Impact - May 2023 - Issue 7

FOREWORD

Louise Barnett Chief Executive

Dear colleague,

Welcome to the latest edition of Impact and the start of a new financial year for our organisation, and all our NHS colleagues.

With the new financial year come new opportunities for us to continue to build on the fantastic improvement work we have been doing together to make our organisation a great place to work and to receive care.

Our Operational Plan sets out ambitious priorities for 2023/24, driving forward our key transformational programmes. A summary of this plan will be made available to you all shortly.

The divisional leadership teams recently came together to share their plans and it was fantastic to hear their exciting plans and commitment to colleagues. Thank you to those of you that have been involved in shaping these plans.

I know the divisional leadership teams are really committed to ensuring that everyone is aware of the priorities that have been agreed, and to ensuring that you all have the opportunity to be involved and engaged in taking these forward together for the benefit of our patients and communities.

One of our key priorities is to restore and sustain elective orthopaedics and other services.

A huge amount of work has taken place over the past year to reduce waiting times, which is thanks to you all. However, we have more to do. You can read about the steps we are taking to further reduce waiting times, including recent success in reducing 78 week waiting times, on page 4. Thank you for everything you are doing to support our elective recovery plan.

The Operational Plan also includes the launch of the first phase of the Electronic Patient Record (EPR). The rollout of EPR is a significant and exciting step for our organisation. In moving to digital by default, it will enhance and improve the way we all work, with further phases planned, releasing time to care and supporting our clinical teams to focus on delivering safe, high-quality care. Please do get involved as we really do need, and value, your knowledge and expertise. You can read more about EPR on page 8

Another key focus for the next 12 months will be on managing our budgets efficiently and effectively. There will be a strong focus on recruitment to support you in your roles and deliver

high quality care to our patients, managing resources well and further investing where we can in key areas. Support is available to all budget holders. You can read more about how we are planning to achieve this on page 14

So much positive progress has been made over the last 12 months on our improvement journey, and that is thanks to you. Please continue to share all your fantastic ideas for change, your innovations, and importantly your feedback on how we can support you in your teams.

If you would like support with an improvement idea, our colleagues in the Improvement Hub will be able to guide you. You can contact the team via sath.improvementhub@nhs.net

We will continue to share more about the improvements we are making, with your help, in future editions of Impact.

Thank you.

MESSAGE

Mary Aubrey Getting to Good Programme Director

Dear colleague,

We are now a significant way through delivering our Getting to Good improvement programme, and we are continuing to make progress thanks to the commitment and dedication of colleagues to make positive change for everyone.

The programme is being delivered in a number of phases. We are reaching the end of the second phase, which is focused on ensuring our improvement projects are successfully embedded as business as usual, so they continue to bring benefits now and in the future.

It is really important that we continue to measure the success of each improvement project once they are embedded to ensure they are still effective. This is the third and final phase and will assure us that they are still making a difference. Some projects have started to transition to this phase already, which is fantastic news.

In March, we continued to make good progress on a number of improvements, including the ongoing rollout of Patient Initiated Follow Up (PIFU). This now includes patients on vascular and upper gastrointestinal tract (GI) pathways. Our next aim is to roll out PIFU within our cardiology, respiratory and Parkinson’s disease pathways to create even more opportunities for our patients to be in control of managing their outpatient care. Thank you to all the teams involved in helping us to progress this initiative to improve the experience for our patients.

We have continued our focus on improving

theatre productivity by increasing capacity so we can carry out more operations, and reducing vacancy levels within theatres so that we have the colleagues to support us to do this.

Other improvements delivered in March included:

• Relaunching training for budget holders to manage their finances

• Recruiting medical posts to support learning from deaths

• Creating oncology and trauma assessment areas as part of the Urgent and Emergency Care Improvement Programme supporting patients to get the care they need in the right place, first time

We will keep you updated on the progress of these improvement projects, and more, in future editions of Impact.

We still have much more to do, but we are moving in the right direction and that is down to all of you for driving and supporting improvements, whether big or small, in your areas.

Thank you for your ongoing support.

IMPROVING PATIENT OUTCOMES

Elective recovery and reducing the length of time our patients are waiting for treatment is a key priority on our Getting to Good improvement journey.

One of the aims in our elective recovery plan has been to eliminate the number of patients waiting 78 weeks or more for scans, surgical procedures and other routine treatment, and we are now close to achieving zero.

Colleagues have made huge progress in significantly reducing waiting times. In November 2022, 2,100 patients were waiting more than 78 weeks. By the end of April 2023, only 53 patients are remaining, some of these include complex and “patient choice”.

We are also striving to improve overall referral to treatment times (RTTs) and cancer performance, including the 62-day wait from diagnosis to treatment.

How are we working towards this?

• With patients waiting for cancer diagnosis and treatment, further diagnostic capacity for urology has been secured, and a three-month tele-dermatology pilot (which involves virtual consultations for a patient with a skin condition) is underway and is being rolled out to GP practices

• Collaborative work between teams has seen the number of clinics and capacity at our hospitals increase

• We are continuing to prioritise patients waiting 78+ weeks by clinical need to achieve zero

• Optimising the Vanguard unit at PRH, and with the continued use of insourcing (recruiting outside professionals) to assist on some weekdays and weekends

• Optimising the use of advice and guidance, patient initiated follow up (PIFU) and virtual outpatients to support access to the right service, in the right place at the right time

• Improving digital technologies in challenged specialties

• Working in partnership across the ICS health economy

Several specialties are significantly challenged due to the backlog created by the pandemic and vacancies within departments. These include urology and gynaecology. We are looking at options for mutual aid in these specialties, as well as the use of robotic surgery.

The Ambulance Receiving Area (ARA) has now opened at PRH, which has enabled theatre activity in our Day Surgery Units (DSU) to be restored.

Trauma and Orthopaedic (T&O) patients have been offered the choice of where they would like to receive their care and some have transferred to other Trusts, including Robert Jones and Agnes Hunt Orthopaedic Hospital in Oswestry to help reduce their wait.

Thanks to the fantastic work across teams, we have been able to protect Ward 36 to enable some elective orthopaedic activity to be reinstated at PRH. This means we are now able to support some of our most complex patients to be treated locally. However we recognise we still have more to do.

Sara Biffen, Acting Chief Operating Officer, said:

“We have been prioritising those patients waiting the longest and we recently eliminated 104 week waits. It is fantastic news for our patients that we have now been able to make significant progress on reducing our 78 week waits.

“Thank you to all our colleagues who have helped us to achieve this.”

A plan is now being developed to support overall reduction in 65-week waits, with the aspiration to

reach zero by March 2024.

Further support for reducing waiting lists will come from the Community Diagnostic Centre (CDC) at Hollinswood, Telford, when it becomes operational in September 2023.

“We don’t want anyone to wait longer than they have to for their treatment and so we have been exploring many different ways, and working innovatively, to reduce the time patients are waiting.”

Sara Biffen, Acting Chief Operating Officer

EMERGENCY CARE TRANSFORMATION PROGRAMME

Delivering timely, high quality emergency care in a safe and effective environment is a key priority on our Getting to Good improvement journey.

We have launched the Emergency Care Transformation Programme to help us to achieve this.

A key aim of the programme is to improve those crucial first steps in a patient’s journey when they arrive at our emergency departments. This work focuses on improving the care and experience for both adults and children.

It is vital that a robust initial assessment takes place so patients can be directed to the service that fits their needs, and that the most poorly patients are identified and treatment is started as soon as possible, for example offering pain relief.

Following an internal analysis of both adult and children’s initial assessment pathways, a number of improvements are being put in place. The Trust has also been supported by the national Emergency Care Improvement Support Team, a clinically-led team which help teams to deliver high quality care.

In paediatrics, a children and young person’s lead nurse has been appointed, alongside a supporting lead consultant. These roles will support this improvement work to ensure that assessments are carried out in line with national recommendations

(triage within 15 minutes) and the feedback from the Care Quality Commission (CQC).

Ongoing improvement work further includes the recruitment of additional trained paediatric nursing colleagues and scoping opportunities to increase space in the paediatric area at PRH over the next 12 months.

As part of the improvements for adult initial assessments, there are plans to increase the number of triage-trained colleagues and the availability of NHS 111 bookable slots.

Saskia Jones-Perrott, Medical Director for Medicine and Emergency Care, said: “Decisions made at the initial assessment stage can help ensure we are providing high quality care for our patients, and also help us to improve flow from the front door.

“We still have much more to do to get where we want to be, but we are starting to make really positive progress and I would like to thank all the teams involved for their ongoing input and support.”

“It is really important that we have the right processes in place to ensure that we continue to improve time to initial assessment, with the support of our system partners.

The Emergency Care Transformation Programme is a three-year improvement journey which commenced last October. There are 134 actions in total across five core workstreams.

Clinical Quality, Outcomes and Co-ordination of Care

Staff Culture, Resilience and Health & Wellbeing

Governance & Risk Communications & Engaging with Communities

Environment, Pathways and Flow

To date 20 actions have been delivered, not yet evidenced and four are delivered, evidenced and assured.

TRANSFORMING QUALITY OF CARE

We strive to deliver high quality care for our patients every day – and our digital transformation will help us to achieve this.

Our organisation is now within six months of the exciting launch of the first phase of our Electronic Patient Record (EPR).

This is a significant opportunity to modernise our core digital infrastructure, ensuring we can provide high quality services for patients now and in the future.

We are replacing our current patient administration system (SemaHelix) with CareFlow. The CareFlow system provides the foundation that the entire EPR system will be built upon and will replace Wardvision and the ED Whiteboard.

Currently more than 5,000 colleagues use SemaHelix, which is more than 30 years old and does not provide the level of functionality required of modern digital solutions. Colleagues will be

trained to use the new systems by September 2023 ready to ‘go live’ in October.

People across all divisions have been engaging in the development of the EPR programme, which will involve transferring over 1 million patient records, 5 million Referral to Treatment events, 3.4 million outpatient appointments and much more.

A significant amount of work is underway, from quality assuring existing data, designing the integration with partner systems, through to planning rosters to enable colleague training to take place.

Over the coming months, a team of EPR floorwalkers will be on wards to answer questions. Colleagues will also be given the opportunity to share their valuable local insight and knowledge during awareness sessions throughout May.

“This is an exciting time to be rejoining the Trust and this digital programme is one of the reasons that I was attracted to the role. Over the coming years this will modernise our systems bringing real benefits to patients and colleagues.

“It is vital that everyone gets involved

in testing the system and completing the training. The success of this building phase depends on the local knowledge and expertise from our valued colleagues, so please do take part in the awareness sessions.”

Josh Pagden Chief Nursing Information Officer

Why do we need a phased approach?

The Electronic Patient Record (EPR) programme will drive long-term change and improvement to help us deliver better care that is more appropriate to the people who need it, when they need it and where they need it.

This year is crucial, as we will be putting in place the necessary foundations for more exciting systems that will come online over the next three years, for example electronic prescribing.

CareFlow will fundamentally change the way we work and will revolutionise:

• Inpatient activity including admission, discharges, transfers and live bed management

• Outpatient activity including waiting list and referral to treatment (RTT) pathway management

• The Emergency Department including clinical noting and patient tracking

Building the EPR over the next three years, will over time:

• Standardise how we manage patient information

• Ensure an accurate reflection of the patient

How you can help...

• May – Nominate a Change Agent for your team. Attend our awareness sessions and test the system

• June-August – Ensure our data is as accurate as it can be – our system will only be as good as the data we input

• Between now and September – 3,000 members of staff to be trained

• October – Go-live

journey

• Help us to go paperless

• Reduce time spent on administration tasks

• Provide faster access to clinical information and notes for colleagues

Importantly, it will support a smoother process for patients and colleagues.

Completing Phase 1 this year will enable us to move to Phase 2, which will include a mix of EPR phase 2 and other programmes. EPR Phase 2 includes:

• Careflow Connect

• Bluespier pre-op assessment

• BadgerNet neonatal

• Advanced clinical noting

• Vitals Paeds

• Flow and Capacity

• Electronic Prescribing and Medicines Management

• Digital order comms results and reporting

• Patient Engagement Portal

To find out more, get in touch with the team at sath.askepr@nhs.net or visit digital.sath.nhs.uk.

“The EPR is transforming how we store and access patient notes and is revolutionising the way in which we work. This is a significant step change and 2023 will secure the necessary digital foundations, as we then prioritise more exciting upgrades.

“We need you to be with us on this journey. With your help, we can

ensure that the implementation of our new EPR system and our longterm digitally-enabled ambitions deliver the changes we strive for to enable you to deliver excellent care for the communities that we serve.”

Dr John Jones Medical Director

CREATING AN INCLUSIVE CULTURE FOR EVERYONE

Part of our Getting to Good improvement journey is focused on making our organisation a great place to work and receive care for everyone.

One of our objectives is to create a culture of inclusivity and belonging, and a positive working environment which values the differences people bring with them.

We also want to engage with our communities to ensure that everyone has fair access to all our services and they are treated with respect.

We are putting in place new initiatives to help us achieve this ambition. This is part of our commitment to the NHS People Promise - ensuring we are compassionate and inclusive.

Our dedicated Equality, Diversity and Inclusion (EDI) team is driving these improvements. This includes supporting and enhancing our staff networks. The networks provide a confidential space for colleagues to talk about their experiences and are open to all, including allies:

• Disability, Ability and Wellbeing Network (DAWN)

• Race, Equality and Inclusion Network

• SaTH Pride (LGBTQIA+) Network

These groups have executive sponsors who listen to the feedback and suggestions our colleagues share.

This year the team will also focus on the development of the EDI strategy and annual report to support plans to create an inclusive workplace culture, to promote inclusion events and faith celebrations, to create an EDI calendar of events, and to work with the Zero Tolerance Group, as well as involvement in the Recruitment and Retention

“We recognise there is a lot to do in creating an inclusive workplace culture.

“Our business is all about people and good health, and the wellbeing of our staff is vital to ensure everyone is treated with respect and dignity underpinned by clear values and

Working Groups.

Jas Smith, Joint Head of EDI, said: “We are committed to improving the working lives of our colleagues and providing excellent care for the communities we serve.

“Diversity and inclusion is an essential part of achieving this vision, and we are focused on listening and responding to feedback from colleagues and building a safe environment where colleagues can seek help and be supported to improve their areas of work.

“We are working to foster a positive working environment, promote a culture of trust and raise awareness of the EDI work that is happening across the organisation and the channels available to colleagues to get involved or access support.”

As well as the staff networks, the team has championed leadership and education programmes including the launch of GALVANISE for aspiring leaders from Black, Asian and Minority Ethnic backgrounds. The aim of the programme is to promote representative leadership at all levels within the organisation. Six colleagues have taken part in this pioneering programme so far.

The poor treatment of colleagues is not acceptable and together we all need to demonstrate and champion the behaviours we expect to see. If you do have any concerns raise them here

We welcome you raising your concerns as we are determined to make this organisation a great place to work for everyone.

behaviours and fair processes. We want to create a place where people are nurtured and developed and diversity is celebrated to improve and ensure all our patients receive the best quality care.”

Rhia Boyode Director of

& OD

Looking ahead

The team is focusing on delivering the Workforce Race Equality Standard (WRES) and the Workforce Disability Equality Standard (WDES). These standards involve the data collection of vital workforce equality information. Understanding our workforce data will help us to promote equality in career opportunities and fairer treatment in the workplace.

All colleagues can help us have a better understanding of our workforce by completing the Equality Information on ESR.

Upcoming staff network meetings:

• Race, Equality and Inclusion: Friday 5 May, 12-1pm, Teams and the University Room O at RSH

• EDI Staff Networks Day: Wednesday 10 May, 10:30-12:30pm, MS Teams

• Disability, Ability and Wellbeing Network (DAWN): Thursday 1 June, 12-1pm, MS Teams or PRH (location TBC)

Race

Gender Pregnancy and Sexual

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ENHANCING CARE THROUGH OUR CHAPLAINS

As part of our Getting to Good journey, we are enhancing our chaplaincy service to improve the quality of care we provide our patients.

The Chaplaincy team plays an essential role in helping us to deliver a holistic approach to patient care, ensuring we are looking after the emotional and spiritual health and wellbeing needs of our patients as well as their physical health needs. The chaplaincy team are also here to support us too.

Our fantastic chaplains work alongside our healthcare colleagues offering a religious presence, counselling, compassionate support and guidance to our patients and their loved ones in difficult times.

In the last 12 months, we have invested in growing a multi-faith team with chaplains from the Muslim, Buddhist and Christian faith groups. This will help us to better meet the needs of our diverse communities so we can deliver an improved service for everyone.

With nine members of the team, they have increased visibility in the hospitals and importantly have even more time to visit patients, providing invaluable pastoral and spiritual support.

As well as patient visits, during 2022, the team was involved in the care of nearly 5,000 patients

through prayers, blessings, baptisms, emergency weddings, support in end of life care, last rites, gatherings of remembrance, holy communion, and responding to emergency calls.

During March this year, the team had more than 450 patient interactions and these figures continue to grow week-on-week throughout April.

Supporting the health and wellbeing needs of colleagues is just as important, and the team is involved in ‘caring for the carers’ who are the backbone of our organisation.

Delivering regular training for colleagues, the chaplains are increasing awareness of how to support a patient’s pastoral, religious or cultural beliefs.

They have celebrated and raised awareness of events and festivals including:

• Ramadan

• Eid

• Easter

• Harvest

• Diwali

• Armstice

Our chaplains also sit on a wide range of staff groups and are active members of various networks, which gives them an insight into the everyday workings of our Trust, including Race, Equality and Inclusion staff network, Palliative and End of Life Multi Disciplinary Team and the Patient Experience Group.

They also continue to support staff health and wellbeing providing a confidential, safe space.

Rev. Pat Aldred, Lead Chaplain, said: “We strive, not only to learn from others, but to become a centre of excellence ourselves.

“We are forging ahead developing new strategies and our hope is to become a more visible presence within our hospitals.”

The team offers a 24/7 service, with the hospital chapels also open 24 hours a day. Contact sath. chaplaincyteam@nhs.net.

“We have recently set up a new Faith and Belief Network, which anyone is welcome to join, and we are celebrating more faith and cultural days within the Trust.

“Ensuring that patients and colleagues know how to contact a chaplain is really important, so that we can provide the best support possible.”

Rev. Pat Aldred, Lead Chaplain

DELIVERING QUALITY CARE

Managing our budgets effectively and efficiently is a key aim on our Getting to Good journey.

Our aim is to build a culture where all colleagues are empowered to continuously improve performance and deliver value for money. Our finance teams have been sharing best practice through dedicated training sessions to support our colleagues and teams to make the best financial decisions.

This was recognised nationally when the Trust was awarded the Level One Future-Focused Finance Towards Excellence accreditation. This three-level NHS initiative is driving higher financial standards for all organisations, ultimately maximising spending to improve patient care.

We are now awaiting the outcome of our submission for the higher Level Two, due in May.

Where we are

Our planned deficit for last year was £19 million, however due to some substantial operational challenges we are reporting a £47.2 million deficit (subject to audit) at the end of the financial year. This is mainly due to costs associated with patient flow, COVID-19 and the use of agency staff.

What are we doing to get back on track?

Partnership working

We are working closely with our system partners to ensure we are working effectively together to deliver high quality and sustainable care for our communities. By ensuring effective management of our budgets we can improve value for money, investing wisely in our services, benefiting our

patients.

We have also implemented a successful Integrated Discharge pilot scheme, featured in January’s Impact, which is ensuring patients are safely discharged, at the right time, to help improve hospital flow.

Restoration and recovery

The Government has committed additional funding to support the recovery of the elective waiting lists, and additional capacity has been commissioned to support this.

Planning

Over the past few weeks an incredible amount of work has taken place to develop our quality priorities, forecast patient activity, undertake capacity and demand projections, and refine our bed modelling.

This planning undertaken during 2022/23 has given us strong foundations for the year ahead. Our divisional leaders, clinical and operational, are fully supporting this process. They are maintaining our triple focus on: Quality, Our People and Value for Money.

Focus on Recruitment

Our biggest drivers of spend are our vacancies and the reliance on agency workers.

Our recruitment team, working with clinical teams, has done a fantastic role in welcoming 1,398 new colleagues into the Trust in 2022/23. We aim to build on this in 2023/24. This includes strengthening and reinvigorating our recruitment plans, investing in our people and continuous quality improvement, and identifying actions to reduce the unsustainable reliance on agency spending. And with your support, taking steps to

improve our retention of valued colleagues.

Reducing agency spend

Our organisation has introduced a new bank incentive scheme for all non-medical colleagues. This new scheme will replace the enhanced bank rates that are currently in place across most clinical areas.

The purpose of this scheme is to reward nonmedical colleagues who work bank shifts each month. It will also help to reduce reliance on agency staff and to encourage more of our colleagues to share in the benefits of working bank shifts.

We have already had positive feedback from some wards with the new Bank initiative helping to retain colleagues and fill gaps on our rosters. You can find out more about this scheme on the intranet here.

“Over the past few months an incredible amount of work has happened to forecast spending, understand our bed modelling and explore ways to reduce reliance on agency spending.

“We will need to work together to ensure we stay on track and manage our budgets as efficiently and effectively as possible. This is the right thing to do for patients and we are confident that together we can deliver these ambitious plans.

“Continued demand across our hospitals will remain our biggest challenge for this financial year, significantly impacting on our financial position.”

Helen Troalen, Director of Finance

In our next edition we will be focusing on our:

• Getting It Right First Time (GIRFT) programme

• End of life care improvements

• Planned Care Hub development

• Successful international recruitment

• Next step on our Hospitals Transformation Programme (HTP)