Impact - December 2022

Foreword

from Louise Barnett, Chief Executive

Dear colleague,

Over recent months we have been increasing the focus on celebration and recognising all that that you have accomplished over the last 12 months, and it has been fantastic to celebrate you and your achievements.

It is really important to me that we take the opportunity to celebrate what we are doing well and share our successes not just Trustwide, but also with the communities that we serve as well as recognising the challenges we face.

By ensuring we engage our patients and families in our continuous improvement work, the quality of our services will be enhanced to meet the diversity of their needs. They are part of the journey with us and understand what we are doing to achieve our vision to provide excellent care to the communities we serve.

In this edition of Impact, we are celebrating our amazing colleagues in Procurement who have won national recognition for continuously making improvements to ensure the best outcomes for our patients and colleagues.

They are a fantastic example of collaborative working and are involved in many critical activities across the health system, including the COVID-19 vaccination programme and the Hospitals Transformation Programme. They were crowned the Health Care Supply Association’s ‘Procurement Team of the Year’ – and it all stemmed from a team away day where they took the opportunity to reflect on their successes, challenges and opportunities.

Another example of successful partnership working is the Integrated Discharge pilot,

where we joined forces with Shropshire Community Health and our local authorities to improve the hospital discharge process for patients. This new way of working, which you can read about on page 4, achieved more positive outcomes for our patients and staff.

We know we still have much more to do, but we are committed to continually finding ways to achieve the best outcomes for our patients. Thank you to all of the teams involved in this.

Finally, I just wanted to wish you all a very Merry Christmas and a Happy New Year. I hope that you get to spend valued time with your loved ones over the festive period Thank you.

Louise Barnett Chief Executive

from Mary Aubrey, Getting to Good Programme Director

As you will be aware, this stage of the Getting to Good programme is focused on embedding the improvement projects to deliver sustainable change so that we can achieve our vision to provide excellent care to the communities that we serve.

This month, we have refreshed the priorities within our programme, so we now include some really important additional projects – Cancer Performance, Emergency Care Transformation Programme and Equality, Diversity and Inclusion. You will hear more about these projects and what we are trying to achieve in future editions of Impact.

Thank you for all your ongoing support with our improvement programme. Please continue to share all your ideas for improvements – either as teams or individuals. We really welcome your feedback on what else we can do to help us to improve the care we give to our patients and your experience of working in our organisation.

This month, I would also like to say a huge thank you to our teams in Maternity, Digital, Finance and Resources and Workforce –particularly in recruitment and retention - whose projects are on track. Among the milestones we successfully achieved in the last month are the implementation of the Bluespier Theatre Management System, improved usage

of the discharge lounges on both hospital sites and the relaunch of our Staff Networks to increase membership and staff voice. Thank you to all of our teams involved.

We know we still have more to do and over the next few weeks, our focus will be on supporting Outpatients transformation, future workforce design and diagnostic recovery.

Finally, in January, you will be able to share the improvements you are making directly with us through our new webform on the intranet. We will keep you fully updated on when this will launch, so please keep a look out for our Getting to Good logo so you can get involved. We want to share as many of your improvements as we can in Impact to celebrate and share the differences you are making.

Thank you.

Dear colleague,

We are continuing to make good progress on Phase Two of our Getting to Good improvement journey.

Integrated Discharge Pilot

Local healthcare partners have teamed up to improve the hospital discharge process for patients, reducing the time patients wait for assessments enabling them to be discharged from hospital with the right support.

The Shrewsbury and Telford Hospital NHS Trust (SaTH), Shropshire Community Health NHS Trust (Shropcom), and Shropshire and Telford & Wrekin Councils have joined together to improve the existing multiagency and multidisciplinary process for the communities of Shropshire, Telford & Wrekin and mid Wales.

In the summer of 2022, the Integrated Discharge Pilot ran for six weeks. The pilot is clinically designed and clinically led and aims to cut the length of time between being medically fit to being discharged.

The project team have worked with ward staff, patients, families and carers and achieved the completion of assessments the same day patients are declared ready and medically fit for discharge.

The pilot, which targeted two wards at the Royal Shrewsbury Hospital (RSH), has provided quicker access to discharge services once a patient was ready to leave hospital, with the aim of discharge taking place on the same day whenever possible.

Many patients are now able to return home with the right support, within hours of being told they are able to be discharged. This reflects a huge improvement in supporting people to leave hospital as soon as safely possible, and to

the right place of care.

Louise Barnett, Chief Executive at SaTH, said: “As soon as a patient is deemed medically fit, there should be no delay in getting them home. Any hour spent in hospital without needing to, is an hour too many.

“The aim of this pilot was to improve the process of getting people home, reduce length of stay and free up time to care and improve patient experience.

“We are committed to getting the best outcome for our patients, and this new way of working puts patients front and centre.”

Patricia Davies, Chief Executive at Shropshire Community Health Trust, said: “We are committed to getting the best outcome for the patients of Shropshire, Telford & Wrekin and mid Wales.

“We recognise how important it is to help our patients return home as quickly as possible. This new way of working maximises opportunities for collaboration with our partners and gives better outcomes to patients, their families and their carers.”

It is early days but we are planning to roll out further with your engagement and feedback.

Frailty Team

A key priority in our Getting to Good programme is delivering high quality care for people with frailty and supporting our ageing population to avoid unnecessary hospital admissions.

Our colleagues in the Frailty team are an essential part of the care we deliver at the front door of the hospital and make a big impact in reducing admissions and improving care.

With the population of over 85s in Shropshire expected to increase to nearly 40% by 2025, and with data showing that an admission to hospital when over 80 years old often leads to adverse outcomes, the work of the Frailty team is an integral service helping our communities.

The multidisciplinary Frailty team screens patients at the front door using the Clinical Frailty Scale to identify patients with frailty who need their support. The team then completes a Comprehensive Geriatric Assessment to try and avoid them having to come into hospital, which is proven to lead to better outcomes for patients.

The team first received funding in 2017 to launch at the Royal Shrewsbury Hospital, followed by the Princess Royal Hospital in 2019. Since then, they have embarked on a development journey with a focus on recruitment to further build the service they deliver.

Alex Pitas, Frailty Service Manager, said: “A key aspect of developing the team has been

investing in our culture, and making the Frailty team a really great place to work.

“We are now fully recruited to, having hired a consultant, four extra advanced clinical practitioners and developed an acute frailty coordinator role.”

As a result of this work, long length of stay bed days used by the over 75s cohort were cut in half from 2017 – 2021, with the team discharging more people from the front door while still maintaining the re-admission rate. This means that patients are being effectively supported in the community in a faster timeframe.

The Frailty Team has also turned a 50-60% vacancy rate into being 100% recruited, a huge step towards meeting the Trust’s vision to deliver excellent care to the communities we serve.

Alex added: “We have also developed internal professional standards to support our vision, from wider ambitions such as delivering a 70hour service and reducing the time frail patients wait on trollies, to local ones such as everyone in the team having an equal autonomous voice and the Clinical Frailty Score (CFS) being used consistently on everyone over 65 years of age.”

Procurement Award

Continuously improving the quality of care and services we provide our communities is a key priority on our Getting to Good improvement journey.

Our colleagues in Procurement have been recognised nationally for their commitment to making and supporting improvements which benefit our patients.

Shropshire Healthcare Procurement Service is a shared system service based at the Trust, also supporting Shropshire Community Health Trust and Robert Jones and Agnes Hunt Orthopaedic Hospital – and the team has been named Procurement Team of the Year in its industry awards (the Health Care Supply Association).

Will Savage, Senior Procurement Manager, said: “The award nomination came about from activities at the team away day that we have set up as a means of bringing the team together away from the day-to-day activities.

“As well as trying to think about how we can continuously improve, we invite colleagues from within the Trust and system such as clinical colleagues, executive directors and also people who do what we do in other parts of the NHS, to talk to us and give us their perspective.

“We discussed the challenges and successes that we as individuals and as a team have faced, and one of the common themes was that we don’t celebrate our own success even though the team is performing at high levels.

“We believe the judges have seen beyond the technical detail, metrics and descriptions of the challenges we’ve had to deal with in recent times, to the importance we genuinely place on our core focus; the patients and supporting our colleagues in what they do for them.”

To take home the award, the team had to achieve excellence in:

• Adoption and implementation of the NHS Standards of Procurement

• Development and adoption of good practice

• Delivery of financial and other benefits

• Customer service excellence

• People development and succession planning

• Collaboration with NHS, private, public and third sector organisations

• Strategic focus

One example of improvement was the success and the broadening of the team’s clinical nurse advisor role to ensure that the link to patient care is maintained and continuously improved.

Helen Trolalen, Finance Director, said: “We are incredibly proud of our Procurement colleagues and the service they provide, and this is fantastic and thoroughly deserved recognition.

“I am always really amazed at the lengths the team goes to in terms of the service they deliver, the innovations they implement, the data they collect and analyse and the way they continuously reflect and improve the service. They are always volunteering to do new things, and they never shy away from learning and improving.

“They deliver a really reliable service across the Trust and the team are well respected. They work on such a broad range of things from supporting our £300m redevelopment plan to the clinically led switching of products to find the best value for money. They are an absolutely cracking department.”

Paula Davies, Head of Procurement, said: “Our focus is genuinely and sincerely about our core focus, the patients. I am incredibly proud of the team for all their achievements, and we are absolutely thrilled to have been recognised."

Celebrating Ophthalmology

quality of life of patients. In the last 14 months, virtual clinics have helped the long waiting lists of patients to be seen in the eye clinic.

This was celebrated as part of the Trust Celebratory Awards when Devaki Nayak, Consultant Ophthalmologist, was crowned the winner of the Getting to Good Innovation Award.

Devaki joined the Ophthalmology clinical team in 2021, and at the time, the Department was in strict social distancing, and patient review and treatment were delayed.

She developed a virtual pathway which enabled more of our patients to attend for diagnostic capture – almost trebling the number of patients being seen at each eye clinic.

Having never been done before, the virtual eye service has since been running successfully, significantly reducing the backlog created by the COVID-19 pandemic.

Devaki said: “Most of our patients are elderly in the eye clinic and we deal with blinding conditions such as macular degeneration, retinal vein occlusion, diabetes and glaucoma. This can affect quality of vision and hence

Louise

said: “I’d like

“We also aimed to make the virtual clinics more robust by raising funds (from a Three Peak trek) for a wide field scanner. This meant the wide field scanner would give us a complete picture of the back of the eye in one click, reducing time for patients. Above all, the clinician can review the images anytime of the day to report the picture/scan.

“The virtual clinic is now working on a very robust platform as the League of Friends of RSH kindly funded the wide field scanner to the department. We are very grateful to the League of Friends for their constant support.

“We now have the scanner and, through the development of the virtual clinic specifically for ophthalmology, we are able to see 18-22 patients per consultation session compared to eight previously in clinic - so it is a win, win situation.”

Devaki’s award nomination read: “The department had never carried out virtual clinics in the MR service. Devaki, is supporting the department to develop the service for the future.”

all of our

working in frontline teams or behind the scenes. The Getting to Good Innovation award showcased and celebrated the innovative work being done by you to improve the care and experience for our patients, so a huge thank you to all our finalists and, particularly Devaki whose successful development of a virtual pathway has much improved the experience of patients whose treatment was delayed because of COVID-19.”

and finalists. It was fantastic to shine a

Embracing innovative new ways of working to consistently achieve high standards of care for the communities we serve is a key priority on our Getting to Good improvement journey.

Barnett, Chief Executive,

to say a huge congratulations to

winners

spotlight on some of our wonderful colleagues

Hospitals Transformation Programme

The Hospitals Transformation Programme is a priority focus for us and will improve care for everyone across Shropshire, Telford & Wrekin and mid Wales.

Over the last few months we have held a number of clinical workshops and pathway development sessions with clinical leads from across our services. Thank you to everyone who has been involved so far - we are keen to broaden out our conversations across the Divisions in the next few weeks.

As we work towards submitting the Outline Business Case in the early spring, our detailed plans will outline how we will put the available funding to good use. This will be a significant investment enabling teams to improve clinical pathways and improve our services for all residents; creating two thriving hospital sites, both for the people who use them and the people who work in them.

Currently, there are many pressures on the health and care system and whilst we are all striving to deliver the best possible care, the way we are configured as a set of hospital services means our patients often experience delays. We need to make these changes now.

Overall, these plans will deliver a range of benefits for everyone in the region at both hospital sites. Including:

• A dedicated Emergency Department with immediate access to medical and surgical specialties

• Timely access to the right specialist teams and consultants

• Elimination of 12-hour breaches and reduced ambulance waiting times

• Shorter hospital stays

• Ring-fenced planned care capacity supporting the needs of our population

• Fewer procedures cancelled

• Improved cancer waiting times

• Services that are resilient to peaks in emergency demand

• A much better environment for patients,

families and staff

• Modern, well-designed facilities

• A better experience of care

• Positive impact on staff experience and morale

• Integrated services for local people

• Simpler and more effective patient pathways

• Working seamlessly across our health and social care partners

• Better access to care when needed, where needed

• A&E Local model

How can you get involved?

Over the coming weeks we will be providing staff briefings to update you on how HTP is progressing, the benefits this will bring and how you can contribute to shaping this critical development for our communities. We will also be organising standalone team and service sessions in the new year. We want to make sure everyone knows,

• Where we are in the process and how the plans have developed

• What the changes really mean for you, and;

• Outline any opportunities for getting involved and helping the programme develop

In the meantime, if you have any questions, or want to find out more by joining a mailing list, please contact sath.improvinghospitals@nhs. net with your name, email and first part of your postcode. If you are a member of staff, please tell us which department you work in.

For all up to date information and latest news, please see: https://www. shropshiretelfordandwrekin.ics.nhs.uk/ hospitals-transformation-programme/

What does this mean for urgent and emergency care?

“Approximately 60% of people currently attending our Emergency Departments will still be seen at the same hospital site that they are now in enhanced urgent treatment services that are available 24 hours a day, 7 days a week.

“In a life or limb-saving emergency, patients will predominantly be taken via ambulance, with expert treatment and care from paramedics on the way, to the new Emergency Department in Shrewsbury. This will be available for anyone needing specialist emergency care across Shropshire, Telford & Wrekin and mid-Wales.”

“Our patients regularly experience delays in accessing the right specialist teams and our services are provided in facilities that are not fit for purpose. Currently many patients are transferred between hospital sites to get the right care, which can add further delays to treatment and have a significant impact on recovery.

“These changes will help us to make sure that everyone has access to the right care, at the right time, from the right clinicians when they

need it most. The reconfiguration of services will also help us to attract more of the right specialist staff and to retain those we have now.”

Dr Ed Rysdale, Consultant in Emergency Medicine and Clinical Director for the Hospitals Transformation Programme

What does this mean planned care?

“These changes will result in real improvements for our patients, modernising our services and significantly reducing delays to planned surgery and cancer treatment, whilst also making the services much more resilient to future pressures.

“Delays to planned surgery have a real impact on the quality of peoples’ lives and their ability to recover or start further treatment. The way our services and resources are currently configured means our staff are fragmented and struggle to provide. The challenge of managing the risk of COVID-19 infection during the recent pandemic exacerbated these problems.

“Investing in dedicated planned care facilities at

the Princess Royal Hospital site in Telford will reduce delays to help people across Shropshire, Telford & Wrekin and Mid Wales get the care they need. This is incredibly important for those needing urgent treatment, particularly for cancer, where earlier treatment leads to much better prospects for recovery.”

Dr Steve McKew Divisional Medical Director for Surgery, Anaesthetics and Cancer

Approval of the FBC will support the release of the allocated capital funding so that building work can commence

Dr John Jones, Executive Medical Director (Acting)

Digital transformation is a key part of Getting to Good, with a dedicated workstream to drive forward the improvements.

Investment in our technology not only helps staff in their day-to-day work, but it also enhances the service we provide to our patients.

The Electronic Patient Record (EPR) Programme is playing a central role in implementing newer systems across the Trust and the team is making great progress this year.

The Bluespier Theatre Management System was successfully introduced to elective theatres in September and Bluespier Whiteboards went live

Progress for EPR Programme

in Trauma and CEPOD Theatres on 6 December.

By the end of 2023, the Trust will have moved away from Sema-Helix to CareFlow PAS, which will allow teams to manage patient information more effectively.

To maximise their functionality, it is important that everyone who will use the whiteboards receives training before the go-live date. More details can be found on the staff intranet.

For any questions about Bluespier Whiteboards or the EPR Programme, please email sath.askepr@nhs.net

"Aside from being paperless, Bluespier Whiteboards provide a more secure, efficient, and standardised system that will be accessible across the Trust. They will help to optimise theatre capacity and planning and enable better coordination of our Emergency and Trauma work, ensuring the timely treatment of patients Importantly, this system also reduces the need for doctors to travel to theatres to add patient details to boards, which will allow them to spend more time delivering care on our wards."

Rebecca Gallimore, Director of Digital Transformation

“We’ve already seen the difference Bluespier Theatre Management System makes to how we work and look forward to Bluespier Whiteboards being introduced as it will help us manage emergency and trauma theatre lists and patient care.”

Steve Turner, Theatre Manager at the Royal Shrewsbury Hospital

'Growing Our Own' in Theatres

As part of our Getting to Good programme we have a workforce workstream. Our workforce is the backbone of our organisation, and we can only provide excellent care for our communities if we recruit the right people to the right roles and retain them.

For this to happen, we need to offer wide-ranging opportunities and have development programmes in place across the Trust to help people on their way to achieving their career aspirations.

Theatres is just one area putting this into action. After struggling to recruit and retain staff, they changed their approach and began placing more emphasis on staff development. Recruitment and retention of theatre staff has become a key enabler for future proofing the service with an experienced, competent, safe, and flexible workforce.

The ‘grow your own’ ethos has introduced a range of development opportunities for staff, including a trainee nursing associate programme, an operating department practitioner degree apprenticeship programme, as well as assistant theatre practitioner roles.

The department is now nearly fully recruited to across both sites, with a skilful team who are focused on providing positive patient experience.

Alison Mattey, Matron for Theatres, said: “We are really focused on our teams and understand that investing in the development of our staff is key to retaining them and their expert experience.

“The ‘grow your own’ approach has allowed our staff to forge their own career path within the operating theatres, which in turn develops the team and improves the care we provide to patients.”

Manju Joseph, Clinical Lead for Theatre Education, said: “By listening to the staff and recognising their needs for professional development, it has refocused our priorities.

“In addition to apprenticeship programmes, we’re also offering leadership and management training, simulation training and advanced speciality specific training as part of our education and development offer.”

For more information about this programme of work, please email a.mattey@nhs.net

“The benefits of ‘growing our own’ are far reaching. Not only does it harness talent and lay the foundations for future success, but it enables us to deliver high quality care in a more sustainable way. Theatres is one area that is reaping the rewards and seeing positive outcomes as a result of the career pathways they are creating and this is something we are keen to emulate right across the organisation. If you have any ideas about how we can further strengthen education at SaTH and grow more of our own, we would love to hear from you."

Rhia Boyode, Director of People & OD

In our next edition

we will be focusing on our: • First patients at RSH new acute floor • Utilising our discharge lounges • Improving our elective recovery • Progress on our Maternity transformation journey