Impact - March 2023

March 2023

Success for Our Radiology Team

Emergency Care Making Progress

Ockenden Report One Year On

Supporting Mental Health

Foreword

from Louise Barnett, Chief Executive

Dear colleague,

I know that, like me, many of you will feel very proud of just how much commitment and dedication there is across our whole organisation to change things for the better – not just for our patients but for each other too.

Every day I hear about fantastic examples of teams working together or collaboratively with other colleagues to drive forward improvements across many areas of our organisation and working life and I am really proud of you.

A fantastic example of team working is from our colleagues in Radiology who put in place innovative new ways of working to enable them to significantly reduce the waiting lists for plain film reporting. Determined to ensure their patients received high quality care, they implemented alternative solutions and succeeded in reducing this by thousands in a matter of months. Well done to everyone involved.

We are beginning to see shoots of positive change within our Emergency Departments, as a result of the focus of the newly-launched Emergency Care Transformation Programme. At the heart of this programme is a real desire by teams to make a difference for our patients, in the face of the enormous pressures experienced. You can read more about the work being undertaken as part of the programme on p8, which includes the rollout of the ImproveWell app. This is a fantastic tool which will enable colleagues who work in Emergency Care to share their ideas for improvement – big or small – and to know that they are being listened to, have an opportunity to shape the way forward and feed back on how things are going.

Another area of continued positive progress

is within Maternity Services. It has been 12 months since the final Ockenden report was published and we have made good progress on the delivery of actions, and providing compassionate, high quality care to all the families who use our services. Thank you to all the multidisciplinary teams who have worked together to achieve this, with further actions planned.

The recent staff survey results also showed us that we are making progress on our cultural improvement journey and improving how it feels to work in our organisation, but we know we still have more to do. We recognise that changing the culture of any organisation, not just ours, won’t happen overnight so we really do value your feedback on what we can improve, and also what we are doing well.

Please continue to share your improvements with us via the Getting to Good page on the intranet here

Thank you for all that you are doing every day to help us get to where we all want to be –working in a welcoming, collaborative, and safe environment providing excellent care for the communities that we serve and supporting each other.

Thank you.

Louise Barnett Chief Executive

from Mary Aubrey, Getting to

Good Programme

Director

Dear colleague,

I am pleased to report this month that all programmes within the Getting to Good programme are on track, with three making positive strides this month. - Digital, Maternity Transformation (you can read more on page 10) and Finance and Resources.

Well done to all the teams involved in these improvement programmes. An incredible amount of dedication and effort has gone into making and sustaining improvements and, while there is more to do, you should all be proud of the progress being made.

Whilst some great progress continues to be made within the Corporate Governance, Elective Recovery, Urgent Care Improvement, Quality and Safety and Workforce Transformation programmes, some aspects are being rated as off track. When this happens each project is reviewed to understand the reasons, with a supporting action plan put in place to bring things back on track.

Projects which are making consistent progress include improving our digital infrastructure (you can read more on the roll out of CareFlow on p7), quality governance and the implementation of the new Patient Safety Incident Response Framework (PSIRF), and the leadership development framework which involves the launch of new opportunities including the Galvanise Ethnic Minority Leadership Programme, Schwartz Rounds (see page 9) and the new Talent Portal (more on this in the next edition of Impact).

We are also seeing improvement in the use of

Patient Initiated Follow Up (PIFU) as part of the Outpatient Transformation Project. In January, 3.7% of patients were placed on a PIFU pathway – this is when a patient initiates a follow-up appointment as and when they need one – nationally the average is 1.7%.

We are hoping to achieve 4% this month by offering PIFU in more specialties, which is great for patients and teams within Elective Recovery.

Finally, well done to our colleagues in Corporate Governance who have successfully delivered all the key actions in the Anti-Fraud, Bribery and Corruption, Board Assurance Framework and Board Governance projects. All these projects have now been closed, which is fantastic.

Thank you to every colleague who is contributing to an improvement and helping to make our organisation a great place to work and receive care. Every improvement counts and if you would like help or support with an improvement idea, you can contact our Improvement Hub colleagues – sath. improvementhub@nhs.net

Thank you.

Supporting Our Vulnerable Patients

An essential part of our Getting to Good journey is ensuring that people receive the same high-quality care for their mental health as for their physical health.

Improved mental health and wellbeing is associated with a range of better outcomes for people of all ages and backgrounds and forms an important element of health care.

Part of this journey has included looking at how we can improve mental health support for patients attending our Emergency Departments, as well as across all our services. This is incredibly important as attendances from patients in mental health crisis continues to rise across the country.

A vital step forward has included the appointment of our own dedicated Mental Health Lead Nurse and Clinical Nurse Specialist Mental Health, and a Mental Health Act Administrator, who work to support colleagues across the organisation to care for patients experiencing mental health issues, including advice and guidance to ensure we are meeting our legal requirements under the Mental Health Act 1983.

The dedicated roles also engage and support close collaboration and integrated working with local partner organisations including the development of third sector input into both of our Emergency Departments, such as the Mental Health Outreach and Inclusion Service.

The Mental Health Outreach and Inclusion Service, which has been recently set up at Princess Royal Hospital and has been in place at

the Royal Shrewsbury Hospital for 18 months, is a new initiative which aims to provide improved mental health support for people who attend our Emergency Departments.

The service can be delivered in the person’s home or other settings and includes providing practical and emotional support to the individual and their family.

Mike Ford, Mental Health Lead Nurse, said: “We are committed to continuing our work and building key relationships, so that we improve the care we are providing to people with mental health issues within our services and across the local care system.

“We want to provide the best possible care for everybody and that includes people who may be experiencing mental health issues.

“We can all experience mental health issues at any time in our lives and it should be treated just as importantly as if you attend the hospital for a physical health problem.”

Alongside continuing this work, next steps for the team include the development of a Mental Health charter and strategy, improved data reporting through the new Careflow system and early flagging of people within our care with diagnosed Learning Disability Autism and Severe Mental Illness.

Care in Our Communities

As part of our Getting to Good Programme, we are trying to increase the access our patients have to care in the community and plan for future demand.

Later this year, a new Community Diagnostic Centre (CDC) is due to open in Telford and patients will benefit from quicker access to tests, checks and scans, without having to come into hospital.

The Government has approved the CDC, one of four in the Midlands region providing tests and treatments in the community away from the acute hospital setting.

Together with STW ICS, and staffed by teams from our organisation, the centre is set to transform how services such as MRI scans, ultrasounds, X-rays and blood tests are offered to our patients.

Services available in the new CDC will include:

• CT

• Non-Obstetric Ultrasound Scans

• X-Ray

• Phlebotomy

• A number of routine Cardio Respiratory tests.

Nigel Lee, Interim Director of Strategy and Partnerships, said: “This is fantastic news for our patients and colleagues. The centre will create additional capacity, reducing pressure on other services.

“The CDC will offer a range of diagnostic checks, scan and tests to help reduce the backlog and diagnose patients more quickly. Importantly, the services are provided in a centre in the community, with easier access for patients.”

The CDC will be based at Hollinswood House,

Stafford Park, which is currently undergoing a complete interior redesign to ensure it is fit for purpose and able to accommodate future demand.

Renal dialysis services from the PRH will also be moving to Hollinswood House, creating more space for our patients and a more comfortable environment.

The purpose-built facility will provide care for lower risk dialysis patients in this satellite unit, with acute services remaining at Royal Shrewsbury Hospital.

The move will allow us to meet not only the current level of dialysis demand but also the forecasted future demand over the next 10 years. This off-site location will also create more clinical space for both patients and staff, with dialysis over two floors and a staff rest room.

Renal dialysis services are currently on a ward at the PRH and the move will allow this space to be upgraded and converted into an inpatient ward, thus providing more beds for patients who are acutely ill.

Pre-Operative Assessment Progress

Improving patient experience and patient outcomes is a key priority on our Getting to Good improvement journey.

This is particularly important for patients waiting for an operation. Any operation or surgical procedure involves a series of stages, including the patient’s pre-operative assessment.

Pre-operative assessments determine whether a patient is well enough to undergo their surgery and the staff play an important role in helping to reduce any worries the patient might have.

Our colleagues in the department have been working hard to improve the service in recent months, trialling the introduction of a onestop triage process. Patients are seen for preassessment on the same day as seeing the consultant and being listed for surgery.

This is benefitting both our patients and our staff. The patient spends less time waiting to be seen resulting in timely optimisation, travelling

to and from the hospital is reduced, and our colleagues can work more efficiently. Where a patient has particular needs, we will adopt a tailored approach to meet their needs.

Rachael Bollands, Pre-assessment Manager, said: “I am so proud of the team and the progress we are making together. We are embracing new ways of working and really seeing the benefits.

“All of this comes at an exciting time, with the Trust having secured £24million government funding for a planned care hub at Princess Royal Hospital.

“If you would like to learn more about what we’re doing, please do drop by the department and we would be delighted to chat with you.”

“We are hoping to trial a pre-habilitation surgery school for our patients and we are collaborating more closely with our colleagues, having set up an annual study day alongside pre-operative anaesthetists to refresh our knowledge and uphold revalidation requirements."

Rachael Bollands, Pre-assessment Manager

Improving Our Digital Infrastructure

As part of our Getting to Good improvement journey, we are transforming our digital services to help us to improve the quality, safety and experience of care that we provide our patients

As part of our overarching digital strategy, we are progressing the delivery of a new Electronic Patient Record (EPR) system. This is a crucial three-year piece of improvement work, being delivered in two phases, which will revamp and modernise how we store and access patient notes.

EPR will ensure a more accurate reflection of the patient journey and, while this will not lead to a completely paperless system, it will help to standardise how patient information is managed across all sites and take our organisation a step closer to realising its digital ambitions by 2025. You can find out more about EPR, and what the first phase involves, through our regular awareness sessions –details here

As part of EPR, we have already implemented the BlueSpier Theatre Management system in our Theatres, and we are now rolling out CareFlow, which will replace SemaHelix, Wardvision and ED Whiteboard - completing the first phase of our digital transformation.

CareFlow is a Patient Administration System which will provide colleagues with access to up-to-date information and improve the quality of information we record. It will also

help equip our emergency teams to track patients as they move through the department, and onto theatre or further investigations.

The first quarter of the programme this year is being dominated by ‘sprints’. These are intensive short periods of work focused on looking at specific elements of the patient journey. Since the start of the year, the digital services team has been working with departments as part of the sprints, spending time with divisions and specialties to ensure the new CareFlow system will be set up correctly and that new processes are signedoff and fit for purpose.

So far, the sprints have resulted in a wealth of information that will assist the implementation of CareFlow and help ensure the switch over runs as smoothly as possible.

Nigel Lee, Interim Director of Strategy and Partnerships, said: “The work that has been carried out in the first part of the year is critical to the smooth implementation of CareFlow applications across the Trust. We have been grateful for everyone’s help with this as it will help us implement a system that works for colleagues in their working environment in the best possible way.”

In our next edition we will be looking in detail at the two phases of the EPR programme and the benefits to both patients, and colleagues.

“The rollout of EPR across the organisation will help to support our teams in their roles and to deliver better care for our patients, which we know is important to everyone.”

Dr John Jones, Executive Medical Director

Emergency Care Services

Making our organisation a great place to work, and a great place to receive care, is a priority on our Getting to Good improvement journey.

One of our key aims is to provide the best emergency care possible for the communities we serve, which is the ambition of our Emergency Care Transformation Programme. Similar to the approach of the Maternity Transformation Programme, its aim is to drive forward improvements in our emergency care services to benefit both patients and colleagues. There are five programme workstreams:

• Workstream 1. Clinical Quality, Outcomes and Co-ordination of Care. This includes elements such as initial assessment, analgesia and quality of care

• Workstream 2. Staff Culture, Resilience and Health and Wellbeing. This includes behaviours, culture and development

• Workstream 3. Governance, Risk and Safety. This covers departmental risk management as well as internal professional standards

• Workstream 4. Communications and Engaging Communities. Focusing on internal and external communications for communities and staff

• Workstream 5. Environment, Pathways and Flow. Achieve and improve flow across all of our wards and therefore, ED.

The three-year programme, which is in its very early stages, has an action plan at the core, which contains a total of 117 actions to deliver. To date 15 (12.8%) are delivered, but not yet evidenced.

This month, there has been a focus on the ED discharge processes and ensuring that our

patients are coded in a timely manner and safely discharged from ED. We are already starting to see improvements in this area, thank you to our clinical colleagues involved.

There has also been a focus on engaging with colleagues and encouraging them to share their ideas for improvement. The ImproveWell app has been launched for colleagues working within Emergency Care – with more than 40 colleagues already signed up. The app enables colleagues to share their ideas on what we are doing well and what we can do to make things better for those working, and accessing care, in our Emergency Departments.

The ImproveWell app has already been successfully rolled out in our Maternity Services. The platform drives engagement and can be used to upload improvement ideas, vote in polls and even share how work is going that day.

Sara Biffen, Acting Chief Operating Officer, said: “ImproveWell has a really important part to play on our improvement journey as it enables those who actually work in the departments to share their ideas and shape what we do going forward.

“We have already seen the app successfully enabling colleagues in maternity services to share their ideas for improvement and this is helping to make a real difference for our families, and our maternity colleagues. I really encourage colleagues in Emergency Care to sign up and have their say in how we can move forward effectively together.”

“It is very early days and we have much more to do, but we are starting to see progress against the actions in our plan. This is fantastic considering the demand and pressures that the department is under on a daily basis, and I would like to thank everyone for their ongoing commitment and dedication to make things better for our patients and colleagues."

Sara Biffen, Acting Chief Operating Officer

Schwartz Rounds

Ensuring that our colleagues feel supported in their roles so they can provide high quality, compassionate care is a key part of our improvement journey.

A patient or a family’s experience of care can often be shaped by the compassion they are shown whilst on their hospital journey, so it is important that colleagues feel fully supported themselves.

Monthly Schwartz Rounds have been introduced on both hospital sites which are open to all colleagues, clinical or nonclinical, giving them the opportunity to share experiences in their role and learn from someone else’s experience, in a safe space.

Colleagues come together to talk and work through the emotional and social aspects of working in healthcare and can reveal difficult, demanding and satisfying aspects of their job. This can help other colleagues who may work in different roles through shared experiences and feelings, and help them to feel supported.

John Skelton, Head of OD, Leadership and Culture, said: “The purpose of the rounds is to understand the challenges and rewards that are intrinsic to providing care, not to solve problems, but to support staff from all disciplines to have an opportunity to reflect on the emotional and social aspects of providing

care and ensure people feel supported by this.

“Evidence shows that it helps people feel less stressed and isolated, with increased insight and appreciation for each other’s roles.”

The next Schwartz Round, titled 'A Day I Felt Proud', will be held on May 19 from 12.30 –2.00pm in Seminar Room 5 at SECC, RSH.

If you would like to be part of future rounds or would like to become an accredited facilitator, please contact John at john.skelton4@nhs. net or Sam Funge, Head of Medical Education/ Medical Education Manager, sam.funge@nhs. net.

John added: “We have had some great feedback from colleagues who attended our Schwartz rounds and found them supportive. Comments such as inclusive and reflective, honest and valuable, reassuring and a privilege to hear and share other people’s experiences. If you haven’t been to one yet, I would encourage you to come along. These are fantastic opportunities for any colleague to talk, listen, share and learn in a safe space.”

“We have held a number of rounds now, each one with a different theme, and the overarching aim is to help colleagues feel more supported in their jobs by allowing them the time and space to reflect on their roles from a cultural perspective encouraging and supporting each other to have these conversations in a safe space.”

John Skelton, Head of OD, Leadership and Culture

Update on Maternity Transformation

from Annemarie Lawrence, Director of Midwifery

This month marks a year since the publication of the final Ockenden Report, and whilst there is still work to be done, I am proud of the determination and resilience our teams have demonstrated during what has been a challenging time.

We have made good progress on the delivery of our 210 actions, whilst continuing to provide responsive and compassionate care for the thousands of women and families who choose to have their babies with us every year. Alongside this, teams are delivering the Saving Babies Lives Care Bundle and many other pieces of work which form a vital part of the safe care we provide.

We remain committed to maintaining the best possible working environment for our colleagues. We are working to achieve a culture of psychological safety where individuals feel confident to escalate any matters that concern them. Whether it’s those I see at my fortnightly Director of Midwifery drop-ins, colleagues accessing support through our health and wellbeing offering, or the increase of 50% in the number of colleagues in maternity services

Name: Cris Knill

Job title: Senior Project Manager, Maternity Transformation Programme

1. What does your job entail?

I am the senior project manager for the Maternity Transformation Programme. My goal is to ensure all actions from the Ockenden reports are delivered following robust governance and assurance processes, alongside other maternity improvement initiatives to better maternity services at SaTH. The overarching programme aims are to reduce stillbirth, neonatal death, maternal death, and brain injury.

2. What is the best thing about your job?

I enjoy working with colleagues to create new

participating in the Staff Survey (amongst the highest uplifts in England), staff are engaging with us and helping us to improve.

As we have moved towards our position of safer staffing, with 24/7 consultant cover on our Delivery Suite and no current vacancies in midwifery, we are seeing student midwives who want to complete their placements with us, newly qualified midwives who want to stay with us and colleagues applying for leadership positions. This is in part thanks to our workforce plan which offers up great opportunities for learning, but also because of an improved culture that shows us people want to stay in the organisation to progress their careers.

Our teams are committed to helping women and families safely have the birth experience they want and the positive feedback we receive reinforces the progress we continue to make.

processes and watching them work effectively, which in turn will benefit a service user.

3. How does your job improve service user care at SaTH?

My job helps to improve maternity services on an operational level, which in turn provides a better experience for families and colleagues.

Ockenden Report - Completion

Batteries

First Report:

47/52 Actions Implemented (89% overall), comprising:

42 (81%) ‘Evidenced & Assured’

5 (10%) ‘Delivered, Not Yet Evidenced’

5 (10%) Actions ‘Not Yet Delivered’

Final Report:

115/158 Actions Implemented (73% overall) as of Feb-23 MTAC.

88 (56%) ‘Evidenced and Assured’

27 (17%) ‘Delivered, Not Yet Evidenced’

43 (27%) ‘Not yet Delivered’

Combined Reports:

162/210 Actions Implemented (77% overall), comprising:

130 (62%) ‘Evidenced & Assured’

32 (15%) ‘Delivered, Not Yet Evidenced’

48 (23%) Actions ‘Not Yet Delivered’. Of these, over two thirds are underway.

Emily Evans is the Service User Chair for the Shropshire and Telford & Wrekin Maternity Voices Partnership (MVP). An MVP is an independent team made up of women and medical professionals who listen and discuss challenges and ways of overcoming them through co-produced solutions.

How has the MVP’s working relationship with SaTH improved?

• The team at SaTH is more open and engaged with us. They do not shy away from the MVP being a critical friend and they are keen to learn and act on ways they can deliver good care.

• We are working with a wider breadth of staff than ever before which helps us join up service user feedback with staff experiences. By doing this, we can suggest patientcentred improvements

that can be embedded and continued in the long-term.

• We co-produce a lot of material rather than just reviewing it, meaning we can engage with service users early on and make sure their preferences are captured and acted upon.

What is the biggest achievement of the MVP?

Reintroducing our 15 steps events where service users, MVP reps and staff tour an area of maternity services, discussing the positives and areas for improvement. We are also proud of the increased focus on communication and listening to service user feedback. This is a long-term goal, but we can see progress, with staff training forming a key part of the development work, as well as new resources such as the birth preferences card. The kindness and compassion of midwives and support staff

is often highlighted within our service user feedback.

What progress would you like to see from SaTH over the next 12 months?

I want service user and staff feedback to be at the heart of improvements and for SaTH’s maternity and neonatal departments to be leaders in coproduction. We still have work to do but we have made good progress in recent time and I am proud of the work that the MVP and SaTH have achieved together.

Success for Radiology

Elective recovery is a key focus for our Getting to Good programme, and this includes diagnostics.

Using innovative and flexible solutions, our Radiology Team has been able to significantly reduce the X-ray reporting backlog caused by pressures from COVID-19 as well as staffing challenges.

At its peak in August 2022, the waiting list for plain film X-ray was at 10,000 but by the end of 2022 the team had reduced this significantly.

As of the beginning of March 2023, there were only 28 reports on the waiting list.

The team was able to achieve this by:

• Investing in home reporting workstations so that colleagues could work more flexibly and maximise their time

• Leading, managing and receiving centre approval for Wait List Initiative (WLI) to undercut outsourcing companies and to invest in colleagues to extra reporting work

• Protecting as much time as possible for reporting radiographers

• Pulling back on the GP backlog to allow sufficient time to catch up on the reporting first, and then reinstate the WLI for the GP backlog

• Outsourcing a radiographer reporting company to support our in-house reporters

Graham Kelly, Consultant Radiographer, said: “As a team we have used creative solutions to help us meet the immense demand for diagnostic services during one of the most testing times for the NHS.

“Crucially, our patients are receiving much more timely reports now. The backlog reduction helps our internal referrers to manage patients more effectively and deliver high quality care.”

“Seeing thousands of reports waiting can put a lot of pressure on our reporting colleagues, so we had to work differently to be able to ease this and provide the right level of care to our patients. Our performance is now better than it was pre-COVID and better than the national recommendations for report turnaround times."

Graham Kelly, Consultant Radiographer

In our next edition we will be focusing on our:

• Restoration and recovery

• Next steps on our Emergency Care Transformation Programme

• Our Operational Plan for 2023/24

• Financial recovery

• How our Chaplaincy team is enhancing care