My personal priorities

In my last blog I promised I would set out some personal priorities as CEO (in line with our existing strategy) that I have been talking through with the board and with some of you already – so here goes!

In no particular order of priority….

Developing a patient safety culture. We have really moved forward in the Trust in the 5 years I have been here about recognising and being open when we don’t get things right and sometimes cause risk to both patients and staff. But the absence of harm does not always mean the presence of safety. Our next stage is how we measure and celebrate safety and create a culture that supports learning – excellence reporting is a great example.

Getting things done. We need to make the organisation ‘work’ better and make it easier to do stuff  – rapidly spreading improvements, using quality improvement methodology to solve issues and move beyond ‘business case’ culture. This is reversing learned behaviours over some time, so we won’t always get it right, but we should call it out when it happens.

Making decision making more transparent. We should be continue to develop as an open organisation and publish how we make decisions, so you can all see and comment on the choices we make. You’ll see this start to come through the daily staff bulletins.

Transforming the nursing workforce. I’m sorry if you’re not a nurse and you feel aggrieved that I haven’t singled out your profession – but the nurses are our largest part workforce, and we haven’t got enough of them. We need to make this a great place to be a nurse, but also recognise we need to create ward and community teams that embrace different skills and professions to generate true team working – we all have a role to play in this.

Sustainability. Our largest collective challenge is the unsustainable growth in emergency demand, from both a financial and quality view. Through supporting primary care, strengthening our community services, and getting the patients to the right part of our hospitals quickly, we will solve this.

The patient voice. Do we hear it enough? Great organisations design service changes in partnership with patients, and get better results. The development of the community hubs is a great example of this.

I hope this gives a sense of my personal priorities, and what I will be focusing on: I’ll be discussing these further with you through a series of staff events in the coming weeks. Would be great to hear your views.


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CEO reflections on first week in post

[Blog post first published: 23 March 2018]

At the end of my first week as chief executive, I thought I would take the opportunity to share with you some of my early reflections on the role and how I want to approach it going forward.

Firstly, it’s really exciting and inspiring – I hope this feeling is one that I never get bored of or take for granted. The opportunity to be able to lead and shape an organisation for the benefits of our patients and staff is a privilege that was really brought home to me after I was appointed and I received ‘good luck’ wishes from many of you. BHT has tons of talented and dedicated people and, along with the rest of the executive team, to be able to serve you as a leader is an honour.

I also get the chance to work with external agencies and partners, all of whom bring an interesting set of perspectives and challenges to how we knit together as a health AND social care system. There are some really innovative changes being planned, especially in mental health and social care organisations, and we should be able to make substantial progress over the coming months in how we create a simpler and more responsive system for the local population.

It is widely recognised that there is no tougher time to be running healthcare organisations. You have put in significant numbers of extra hours; the demand for care has been relentless; and we have real challenges in recruiting the numbers of people we need. The statutory requirements of a chief executive are numerous and complex, but they can be basically distilled down to (a) keeping patients and staff safe and (b) sound financial stewardship. Being able to discharge these responsibilities is our collective challenge, and what makes the roles we do so demanding but ultimately rewarding. There will no doubt continue to be difficult decisions ahead of us: my personal mantra is that if these are made with the patient and staff put front and centre we won’t go too far wrong.

To succeed, all routes in my view lead back to how we support leadership and engage with our people – watch this space for plans for the rest of the year. Thankfully I have a fantastically supportive Chair and board, along with access to colleagues in my team, across the organisation and outside that I will be drawing on for their wisdom and experience at every opportunity.

Finally, when I walked through the door on Monday, in my new role, one of my strongest feelings was one of responsibility. This is my fifth year at the Trust; I know many of you and am proud to work for you as colleagues. I now, on behalf of the executive team and with oversight from the board, have the job of plotting this organisation’s strategic future through the myriad of challenges that will appear in the road ahead of us. There is nothing more important to me than continuing our onward journey towards being outstanding for our patients and the public in everything we do: to do so I’m going to need your help, and look forward to working with you all.

Thank you for reading this far and for your support over the past week. It is important to me that I listen to you, and that your experiences and suggestions continue to shape everything that we do. We’ll have ample opportunity to talk over the coming weeks and I’ll publish where and when shortly.

Neil Macdonald

Chief executive


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Raising concerns


My Latest vlog, which you can view above, arose out of a conversation with Trust chair Hattie Llewelyn-Davies where we were reflecting on the topic of raising concerns. This is a subject that has been of much discussion across the NHS over the past few years and, for us both, how comfortable staff feel to speak up is an important barometer of our culture and values. It is an open culture that welcomes bad news and supports staff to raise concerns that ensures we keep our patients safe.

So I’m pleased to be joined by Hattie and non-executive director Graeme Johnston to share our personal experiences of raising concerns. You will also hear from David Sines, our designated non-executive director for whistleblowing and Tracey Underhill, our new freedom to speak up guardian.

As you will see in this vlog, we understand that having the confidence to speak up isn’t easy, which is why it is important to us – and the rest of the Board – that our staff feel supported and enabled to talk about their concerns.

There are a number of different ways you can raise a concern in the Trust. In the first instance, please talk to your line manager or clinical lead, if this is not possible or you wish to raise your concern in confidence please contact our Freedom To speak Up Guardian – Tracey Underhill on her dedicated phone line 01296 316027 or 07768612590 or email

Alternatively, you can contact David our designated non executive director for raising concerns via email or any of our executive directors or refer to the Trust’s raising concerns policy which has been reviewed and is about to be re launched in September.

Please be assured you can speak up safely and I encourage you to do so in the interests of all our patients, staff and the quality of care we deliver.

What else have I been doing since my last blog:

  • Continued with the series of SDU strategy meetings, including plastics & burns and radiology, as well as my quarterly catch-up with SDU leads
  • Hattie and I met with representatives from NHS Improvement to review our operational performance. We also attended a meeting with the CEO and chair of East & North Herts NHS Trust to share what we are doing in Bucks and see if there are opportunities for shared learning
  • Work on moving to a Buckinghamshire accountable care system is progressing. I attended a meeting at the King’s Fund with Secretary of State for Health, Jeremy Hunt, and Simon Stevens, chief executive of NHS England, to discuss next steps and meet with representatives from the other 7 accountable care systems. On the same day, we were delighted to hear our bid for an additional £4.2m to improve our A&E facilities had been successful
  • Within Bucks, I chaired the ACS Board and we held a CEO and chair workshop with all Bucks ACS partners
  • I spent Feedback Friday with the community dietetics team
  • I met with the chief executive and chair of the Spinal Injuries Association
  • I welcomed our new intake of FY2 doctors at their induction, spoke to the latest cohort of our leadership pathway programme, and opened the integrated children and young people services’ celebration event
  • Caught up with Sir Andrew Morris, chief executive of Frimley Health NHS Foundation Trust.
  • Visited the clinical areas at Amersham Hospital and talked to the team about how we can address the staffing challenges in Waterside ward
  • Met with Chris Hopson, chief executive of NHS Providers
  • Welcomed Jim Mackey, chief executive of NHS Improvement, and his team – including the Prime Minister’s special advisor for health – to Wycombe Hospital where we were able to showcase cardiac, stroke, MuDAS and community hubs                                 visit group

But it’s not been all work and no play. I was invited to the High Sheriff of Buckingham’s summer reception and as you can see from the picture, had great fun at the National Spinal Injury Centre’s family fun day.


All that remains for me to say is to those of you taking a well-earned break over the summer I hope you relax and to those of you working, a very big thank you.


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Bringing the Accountable Care System to life

It’s been a hectic but successful few weeks since my last blog, with a particular highlight being the announcement of Buckinghamshire Healthcare NHS Trust as one of eight accountable care systems (ACS) in the country. I was proud to be able to talk about what this will mean for us at the Health & Care Show at the Excel Centre in London, Europe’s largest integrated health and social care event, building relationships between commissioners, providers and suppliers.

Lou Patten, accountable officer of our Clinical Commission Group, and  I led an accountable care system  joint working workshop which was attended by a cross-section of employees from Buckinghamshire Healthcare NHS Trust, Oxford Health NHS Foundation Trust, Aylesbury Vale  and Chiltern Clinical Commissioning Groups, Fedbucks  (a professional body representing GPs), Buckinghamshire County Council and South Central Ambulance Service. The purpose of the session was to develop shared working and accelerate our plans. It was great to see teams from across the system come together.

I was delighted to welcome Lou, and her deputy, to our executive management committee so that we could discuss how we can make it easier for teams from Buckinghamshire Healthcare NHS Trust and the Clinical Commissioning Groups to work together – vital as we become an accountable care system .  We have agreed to hold regular joint executive meetings – a clear case of taking a different approach to strengthen our working relationship.

Community hubs group

Accountable care systems are all about how we engage and serve our local communities and I was delighted to welcome more than 100 members of the public to our successful open day at our community hub in Marlow where we talked to them about the improvements we are making to healthcare in their local community.

Here are a few more highlights from the last couple of weeks.

  • Visited clinical areas at Wycombe, including the stroke ward, ward 8, the paediatric and neonatal areas and Loakes theatres. Staff were doing a great job trying to keep patients cool in extremely hot weather.
  • Attended the Quality Committee meeting at Stoke Mandeville Hospital, followed by a morning in the trauma theatre and the afternoon in the neonatal unit. Both teams were great examples of how every member of the team is valued and is of equal importance and the CARE values being displayed through our compassionate leadership.
  • Met with GE Health. This was an exploratory meeting to see how we can work with commercial partners to promote health information, increase patient involvement and develop new products.
  • Leaders from across the system attended a BHT Way event where we talked about the importance of our people and developed plans to improve staff engagement and shared best practice. Nicole Ferguson from Wrighton, Wigan & Leigh NHS Foundation Trust talked about her Trust’s experience in improving staff engagement and the lessons they have learnt.
  • Led the sexual health and stroke & neurology SDU strategy meetings.
  • Spent Feedback Friday in Children’s Therapies at Wycombe.
  • I, Carolyn Morrice, Tina Kenny and Liz Hollman met with regional Care Quality Commission Leads to discuss the progress we are making against our strategic priorities and our ambitions to move from requires improvement to outstanding. The Care Quality Commission told us about the changes to the current inspection regime.
  • Visited the Shaw clinic to meet with Jackie Sherrard and other members of the team. Significant progress has been made and Jackie’s leadership has made a significant difference.
  • Invited to attend an awards ceremony at Amersham School. I spoke to the young people and their parents who attended about the importance of resilience and being focused on your goals. I was also delighted to present awards to those who had achieved excellence.
  • Last week I spent time with A&E, Ward 10, Theatres, ICU, Labour Ward, Neonatal Unit, Ward 17, 16B, 8,9, 5,6,7,4 and Ward 3 at Stoke Mandeville Hospital to test staffing levels and see the challenges you face. As a result a briefing has been circulated to all clinical teams to address the issues that were raised and we will continue to monitor the situation.
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NHS staff continue to show their dedication

These last few weeks we have witnessed three horrific incidents in England. It is beyond comprehension what has happened and my thoughts are with those that were injured and the loved ones of those who lost family and friends in Manchester and London.

Amidst all of the sadness and chaos, it has been humbling to see and hear amazing stories of emergency services, including NHS staff, responding bravely and diligently, with little thought of themselves. Such as Kirsty Boden, a nurse at Guy’s Hospital, who died after stepping in to help others who had been attacked at London Bridge. Such as Dr Malik Ramadhan. He was cycling home after his shift at Royal London Hospital and rushed back after seeing police vehicles, instinctively knowing he would be needed. After the attacks, hospitals ended up turning away doctors, nurses and other staff who were volunteering to come in and help.

These events serve as a further reminder of the great work of NHS staff and it is important we all take the time to reflect and celebrate this. These incidents also highlight our responsibilities as a first responder in a major incident and emphasise the importance of having strong plans in place. The terror attacks remind us that we must continue to remain vigilant and be prepared. If you haven’t already, please take the time to look at the plans in place for your ward or department and discuss with your manager.

I love the NHS because it is all about people – the people who work in it and the people we serve – and that is what inspires and motivates me, so it is no surprise to see staff respond in this way. Yet, for me this also shows the quiet and steely determination NHS staff have – to look out for others and try to make things better.  And I see and hear this everyday within our organisation. I recently visited ward 3 and spoke to staff who were going to the funeral of a young boy who had been in their care for the past three years and supported him and his family over recent months. It is amazing the power and impact their care had and their bond with the family was so strong that they were insistent staff attended the funeral.

I am proud to work in an organisation that has so many dedicated and inspirational staff. For that, I would like to say thank you and continue doing what you are doing because you are making a significant difference to peoples’ lives.

What else I’ve been up to – some highlights from the past few weeks

  • Opened the ‘Better patient care through innovation’ event held at Wycombe Hospital. The event, a collaboration between the trust and Oxford Academic Health Science Network (AHSN), showcased the benefits of innovation and collaboration between universities, industry and the NHS.
  • I attended the ‘Personal, fair and diverse’ staff conference, looking at how we are improving and supporting staff, patients and visitors.
  • Interviewed for the director of OD and workforce transformation and I wish Bridget O’Kelly all the best in her new role.
  • Went to Buckingham with Tina Kenny to meet with a lead GP for the Buckingham locality, to discuss how we can support local GPs and develop services in the north of the country.
  • Led May’s team brief, providing an overview of the year ahead to staff.
  • Held public board, which included the presentation of awards to the recent winners of the CARE awards. This is always my favourite part of the meeting as I get to personally thank and congratulate staff who go to extraordinary lengths to deliver the Trust’s values.
  • Visited staff in the SHAW Clinic at Wycombe hospital (picture below) and heard about the great work they’ve been doing to improve staff engagement.


  • Met with Tracey Underhill who has recently been appointed at the new freedom to speak up guardian. Her main role is to support staff to in raising your concerns safely.
  • Continued to meet with anaesthetics and critical care, ENT, palliative care and acute and general medicine SDUs (picture below) as part of our work to support all services to develop local plans for the future.


  • Attended the quality committee.
  • Attended the Buckinghamshire, Oxfordshire and Berkshire West (BOB) STP executive board.
  • Chaired a session on maternity and developing local maternity systems at the NHS England South Central Medical conference.
  • Welcomed colleagues from the NHS Improvement clinical productivity team who came to talk to clinical and operational leads and the executive team about improving productivity.
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National recognition for Buckinghamshire – leading the way in integrating care

I am delighted to inform you that Buckinghamshire has been designated as one of eight Accountable Care Systems in the country by NHS England. BHT is a key partner in the system and this national recognition will put you on the map as leading the way in developing new models of care.

We have heard for some time from our patients, communities and staff that we need to do more to join up health and care services, making it easier for people to access the right care and support. We have begun that work by investing significantly in out-of-hospital care, working with GPs, social care and the voluntary sector to develop our community hubs pilots. We have teams of doctors, nurses, therapists, social care and paramedics working together to support older patients to remain independent and avoid a long stay in hospital. We are leading a collaborative with other musculoskeletal providers in the county to improve care and stop long delays in treatment. These are just some examples.

But we know there is further to go. For example as we work with primary care and mental health in A&E, or support GPs to provide more local diabetes care. And this isn’t just about making it easier for the people who use our services; fundamentally we also want to make it easier for staff – tackling IT, governance and all those other important parts of the job that are too hard or cumbersome to complete because of different systems and ways of working between organisations.

Becoming one of the first Accountable Care Systems in the country shows the commitment of all health and care organisations in Buckinghamshire to get this right. It provides greater freedom, investment, and added pace to implement our plans. For BHT, this is an exciting development as we strive towards our ambition of becoming one of the safest healthcare systems in the country.

Please read the update on our website to find out more.


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Great teams and great people

Last week Carolyn Morrice and I were honoured to represent the Trust at an awards ceremony in London where BHT was named as one of the top 40 trusts in the UK  by health intelligence specialists CHKS.

Awards CKHS_buckinghamshire_web

The award is a great reflection on the continuing improvements we are making in our progress towards becoming one of the safest healthcare systems in the country, and is another example of external recognition for your fantastic achievements in patient care and experience.

The guest speaker was explorer Sir Ranulph Fiennes and just a few days later his speech about evaluating the terrain ahead and embracing the unexpected came to mind as the NHS was caught up in the global cyber attack. Although relieved that we were not directly affected, I know that a lot of people spent significant time working over the weekend managing the situation and ensuring contingencies were in place. I want to say a huge thank you to you all.

These recent events have reinforced my view that we have great teams and great people working in the Trust – dedicated, compassionate and caring – and your commitment to our patients, service users and communities is humbling.

What else have I been up to:

  • The value of providing great care for the youngest in our community was reinforced to me when I shadowed Ellie Howard, a Health Visitor in Buckingham. The changing role of health visitors, providing a range of support and being the bridge between midwifery, school nursing and GPs was evident and it is important that we continue to support these teams to collaborate with each other
    Neil with health visitor Ellie_web
  • Whilst in Buckingham I visited the community hospital and staff told me that team morale was improving – something reflected across the Trust in the encouraging results from the recent staff survey – and they felt supported by the senior nursing staff on the wards Neil on inpatient ward at buckingham_web
  • I met with GPs to discuss how we can work more closely together and also participated in a workshop with colleagues from across Buckinghamshire to discuss how we can develop as an accountable care system
  • I attended the NHS Improvement’s Chief Executive Advisory Committee, presented the annual governance statement at the Trust’s Audit Committee, attended Quality Committee, and with the rest of the executive team we discussed our operational performance with NHSI at our regular oversight meeting
  • I met with cardiology, integrated therapies, paediatrics, oncology, respiratory medicine and haematology SDUs to discuss the development of their service strategies
  • I spent Feedback Friday with the cardiac and stroke teams at Wycombe Hospital where I saw the newly refurbished Hyper Acute Stroke Unit which was launched just last week and work was underway for the new catheter laboratory due to be ready in August
  • “We can and we will” was the message of the week when I met Belinda from the validation team for my “randomized coffee trial” meet-up. It was good to have the opportunity to chat and find out more about the team
  • I visited several clinical areas at Stoke Mandeville where, for example, colleagues on Ward 10 described SAFER work and its impact on length of stay
  • I visited the urology suite at Wycombe where the team have made good progress with the recruitment to new roles and its nursing teams
  • I, along with Neil Macdonald and non-executive director Graeme Johnston, represented the Trust at the Scannapeal 30th anniversary celebration event. Scannappeal has been a major supporter of the Trust since it was set up in 1987 raising over £12m to benefit and improve patient care.
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