I’m back after a break – a combination of challenging times and an attempt to take at least a few hours off over a weekend! My last diary was back in January. It seems like an age ago, when managing our winter pressures was our daily priority

 

Difficult times

 

Winter went pretty well, thanks to the huge efforts we made internally to manage our flow and discharge processes, along with excellent support from community and commissioner colleagues. Our length of stay for patients admitted as emergencies is now two days less than a year ago, and this creates the bed capacity we need to manage new admissions in a timely manner

It has been a hard few months. Regulator pressure has been stifling at times, and some weeks we are reporting on the same issues to both regulators and commissioners. Reporting is important, of course, but in itself it does not improve care and it diverts a considerable amount of staff time from patient facing activities

 

It can be frustrating too when time has to be spent explaining how to interpret the data that we are being questioned on! I don’t think we have yet got the whole regulation / inspection process right?

 

 

 

 

Our Chair, Lord Hunt 

 

Our Chair, Lord Philip Hunt, finished this week. He has been an excellent chair for more than three years, and I have learned much from him. I am particularly proud of our joint commitment to running the Trust in an open and transparent manner. Phil moved our Board into public session, and we rarely have a private agenda. We are accessible to all through social media, we meet frequently with members of the public, and we speak freely about our challenges and our decision making with stakeholders, interested parties and the media

 

I have no doubt that openness is the right policy, but it can be a difficult one to adhere to in a culture where it is not the norm, particularly in an organisation with challenges. It can be interpreted as evidence of more red flags than there really are – twice now I have been told that the reason for concern is ‘there is too much noise around HEFT’, 

 

The Kennedy Review was a turning point

 

There was, of course, a lot of ‘noise’ around the release of the Kennedy review at the end of last year, but I think few would argue it was the right thing to do. We continue to work through the implications of Sir Ian’s findings, and will be doing so for some time to come, but opening up this very difficult matter has undoubtedly built trust and helped us, and many of those affected, move forwards in a different and better way

 

I have certainly made some different decisions as a result of the learning and insights in the report, and my team has too. And I know from speaking about this in other fora that his insights resonate strongly elsewhere in the service as well

 

A new approach to delivery

 

We have re-structured our senior teams this month. Nearly 4 years ago, when I took up post, the Trust had ambitions of global influence (!) Now, I am pleased to say, we are set up to deliver our obligations more locally. Perhaps the most innovative aspect is to make the Medical Director, Chief Nurse, and Deputy CEO jointly responsible for delivering performance and quality. It feels right because, after all, ‘operations’ is mostly about what doctors and nurses do. Also, it mirrors at Board level the set up we have in directorates and divisions, of a doctor/nurse/manager trio

 

I think it is time to do away with the notion of clinicians having dual reporting lines of ‘operational’ and ‘professional’. They are one and the same thing, surely?

 

Our structure is also leaner, with fewer executive directors and much greater involvement with front line working. Transformation and operations are brought together, because that will be the main task in the coming years. Our experience over the winter was that it was the sense of engagement and common purpose that created the improvement during and following the ‘perfect week’ initiative, and this will be our way of working from now on

 

There is a sense of optimism in the teams that wasn’t present before. I think the time is right, and the set up and people are right now, and we will have a good year!

 

5 Year plans and the future

 

Finally, the topic of the year is going to be 5 year planning. At least, it should be because the challenge is a very large one indeed. All organisations must submit their plans by the end of June, but will they describe the future in a realistic and achievable way? I doubt it personally, and my guess is that there will be more iterations needed before they do. More to come on this topic from me!

 

This week we will hear from Simon Stevens at the NHS Confederation Conference, and I will be fascinated to see where he plans to take the service. The early snippets are promising and I am optimistic. I will report back!

 

 

 

 

Footnote:

I will aim to produce this diary fortnightly. In the meantime, do take a look at my – it is updated weekly and points to many fascinating insights and views