Impact Magazine - March 2024

The executive team and I are incredibly grateful for, and proud of, the contribution that you have all made to make our organisation a great place to work and receive care. So many of you have gone above and beyond to support our improvement programmes on top of your day-to-day roles to make a positive difference for everyone.

April will herald the start of a new chapter for our organisation, bringing with lots of new, exciting opportunities. We will continue to focus on our Getting to Good improvement journey, building on the fantastic progress we have made so far.

We know we are making improvements, not just through our regular reporting and assurance routes but from what our colleagues, and our patients, are telling us.

The results of our latest NHS Staff Survey show we are moving in the right direction and that the work we are doing as part of our culture improvement programme is making a difference.

We are not yet where we want to be. There are some key areas that we need to focus on. These include ensuring we have a compassionate culture and supporting the wellbeing of colleagues. Thank you to everyone who took the time to fill in the survey. It is a snapshot in time, but it helps us to

As the current financial year draws to a close, it is important to reflect on the achievements we have made together over the last 12 months for both our patients and colleagues.

understand how it feels to work here, and in the NHS as a whole, and enables us to put sustainable improvements in place to make things better.

We have also received the results of the Care Quality Commission (CQC) maternity survey which showed that we are making improvements in the care we provide to families using our maternity services. It was pleasing to hear that women said they felt listened to, treated with respect and dignity and felt involved in the decisions about their care. It is so important that we continue to listen to our families and put them at the heart of everything we do. You can read more on p13.

We are awaiting the results of our CQC inspection, including well led, which took place last year. The initial feedback recognised some positive improvements since our last inspection in 2021, however, we know there is more for us to do as we strive to deliver excellent care for the communities we serve. We are expecting to receive the results in the next few weeks, and we will share them with you as soon as we are able to.

As you will be aware, April will see the launch of the first phase of our Electronic Patient Record (EPR) programme. We recognise that this will be a considerable change and will impact many colleagues across the trust.

Thank you to everyone for your enthusiasm and willingness to be part of this exciting, critical piece of work. It will bring enormous benefits, significantly improving the quality and safety of the care we provide to our communities. You can read more about the countdown to our Go Live weekend on p8.

We are continuing to invest in and increase the ways our patients can access the care they need, closer to their homes. The Community Diagnostic Centre in Telford is a key part of this vision. Not only is it more accessible for our patients, it is also helping to reduce the pressure on our busy hospital sites. The latest phase is the opening of a teledermatology service, which is supporting patients on our cancer pathways to be seen quicker. You can read more on p4.

We should feel proud of how far we have come, and that we are moving in the right direction.

Thank you for everything you are doing.

Dear colleague,

Mary Aubrey Getting to Good Programme Director

We are continuing to make good progress on our improvement journey through our Getting to Good programme.

It is fantastic to see ideas and projects coming to fruition, and learning about the difference each one is making for our colleagues, and our patients and their families.

We have seen some fantastic results in the last month, all of which will help us to achieve our vision to provide excellent care for the communities we serve. A huge thank you for everything you are doing to support our improvement journey in your roles.

Highlights include:

• The launch of the new MRI scanning service at the Community Diagnostic Centre (CDC) in Telford. We have invested £1.4million in the stateof-the-art scanner which will provide additional capacity, and reduce waiting times, for patients who need non-urgent scans. You can also read more about the latest service now being delivered from the CDC and how we are increasing access to care in the community for our patients on pX.

• Developing outstanding leaders will help us to create a great place to work and receive care. Nearly 2,000 colleagues have now accessed the Trust’s Leadership Development courses and programmes as part of the workforce transformation programme. This includes the

SaTH 1-4 leadership programmes, Galvanise and STEP management. The development of our own internal facilitators has been fundamental to the success of the programmes, and has also resulted in savings of £500,000..

• The successful completion of the training and education project as part of our workforce workstream. The aim was to improve compliance for mandatory training, launch the new Learning Made Simple (LMS) platform as well as introduce new apprenticeship opportunities. You can read more about the progress we have made to our education offer, and the difference it is making, on p14.

Finally, let me bring you up-to-date on the overall Getting to Good programme status, which is at:

• 47.8% – not yet delivered

• 28.3% – delivered, evidenced and assured

• 12% – delivered not yet evidenced

• 12% – descoped

Thank you for everything you are doing.

INCREASING ACCESS TO CARE

One of our key priorities is increasing the access our patients have to care in the community, and closer to their homes.

The new Community Diagnostic Centre (CDC) in Telford has transformed how services such as MRI scans, CT scans and blood tests are offered to our patients.

The CDC is based in Hollinswood House in Stafford Park. As well as creating additional capacity and reducing pressure on our hospital sites, it means that patients have easier access to diagnostic checks, scans and tests.

To further increase the services offered in the community, a new teledermatology service has just launched at the CDC helping patients to have faster diagnosis and treatment for skin cancer.

The teledermatology team, in partnership with Integrated Care Board (ICB) colleagues, has been working on the teledermatology pilot project for a year to implement the best model of care for Shropshire, Telford and Wrekin..

The final operating model involves a patient attending clinic to have high quality photographs taken which are then triaged remotely.

A qualified professional clinical photographer then takes a series of digital photographs of a patient’s skin lesion. The photographs are then sent to a dermatologist for remote assessment to see if the patient needs to come into hospital for further treatment.

Remote triage enables dermatologists to review twice as many patients than during face-to-face appointments.

The teledermatology service is currently operating from the renal dialysis unit, also based within Hollinswood House, until its purpose-built clinic is completed in the spring.

It is currently available for all urgent suspected cancer (USC) referrals from within the area and is currently open on Mondays and Thursdays.

Over the next few years, if needed, the service could be extended upto six or seven days a week.

The aim is to make it as accessible as possible for our patients.

Helen Childs, Clinical Dermatologist Specialist Nurse, said: “The teledermatology service prioritises patients referred by their GPs with lesions to get high quality photographs taken quickly.

“There is a virtual review of the photographs and then it is decided whether the patient needs to be seen by a clinician.

“The turnaround from GP to teledermatology is a matter of days, which is great for our patients. Feedback from the patients has been really positive so far.”

Dr Dimple Jain, Clinical Lead for Dermatology, said: “I reviewed the data from the pilot study and the majority of the lesions were benign, which meant that about 30 per cent of patients did not need a face-to-face appointment.

“Not all patients need a two-week face-to-face appointment. We downgrade some to routine, urgent or redirect a patient to another service. This means we are redirecting patients to the right place for them to be seen.”

Lynne Morris, Respiratory, Renal and Dermatology Centre Manager, said: “We have streamlined the pathway for patients which means they are having photographs taken quickly instead of lots of different waits to access surgical opinion for removal or to have advice. It is providing them with an early reassurance. Those patients who need to be seen on the two-week referral pathway are benefiting from this too.

“We are already seeing an improvement to cancer targets, such as Faster Standard Diagnosis (FSD), 31 days and 62 days, and now it is about sustaining and maintaining those improvements.”

Lynne added: “What Helen and the team have been able to achieve with the resources they had, to be able to introduce this service is a phenomenal.”

Benefits for the patient:

• Fewer patients need to travel to hospital to be seen by clinician

• Quicker appointment for photographs to be taken

• Triage outcome is within two weeks rather than waiting two weeks to be seen in person - a quicker outcome for the patient

• Many patients with non cancerous lesions can be discharged back to the care of their GPs without needing a clinic appointment

• Patients requiring a surgical procedure can be booked directly or referred to specialist surgeons via a skin cancer multi disciplinary team meeting, reducing the number of hospital attendances for the patient

Benefits for the clinician:

• Quality of digital photographs creates greater diagnostic ability

• Greater flexibility as images can be reviewed remotely

• Clinic space is not required to conduct the reviews

• We now have the ability to triage more than 20 patients in a session rather than nine patients seen for face-to-face appointments in a similar time

• Better utilisation of the two-week referral clinic capacity

• More capacity created enabling the service to accommodate other general dermatology and paediatric patients, reducing their waiting times

Case Study

Jane McEvoy, from Jackfield, near Telford, was one of the first patients to use the new service. She had been referred by her GP to have a lesion on her face photographed. Jane said that it was the third lesion that she had had with the second one on her breast being cancerous.

Jane said: “My GP told me that this was a new service and I would be seen very quickly, which I was. It is a worry when you have had a lesion that was cancerous and also because it was on my face.

“I wish it had been around the first time I had a lesion – as this service is absolutely brilliant. It was so easy and everybody has been so friendly.”

Since we embraced HVLC and GIRFT, the waiting times for cataract patients have reduced significantly. Patients are now operated on within a few weeks from assessment, and we have received excellent feedback from patients about their positive cataract surgery experience. All this is being done with state-of-the-art equipment without compromising our excellent quality of care.

Dr Palpandian Viswanathan, Clinical Director for Ophthalmology

Ambitious

IMPROVING OUTCOMES FOR OUR PATIENTS Getting it Right First Time

We are always looking at new ways we can improve the treatment and care we provide our patients.

A number of our clinical teams are working in partnership with external peer clinicians to review how we are performing and to understand if there are opportunities for us to improve our efficiency.

The overarching aim is to ensure our patients are accessing high quality care quicker which will help to improve outcomes and patient experience.

We are currently part of the High Volume Low Complexity improvement programme (HVLC). HVLC is an initiative that was launched by the NHS in 2021 and is designed to help drive down waiting lists for elective surgery.

The programme works in partnership with the National Elective Recovery Board and is led by Professor Tim Briggs and the Getting It Right First Time (GIRFT) team.

One area where we are seeing great improvement is Ophthalmology. The Ophthalmology team has made considerable improvements to the efficiency of the cataract service.

40% of lists are now 8 or 9 cases, compared to all lists being 6 cases previously Dr Laurence Ginder, Associate Medical Director, said: “The team has made excellent progress and this is a testament to their engagement with the GIRFT programme despite a challenging environment.

GIRFT aims to improve patient care through indepth reviews of services, benchmarking and datadriven evidence to support change. Up to 60% of people on waiting lists need high volume, routine surgery. GIRFT is working to reduce the national backlog of patients waiting for these operations and improve outcomes and access to care.

“A massive thank you to all the team for their positive attitude and great contribution to improving care for our patients in Shropshire, Telford and Wrekin.”

Other areas that have shown improvement within the HVLC programme include an increase in day case procedure rates and ambulatory orthopaedic pathways.

We will be sharing more information about our partnership with GIRFT and the improvements we are making in future editions of Impact.

COUNTDOWN TO CAREFLOW

The roll out of the first phase of our exciting Electronic Patient Record (EPR) programme is just around the corner – transforming the way we will work and care for our patients.

EPR, part of our digital transformation programme, is critical to improving our working practices and will long-term help us to deliver more integrated working within the Trust and with our partners. A huge amount of work has already taken place as we prepare for this major change for our organisation.

Phase one will see us transition to the CareFlow Patient Administration System (PAS) and CareFlow ED (Emergency Department), along with introducing the Patient Flow system on our wards and the electronic CAS Card (eCAS) in our Emergency Departments (EDs). This will replace outdated SemaHelix, Wardvision and ED Whiteboard, providing enhanced functionality for our EDs, as well as inpatient and outpatient activity.

Dr Adrian Marsh, Emergency Department consultant, said: “EPR is a real opportunity for our Trust, but is also fundamentally a new way of working. It will bring huge changes in the way colleagues in ED, and other Trust colleagues who see patients in ED, work.

“CareFlow has been a long time coming. SemaHelix is outdated and we need to move towards a more modern way of working.

“The ED module means that we will all have to work differently within the emergency department including healthcare assistants, nurses, doctors and also specialties as well.

“Anybody who sees a patient in ED is going to have to contribute to that patient’s electronic patient record. This will improve the quality of the discharge letters sent to GPs and support discharging patients from the ED in a timelier manner. Long-term this will support better flow within our hospitals and the wider system. “

Dr Adrian Marsh, Emergency Medicine Consultant and Post Graduate Clinical Tutor, said:

“Anybody who sees a patient in ED is going to have to contribute to that patient’s electronic patient record. This will improve the quality of the discharge letters sent to GPs and support discharging patients from the ED in a timelier manner. Longterm this will support better flow within our hospitals and the wider system. “

He added: “Under the new system, everything will run in real time within the ED and

“It may feel like a very different way of working but the patient is everyone’s responsibility and therefore, it is the duty of all of us to ensure that medical records are up to date and contemporaneous.

“We all need to work together. If you are unsure, then please come and ask one of us. We will help and support you.”

CareFlow is just the start of the EPR transformation journey, with more benefits for patients and colleagues to come. Look out for updates on the next phase of EPR, and the digital transformation programme, in future editions of Impact.

Anyone who uses SemaHelix, PSAG or contributes to paper records in ED will be affected by the changeover taking place from Friday 19 April to Sunday April 21. Thousands of colleagues are being trained in using CareFlow so they are prepared and ready ahead of the switchover.

Friday 19 April – SemaHelix will switch off Sunday 21 April – CareFlow will be switched on

Ambitious

This includes colleagues in the therapies team who have achieved 82% training compliance. The team has been engaged with the EPR programme project from the start.

Colleagues in Therapy Outpatients currently use SemaHelix for clinic management and bookings. Office Managers, Karen Plume and Julie Williams, were part of the early functional design groups to help with patient letters and working through Standard Operating Procedures (SOPs).

Mandy said: “It was essential for me to ring fence time for our office managers to be fully onboard with this change to make this the best it can be. This will enable us to deliver the best patient care

because we are expecting the right patient, at the right time with the right information.

“CareFlow can give us more accuracy, better planning of clinics and more granular details from the dashboard. This data will allow us to understand our workforce requirements and our capacity and demand to help us make service and quality improvements for our patients.”

The therapies team have more than 20 Change Agents ready to help with Go Live in April who are ready to answer questions and offer support.

This is really exciting for the Trust and our patients. Clinic templates and management will be more robust, it’s visually more attractive and gives more flexibility and adaptability. It still does exactly what SemaHelix did, but with more bells and whistles.

Ambitious

Mandy Taylor, Acting Therapy Centre Manager

Are you ready?

The clock is ticking and we need your help

Ensure all patient records are up to date – a system is only as good as the information we put in

• Ensure your team’s business continuity plan is up to date and tested in readiness for working without our digital systems

• Work with your Change Agent to test your readiness

• Help with timely discharges ahead of the go-live weekend.

If you have any questions, queries or suggestions, please don’t hesitate to contact the Digital Team, your Change Agent or visit digital.sath.nhs.uk.

MATERNITY

A huge thank you to the obstetrics and midwife teams for bringing my baby boy into the world safely. You are all wonderful and so appreciated.

Each and every person we came across was kind, informative and you all made a very nerve-wracking experience into a lovely one. I was so worried about having a C-section this time around (after previously having a pleasant uncomplicated natural birth) but I feel like everyone went the extra mile to reassure me.

Staff in theatre and recovery especially were incredible. They could tell I was nervous, but they were chatty and kind and I ended up having a good laugh with them all.

I also feel every safety precaution was considered, with the team consulting my gastro team to discuss (I had bowel surgery 2 years ago), this multidisciplinary approach made me feel in very good hands.”

Viola Jackson, (pictured) following the birth of her baby boy, Lenny.

Listening to women and ensuring their voices are heard is vital to the sustained progress we are making in our maternity services.

The Maternity Transformation Programme is part of our Getting to Good improvement journey, and is due for completion at the end of March 2024.

One of our priorities is to listen and act on feedback from our families so that we can continually improve the maternity care we provide.

The results of the Care Quality Commission (CQC) maternity survey 2023 have just been published, which found that women felt involved in their care.

Annemarie Lawrence, Director of Midwifery, said:

“The recently published results of the survey, which covers all aspects of maternity care, showed that women cared for by our teams felt involved in decisions about their care, listened to and treated with respect, dignity, kindness and compassion.”

The survey is designed to build an understanding of the risk and quality of maternity services in England. More than 25,000 responses were received from women who gave birth at 121 Trusts in January and February 2023.

• Thinking about your care during labour and birth, were you treated with kindness and compassion?

• Did a midwife or health visitor ask you about your mental health?

When broken down by section, in the category ‘Your labour and birth’, we scored ‘much better’ than most other trusts and were the highest scoring trust in our region. There were no sections in which the Trust scored worse than most other trusts.

Annemarie said: “We welcome the annual CQC Maternity Survey as it gives us independent feedback about where our service users think we are providing outstanding care, and areas in which we need to improve. We are continuing with focus and commitment to listen to families, putting them at the heart of the care we provide.

“We are co-producing an action plan alongside our local Maternity and Neonatal Voices Partnership (MNVP) with a particular focus on feeding and increasing awareness of mental health support postnatally, which have been highlighted as areas where service users’ experience could improve.”

Our trust received a score higher than 9/10 in 14 questions from the survey and results were ‘better’, ‘somewhat better’ or ‘much better’ than most other trusts in three questions.

These include:

• During your antenatal check-ups, did your midwives listen to you?

• Thinking about your antenatal care, were you involved in decisions about your care?

• During labour and birth, were you able to get a member of staff to help you when you needed it?

Amy Walsh, MNVP Shropshire and Telford & Wrekin Co-Lead, said: “The survey results echo much of the feedback we receive from service users and highlight the improvements made, particularly in the area of communication.”

Emily Evans, MNVP Co-Lead, added: “The MNVP remains dedicated to providing both challenge and support to SaTH, ensuring improvements are driven by service user feedback. We look forward to coproducing an action plan to address key areas highlighted within the report.”

EDUCATION & TRAINING

Creating an environment that encourages learning, development, innovation and success is a key part of our improvement journey.

One of our organisation’s key strategic pillars is ‘Growing for the Future’. This focuses on how we recruit, retain and welcome back colleagues so we can provide excellent care for the communities we serve.

We are working to ensure there are opportunities for colleagues to develop their full potential and have access to the right learning and development. This improvement work is being driven by our colleagues in the Education team.

To achieve this, the team has been making training accessible to all colleagues as well as increasing mandatory training compliance.

We launched Learning Made Simple (LMS), an online portal which delivers and manages mandatory training. Since its launch:

• More than 94% of colleagues have registered on the system

• On average, 2,136 face-to-face courses and 8,551 eLearning courses have been accessed each month.

All colleagues need to complete statutory and mandatory training to ensure we are able to evidence they have the required knowledge to carry out their roles and to provide high quality, safe care for our patients.

As a result of LMS, mandatory training compliance has been above target since January 2023, with a figure of 92.18% in December 2023, an increase from 80% since before the platform was launched.

To sustain this improvement, this month we launched the Mandatory Training Group to help subject matter experts further improve mandatory training compliance.

We have also launched the SaTH Education Prospectus so colleagues have better access to information on professional development, and have mapped out a number of career pathways to support colleagues’ career development.

We are committed to providing high quality, safe care to our patients by enabling our colleagues to develop and reach their potential.

Although we have successfully delivered our Getting to Good targets, we want colleagues to feel there are endless opportunities to learn and develop in their chosen career and we look forward to the next stage of our education journey.

James Owen, Deputy Director of Education and Improvement

Ambitious

Mandatory Training Case Study

THE CLEANLINESS TEAM

A year ago, the Cleanliness team’s statutory and mandatory training was at 83% for PRH and 75% for RSH.

By June compliance had dropped to 76% and 67% respectively. The team found it difficult to complete training because they didn’t have access to computers.

The team introduced paper-based workbooks and held face-face sessions at both sites, both in hours and out of hours, day and night, to enable them to complete their training.

Eleven months later, compliance rates have risen considerably to 94.76% for PRH and 93.96% for RSH. The team has now introduced training supervisors to sustain this improvement.

We are also offering more apprenticeships within our organisation to support the growth of talent.

We currently have 183 colleagues on apprenticeship programmes across a range of roles including engineering, leadership and management, pharmacy, radiography and nursing.

To enable us to offer more apprenticeships and boost training opportunities, a levy can be accessed to help pay for apprenticeship training costs.

The amount of levy we pay is related to how many people we employ. Due to increased staffing numbers and cost, the amount of levy we contribute has increased significantly since 2020 meaning we have an increase in funds available to support colleagues taking on apprenticeships.

You can contact our colleagues in the Education Team via sath.education@nhs.net if you would like to find out more about how to access apprenticeship funding.

HEALTHCARE SCIENCE Case Study

Case study: Joe Bowkett, age 20, is undertaking an apprenticeship as a Healthcare Science Practitioner

“The opportunity to work as a healthcare science practitioner/dosimetrist, with a degree integrated into a fulltime job, was an amazing opportunity to start a rewarding career after finishing my A-Levels.

“The apprenticeship includes working full-time with one day a week to catch up on university work such as online lectures, further study and completing assignments.

“I am lucky to be around a wealth of knowledge as I am able to collaborate with a range of different roles including consultants, physicists, engineers and radiographers. This means that I always have the best people around to assist in my training and allow me to learn from experts.”

In November last year, we opened the SaTH Education, Research and Improvement Institute (SERII), a new teaching facility, based at RSH.

SERII 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.

In our next edition we will be focusing on:

• Transforming emergency care

• Futureproofing our hospitals

• Improving our cancer performance

• Creating a great place to work