for our communities. This includes looking at new ways of building our workforce and developing career pathways and remains a key focus of our Getting to Good programme. Our Theatres department continue to reap the rewards of ‘growing their own’, with colleagues encouraged to develop in line with clear career pathways. Wide-ranging development opportunities are helping colleagues on their way to achieving their career aspirations and are proving pivotal in the delivery of safe, efficient and timely patient care. The ‘grow your own’ approach was initiated in Theatres following years of difficulty in recruiting and retaining staff. With an untapped resource of highly skilled colleagues who didn’t have the right academic qualifications to progress there was a real opportunity for an innovative solution. It all began with introducing a Level 3 Theatre Support course and a Level 4 Assistant Practitioner course. From there, a clear career pathway was mapped out for Operating Department Orderlies (ODOs) to become Registered Operating Department Practitioners (ODPs) through an ODP Degree Apprenticeship. In September 2023, 14 staff across both sites were given a secondment opportunity and joined the ODP Degree Apprenticeship course. Thirteen of these are colleagues from within Theatres who were previously working in a Healthcare Assistant (HCA) role. More recently, the career pathways have expanded to include Nursing Associates and in September, three Theatre HCAs joined the Trainee Nurse Associate Apprenticeship.
Alison Mattey, Theatres Matron, said: “The recruitment, training and development of our new theatre colleagues is pivotal in the delivery of safe, efficient, and timely patient care. Building outstanding theatre teams is our ethos, and staff development is at the centre of this. “Over a number of years, it was becoming increasingly apparent that recruiting experienced theatre staff was becoming more and more difficult to do, so we had to look for a solution within our own department. “We already had an untapped resource of highly skilled theatre HCAs who were unable to progress and develop their skills further. These colleagues either didn’t have the academic qualifications to gain entry to degree level nurse and ODP courses or could not commit to the financial burden associated with these courses, so we started the ‘grow your own project. “None of this could have happened if Theatres did not believe and invest in the vision and ethos of growing your own.” Impact Magazine - Issue 11
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THE THEATRE ACADEMY
The next phase of the Theatres recruitment strategy was the launch of a Theatre Academy. The academy is a cross-site standardised, structured training programme for all new colleagues joining Theatres. It launched this Autumn and will run over four weeks, three times a year. The programme will be delivered by the department’s Professional Development team and will be grounded in evidence-based practice. The training package will include a blended learning approach with face-to-face sessions, hands-on demonstrations, practical assessments,
Elena Davies joined the Trust in 2014 as an HCA and completed her NVQ at a local college. A few years later in 2017, after the introduction of the Level 4 Assistant Practitioner course, Elena decided to develop her career prospects further and proceeded to enrol on the course, which was a two-year foundation degree. Elena said: “The opportunity to study, whilst working really appealed to me. I wouldn’t have been able to take this chance outside of working for SaTH. There are so many more opportunities now for progression than there were 10 years ago.” Elena completed the course and qualified as a Scrub Practitioner, but her aspirations took her further, and in 2023 she joined the ODP Degree Apprenticeship course. She will qualify in 2024. She said: “I am grateful to have had the chance to develop my career on a gradual learning curve through SaTH, it has given me a greater understanding of the role and more confidence and familiarity. “My team have been so supportive, and I have learnt so much from them. I have been able to learn and develop to a level I didn’t think possible and that makes me very proud and grateful for the ‘grow your own’ project.” 12
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and eLearning. The academy will also host open days where applicants can find out more about the different roles on offer and be interviewed all on the same day. The aim of the academy is to build on the recent recruitment success and facilitate a smooth transition into the clinical setting for those starting out on their new career path. Not only will this exciting initiative offer more development opportunities within the community and it will increase capacity within Theatres to deliver safe and timely care for our patients.
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VOLUNTEER TO CAREER There are many innovative ways we are helping to develop the next generation of health and care workers.
Julia Clarke, Director of Public Participation, said: “In early 2023 the Public Participation team secured a grant from Health Education England to deliver the Volunteer to Career programme.
One way is through a new programme we are delivering called Volunteer to Career which is providing direct routes into the healthcare sector. It is aimed at people who are interested in pursuing a career in the NHS. They can volunteer in our hospitals to explore whether it is the right career path for them. Not only does it mean we benefit from these fantastic volunteers, it also helps them on their chosen path into employment or further education. Our first cohort has recently completed the six-month programme which was focused on midwifery, and we are now on cohort two. Charlotte Newby was part of the first cohort in midwifery, and she is now studying at Staffordshire University doing a degree in Midwifery. She is currently doing her student midwife placement at PRH. She said: “I am loving it and I would like to thank the Trust for the opportunity I had on the Volunteer to Careers programme as I think this strengthened my application for university. “The experience to work on the postnatal unit before deciding on this career path was a really good insight into this career.”
“This is an initiative which provides an opportunity for individuals to explore different opportunities, expand their knowledge and is particularly advantageous for those who may want to pursue a career in the NHS. Volunteering has always been a valuable pathway for our participants to advance their careers within the NHS, and this programme supports that even further. “The clinical lead was Rachel Armstrong and working closely with Rachel Higgins from Public Participation, they have delivered an outstanding programme for anyone interested in finding out more about a career in the NHS and we hope to continue this, looking at both clinical and non-clinical opportunities in the future.”
“This is a fantastic opportunity for anyone looking for a career in healthcare whether they are leaving school, changing careers or are simply looking to find out if healthcare is the next step for them. “It benefits them as they are able to volunteer in a specialty (midwifery) and learn first hand about what that career would involve. It also benefits and supports our colleagues and patients as our volunteers bring so much to our organisation in terms of different skills and abilities.” Rachel Armstrong, Non-Medical Education Manager Impact Magazine - Issue 11
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LEARNING AND DEVELOPMENT Enabling a culture of learning, improvement and innovative will help us to recruit and retain highly skilled colleagues so we can provide high quality care to our patients. One of the strategic goals in our Trust Strategy is to support and encourage our teams to constantly strive to improve the services we deliver. Our aim is to provide lifelong learning and development opportunities for colleagues equipping them with the knowledge and tools to perform at their best. To support our teams to do this, we have invested in a SaTH Education, Research and Improvement Institute (SERII) – a new teaching facility, based at the Royal Shrewsbury Hospital.
the perfect location to bring together colleagues from different areas of the Trust and see how they have been able to develop and hone their skills to support high quality patient care.” We have an ambitious plan to become a university hospital trust and this centre demonstrates our ongoing commitment to provide outstanding teaching, research and innovation opportunities for our colleagues which will help us on this journey.
The new centre has five skills laboratories which simulate a clinical environment, two of which are used by Keele University for the training of junior doctors, as well as teaching classrooms, hot desks and office accommodation. SERII will also support the Trust’s ambitious plan to become a university hospital trust, helping to attract and retain highly skilled staff. Dr John Jones, Executive Medical Director, said: “The opening of SERII was a wonderful day in
“It is incredibly important that we enable a learning and innovative culture for colleagues across all our professions to realise our vision of delivering excellent care for the communities we serve.”
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SERII was opened by colleagues whose own stories showed why learning and development is important, including Sarah Sandy. Sarah, Team Lead for Therapies, set up a therapies local induction to improve the process for new colleagues joining the Inpatient Therapy team at RSH. The induction process within the department was not standardised and the quality was inconsistent which led to a large turnover of staff with poor retention for various reasons. Sarah setup a working party to include all therapy colleagues across all pay grades, including new starters. Actions included producing an electronic booklet that could be emailed to new recruits before their start date including team and hospital
information; developing a shadowing programme for the first four weeks into post and international recruits being assigned a buddy for support before and after starting work. At the end of the four-week induction programme, the team has been meeting with the new employees to evaluate the induction and how prepared they felt to start their role within therapies. Each new staff member is given a feedback form to evaluate the process and feedback has been positive so far. Staffing levels have now stabilised with good retention, and while it is not possible to solely say that this is due to the induction process, it has clearly had a positive impact on new colleagues.
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IMPROVING OUR FINANCIAL HEALTH Ensuring that our organisation is in the best financial health is one of our key improvement aims. We are operating in a challenging financial environment with the Trust, and the wider system, currently in deficit. However, we have a long-term plan in place to ensure we are using all our resources in the best way possible to provide value for money. This will enable us to maximise the use of every pound we spend to benefit our patients. This is outlined in our Trust Strategy. Our ambition over the next five years involves stabilising our deficit, improving our financial position, and then sustaining it. There has been a phenomenal amount of work happening to understand what our financial pressures are. This work by our divisions means we have a more in-depth understanding of what is causing our deficit and what the steps are that we need to take to reduce this. Crucial to our success is strengthening financial literacy across the Trust and further develop the skills across our teams and managers to understand and effectively manage the resources that we have. As part of our improvement journey, our finance colleagues are continuing to roll out their training offer to budget holders. There are focused monthly sessions covering all aspects of finance as well as
bespoke sessions for consultants and a dedicated session as part of the STEP leadership course. Our budget training offer has been recognised nationally and we were asked to showcase this recently at a One NHS Finance FACE event which was attended by finance colleagues from across the NHS. The Trust’s bid for Level Two Future Focused Finance accreditation through the One NHS Finance Initiative was also successful, and the finance team is now working towards Level 3, which is the highest acreeditiation level. Adam Winstanley, Deputy Director of Finance, said: “We are so pleased to have achieved this recognition as the teams have worked really hard on making budgeting as simple as possible. “Our assessors highlighted exceptional areas of good practice in the department including team resilience, commitment to team building and the development culture in place. “They were also impressed with how closely finance engaged and supported the rest of the organisation, and the strong leadership example that it sets to non-financial colleagues.”
Rhia Boyode, Director of People & OD
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5S METHODOLOGY Colleagues on wards at RSH and PRH have been helping to make financial savings by reducing waste, whilst also improving the way they work. Colleagues on Ward 15 and 16 at PRH wanted to create a safe and clutter free environment as they felt it would help them to provide safe and more efficient care. They wanted to ensure all necessary equipment was stored in an appropriate place on the wards making it easily accessible for all colleagues, and meeting IPC standards. Using the 5S improvement methodology, the team standardised ward stock which meant removing redundant and overstocked items – at the same time contributing to financial savings. 5S is a strategy – sort, simplify, sweep, standardise, self discipline - that helps to keep the workplace safe and organised, reducing the time that colleagues spend looking for items that should be readily available. The Ward 15/16 team measured the success of their work through the use
of the 5S levels of achievement grid and have received good feedback. Each week stock is checked by the housekeepers and to date a 4.4% reduction has been achieved. If you would like support with 5S, or would like to explore what other improvement methodologies would work for you and your team, contact our colleagues in the improvement hub – sath.improvementhub@nhs. net.
“The support and development of our budget holders and the improvement of financial literacy across the Trust is so important to me. If we manage budgets closely and make wise expenditure decisions we can maximise investment in our services which will improve the care we can deliver to our community.”
Helen Troalen, Director of Finance Impact Magazine - Issue 11
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BECOMING MORE EFFICIENT We are investing in new ways of working to improve efficiency and to support and empower our colleagues to be the best they can be. As part of our drive to improve our workforce planning, we are rolling out the Electronic Staff Record (ESR) manager self-service engagement tool. The aim is to introduce the service to managers starting from 2024 with a planned rolled out programme.
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or contracts which effect pay i.e., Acting up, extension to fixed term or secondment dates Manage terminations Support staff with personal information changes i.e., name changes
What have we achieved so far? Through the self-service app, managers will have access to better quality information enabling them to make decisions to support their teams more effectively. Managers will be able to act quickly and manage pay and contracts without the need to fill in forms. As well as improving efficiency, the self-service system also supports our green and financial health ambitions by streamlining processes and enabling offices to become paperless, reducing associated costs. Benefits include: • • •
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We have successfully introduced manager selfservice in to the following three services accounting for 56% of colleague records being supported. • Temporary Staffing Department which maintains more than 7,000 colleague records • All Medical and Dental staff group covering more than 1,800 colleague records • All Non-Medical Internal Recruitment activities You can contact our colleagues in ESR if you would like further information about the project or would like to be considered as a pilot area. Contact Karen Cameron on MS Teams or email sath. esrmanagerselfservice@nhs.net.
Real-time visibility of staff records and changes Managers will be able to run reports directly from ESR about their own teams Access in the workplace, at home or on the move via an internet connection on a mobile device Auto-generated ESR notifications delivering messages, reminders and updates
What changes can a manager make? •
Make Assignment Changes to hours, position,
“This system has enabled us to modernise and streamline processes, take greater control of our staff information and reduce paper/electronic forms and email traffic. This supports wider integration of other workforce systems, including digital rostering. One of the key benefits to this system is that Medical People Services is now able to make changes impacting on pay on ESR without having to complete forms that can be delayed or lost in email communications.”
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In our next edition
we will be focusing on: • Investing in our nursing workforce • Growing our Medical Examiner Service • Patient-centred care delivered out of hospital settings • How research is transforming patient care
G Partnering Ambitious Caring Trusted
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