Objectives

We have published our objectives for the next two years following workshops with some of the teams and a great ‘BHT Way’ session we held with many of you at the end of April. These are the priorities you and the Board have agreed to focus on as we pursue our journey from CQC-rated ‘good’ to ‘outstanding’ and the safest healthcare system in the country.

We continue to focus on goals that meet the triple aims of improving our quality, people and money and setting as a priority a small number of important objectives that together would meet these. We felt it was important to do fewer things, and do them really well, so it was an interesting experience persuading the Board to agree only three! These are:

Improving our culture. I am convinced that this is the building block of getting to greatness and there are many things that go into this. Using patients to co-produce service change; making it easy to ‘get things done’ in the organisation; all staff being able to use Quality Improvement to make changes; and involving all staff in contributing to our financial challenge – these are all critical parts of building these improvements. I would especially draw your attention to the ‘Small Change, Big Difference’ campaign being led by Tina Kenny which is already starting to gain some momentum.

New solutions to workforce. Healthcare is a people business and we need to tackle the local shortages. We will do this through innovating new roles and building stronger multi-professional working, whilst also developing new partnerships in education and training. How we tackle inequalities in our workforce is also critically important: to represent our communities we must be inclusive and representative. Making this Trust a really great place to work is the other part of this puzzle, to support and enable our staff to be their best selves at work.

Tackling inequalities and variation. As the largest healthcare provider in the county, and its biggest employer, we must play our role in reducing the stark inequalities that exist between our communities. Alongside this we must look to tackle variation that happens in our clinical services and support this by developing clear strategies for dealing with moving us forward digitally, whilst ensuring our buildings are fit for future use. Our next BHT Way is designed to help us explore this objective together in more detail.

So, a bit to do! I find these goals exciting and hope you all can get behind them. I am looking forward to seeing you as part of my forthcoming all-staff sessions in July, and discussing your team’s contribution to our Trust objectives and our organisation’s journey to ‘outstanding’.

As ever, do get in touch on the details below with any comments or questions.

Neil

07920 071 814

Neil.macdonald4@nhs.net

@NMacdonaldBHT

 

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Reflections

It’s the time of year when I have all the statutory accounts in front of me to sign: our financial and quality accounts and our annual report. These are compulsory reports where we tell the public how we have spent their money and how well we have looked after them. They are externally audited and a lot of work goes in to producing them, so my thanks to all involved who put significant hours in getting them ready. It seems fitting at this point to reflect on how 2018/19 has been.

In terms of the quality of care we provide, I only have admiration for what you have all achieved in the face of ever increasing demand for our services. Across the board we have seen improvements in how patients have rated us in their experience of care, and we know there are multiple examples where our outcomes are comparable with the best in the region and country. Reading back through my CEO reports to the Board over the year, there are countless examples of awards, recognition and outstanding practice; to achieve this in the face of the triple challenges of demand increases with workforce and financial restraints is all the more remarkable.

It’s a different picture on the money. We ended the year with a £31.6m deficit, which is significant. As a result, our regulators have altered our ‘segmentation’, meaning that we are now under a much greater degree of scrutiny and it is more important than ever that we meet our target this year. As well as keeping patients safe, we have a legal duty to ensure we make the best use of taxpayers’ money. There is more work to do here during the course of the year which I will talk about in a later blog; this is critical for us to get right if we are to raise the money to invest in our digital transformation and estate.

Like most places in the country, we still have significant challenges in finding and retaining the numbers of staff we need. This remains a high priority for the Board and we are starting to make some progress in tackling these issues. For example, I am delighted that we have agreed with Bucks New University the start of nurse training in Aylesbury from September – the first time nurses have been trained in this county for many years. Our staff engagement scores continue to increase – we are now well above average in many areas, with some pleasing improvements in developing a safety culture.

So in summary, there was much to be proud of last year, and there are some important areas of focus for the year ahead. We await the publication of our CQC reports in a few weeks. What we do know from their verbal feedback to us is that the culture of this organisation is compassionate and caring. To me that’s undoubtedly the most important thing.

As ever, do get in touch on the details below with any comments or questions.

Neil

07920 071814

neil.macdonald4@nhs.net

@NMacdonaldBHT

 

Building a climate of respect

Dear Colleague,

Towards the end of last year, colleagues and I recorded a video with some thoughts as to how we could strengthen a climate of respect in the organisation. You can watch it here: Building a Climate of Respect (7 minute video).

It is one of the NHS’s idiosyncrasies that it sees disproportionately much higher levels of workplace bullying than other sectors nationally. We at BHT are not immune to this; whilst we’ve made good progress in creating a more supportive culture, according to our staff survey 11% of you have witnessed bullying, harassment or abuse from a manager, and 16% by a fellow colleague. If you pause and think about it, these are extraordinary numbers. “Building a Climate of Respect” has been produced as a direct result of listening to your concerns and the feedback in our staff survey. We must all recognise the importance of respecting each other in the workplace now and in the future.

I am sure many of you have met Tracey Underhill, our Freedom to Speak Up Guardian (FTSUG). She does a fantastic job, and I am always happy to see that her work load is ever increasing. Just as trusts that report more incidents are safer, I’m sure trusts that ‘speak up’ more are better places to work (and therefore provide better patient care).  In fact, this is supported by evidence collated by the National Guardian Office, which shows an apparent correlation between how well staff are supported by managers and leaders to speak up and the trust’s overall Care Quality Commission ratings. If you haven’t met Tracey, involved her with your team or department, or if you have a concern that you are worried about sharing, then she will always be delighted to hear from you.  She has a wealth of expertise on what good and not so good practice looks like when managing relationships, teams and so forth.  You can contact her on 01296 316027 or via tracey.underhill@nhs.net .

There is also a new dedicated information resource guide for all staff in any role which has been developed to support you; it can be accessed here: Building A Climate of Respect Resource Guide. It contains useful information about how to identify, better manage and deal with the impact of bullying and poor behaviours that we know can sometimes arise. If you know of other helpful resources to share that can help us to further develop the guide then please let Tracey know.

The “Building a Climate of Respect” video sets out some expectations about what sort of behaviours should be expected in the Trust. Changing culture is never going to be something achieved overnight, but we have a collective responsibility to make this a great place to work. Perhaps the following are food for thought:

• People are much more likely to change behaviour through reward / praise rather than punishment / criticism.
• Try smiling and saying hello to a colleague you haven’t met before – you will be amazed at the impact this can have. Manners are just as important when speaking with colleagues as they are with our patients.
• Every now and then read back your emails to yourself – it is so easy due to time pressures to create a tone that is rushed and not as respectful as it could be.
• If people cannot do something, it is more than likely it is because they haven’t got the right training, tools or environment, not because they do not want to.

Imagine the collective change we could create if we all took the time to think about how we interacted with colleagues and made a small change.

As always, please get in touch with any thoughts or questions.

 

Neil

07920 071814

neil.macdonald4@nhs.net

@NMacdonaldBHT

Happy New Year!

Dear Colleague,

Happy New Year!

I hope that whatever you were doing you managed to spend some well-deserved restful time with family and friends. My thanks to all of you who were working over the holiday period.  It was great to see many of you celebrating together in your departmental teams; some spectacular feasts on display!

So what will 2019 bring? Here are some thoughts as to what might be coming our way.

Firstly, Brexit. No matter what your personal views, there is no doubt this will continue to dominate the political and economic agendas, and as the NHS is intrinsically linked to both of these, it will be really important for us to be prepared for all eventual scenarios. We received refreshed national guidance just before Christmas and many of you will be working hard to ensure we have everything in place. A Brexit contingency group chaired by the Chief Operating Officer, Natalie Fox, has been established to lead and coordinate activities, working with partners across the county. We have been running workshops to support all our EU staff (8% of our workforce) and will be supporting all settled status costs – if there are any questions about any of this please do not hesitate to get in touch.

The NHS Long Term Plan was delayed in publication, but should be coming out in early January. This will outline the priorities for the NHS over the next 10 years off the back of increased funding (3.4% growth over the next five years) announced by the government last summer. Following its publication, we as a Trust will look at how we align our priorities to those outlined in this national plan. These are likely to focus (but not exclusively!) on the following:

• Frailty, with investment in community-based integrated services
• Faster adoption of technology, especially in outpatients, such as electronic records and telephone/video conferencing appointments
• Solving the healthcare workforce gaps i.e. looking at ways we can attract and train more people to come and work for the health service
• Prevention – helping people to stay fit and healthy and prevent them from becoming ill in the first place – something the NHS lags behind on compared with developed healthcare systems in other parts of the world

Finally, over the next three months we will be setting our organisational plan for the next year and beyond. In parallel with our ongoing road to financial recovery, we will be looking to continue to develop the Trust as a great place to work; supporting innovation to enable us to continue to meet rising demand; and making significant headway in plans for the upgrade of both our digital and building infrastructure.

Plenty of challenges and plenty to be excited about. I look forward to doing it all with you and to seeing lots of you in the coming weeks at the all-staff sessions. As ever, do get in touch on the details below with any comments or questions.

Neil

07920 071 814
Neil.macdonald4@nhs.net
@NMacdonaldBHT

The CQC is coming!

Dear Colleague,

It’s been nearly three years since they were last here, so we are overdue a formal inspection – although we do see them every 3 months or so to update them on where we are. Some of you have also presented to them at these sessions so they have a fair idea of our successes and challenges over recent months.

It is likely they will be here at the start of February. This is undoubtedly one of our more demanding times of the year – don’t worry, they are assessing on us how we care for our patients in a range of different circumstances, not on how busy we are. There will be an announced inspection on any number of our core services (which cover almost all the things we do) followed by an unannounced inspection at a date shortly afterwards.

Four messages from me:

1. Often their judgements are not directly about the care provided, but the evidence we record  that proves how we monitor this care. They have asked for a huge amount of information. A big ‘thank you’ from me to all who were involved in pulling this together – it was a massive amount of work at short notice. We will continue to get these requests over the next few weeks, so if someone asks you for some information in this regard, please do all you can to support them.
2. One of the most important bits of feedback we can give is what you, our staff, think about the care we provide. Everyone who wants to talk to the CQC will be given the opportunity to do so– look out for the messages inviting you to attend focus groups over the coming weeks. The more of you who get involved, the better informed the inspectors will be.
3. Sometimes it is the attention to detail that can let us down. All the work we do to showcase our fantastic care can be let down if we don’t get the basics right. For example, if we don’t fill in documentation properly or miss following agreed policies. Don’t let this catch you out!
4. Finally – I’ve visited a number of Trusts since taking over, and I have no doubt that we provide comparable care to those organisations with much higher ratings. A lot of what we do is genuinely outstanding. This is a fantastic opportunity to showcase our people and our services, and as a result attract more great people to work here – seize the opportunity!

I am really looking forward to the process as I know we’ll show the CQC why we’re proud to be BHT. If you want to get in touch to share thoughts or get involved, you can contact me as always on the details below.

Neil

07920 071 814
Neil.macdonald4@nhs.net
@NMacdonaldBHT

Our financial position

I am sorry there has been a gap of a few weeks in between my blogs. Since September we have launched the monthly CEO Brief and made it open to all staff. It has been great to see so many of you there – please come along if you can. They are also filmed so you can catch up here: CEO brief videos

I would like to update you around our financial position – which is not where it needs to be. There are a number of reasons for this: increasing demand on our services; the volume of medications we are using; our backlog of maintenance in estates; and the number of temporary staff we are having to use, amongst others. The Trust’s historic debts and borrowings also cause us financial pressures, as do our PFIs – the buildings which are run on our behalf by private companies.

It is without doubt that we have a far greater challenge this year than in previous years, and will require all your help to fix it. I would urge you all to be aware of this and take this into account as you deliver your services. Remember, as well as providing safe and compassionate care we also have a duty to look after taxpayers’ money and spend it wisely.

I am, however, actively seeking to change the tone about how we talk about our finances. When we reflect on messages about money, to date (and probably every year we’ve been talking about the issue) they are almost entirely negative in tone – ‘keep within budget’, ‘don’t spend on this’, ‘we can’t afford that’ and so on. It is right that we have to manage our money properly, but I believe that people are motivated by reward and positive change far more than by restrictions and central control.

As we go into next year I would therefore like to discuss with you, and ask you all to think about, how we can change this. We will definitely be thinking about incentives and how we can use good financial management, or more efficient ways of working, to provide reward and investment for staff and patients at department level, so we can directly link good practice to improvements in patient care and staff wellbeing.

If you have any ideas around this, please get in touch with me directly. This is critical to creating a culture where success breeds success.

Finally, I leave you with the example of Kelly, one of our domestics from our Brookside clinic, whom I met last week. If the non-clinical waste bins in her area aren’t more than half full, she deliberately empties them without always changing the bin liner, because she is conscious of the cost of replacing these. It is small steps such as this that together will achieve the bigger goal of financial stability as well as better care for our patients.

As always, it would be great to hear from you.

 

Neil

07920 071 814

Neil.macdonald4@nhs.net

@NMacdonaldBHT

Dealing with current and future gaps in our nursing workforce

Dear Colleague,

I hope you are all well and, where possible, enjoying the summer weather and trying to get some time off. This unusually hot summer has put some additional stress on us in terms of demand for our services. Some parts of the Trust are also really challenging to keep cool; I’m really grateful for all you have done to look after each other and our patients.

I set out in my opening blog a set of priorities, one of which focused on a desire to ensure we were able to deal with the current and future gaps in the nursing workforce. That is not to say by any means that vacancies in other professions don’t cause us significant challenges, but the nursing workforce is by far the largest body of staff. Future projections for those entering nurse training nationally are worrying. We don’t have the number of nurses we would like at this moment, and with 1 in 9 posts vacant in England, this is unlikely to resolve quickly. So how do we adapt for a world where there aren’t enough nurses and we know that more qualified nurses = better patient outcomes?

My personal thoughts as to what we need to focus on:

• How is this organisation a great place to be a nurse? Yes, being competitive on pay within the bounds of agenda for change is important, but what can we offer that is different? Access to different specialty rotations, opportunities for personal development, pathways into specialist roles and working for a Trust that has been recognised nationally for some of the innovative work we do here – we do good things, but we need to do more. Most importantly, how do we make nursing more enjoyable here: developing professional autonomy and an environment where nursing can thrive?
• We will have to get better at managing the future supply of nursing: this will involve working with numerous educational providers and developing partnerships that bring nursing education directly into the county and our own organisation.
• New roles – we need to accept that with not enough nurses coming through the universities we will need to look at different training routes (driven via apprenticeships) and the vocational training of higher banded support staff.
• Some of the solutions will come through redesigning the team structures that serve wards, departments or localities. This means looking at all the clinical and non clinical professions that will be needed to work together to provide the most appropriate care. This includes therapists, technicians, clerks, pharmacists and psychologists, for example, who will all have roles to play. It is critical that these teams are designed at ward / theatre / locality level involving all members of the multi-disciplinary team around the needs of our patients. Some areas, such as the National Spinal Injuries Centre, are already forging ahead with some innovative new models.

It’s a daunting problem but one which everyone is facing; and one for which I know we have the skills and experience to tackle together. Carolyn is leading this programme and will require all of your support: if you want to help and advise us on this journey please do get in touch, we want to hear from as many people as possible.

Once again, thank you for all that you do. Please do contact me if you want to discuss anything further; thanks to all of you that have already done so.

Neil
@NMacdonaldBHT
07920 071814
Neil.macdonald4@nhs.net