I think it’s an understatement to say there’s a lot happening right now. At a national level we have seen the recent publication of the 10 Year Health Plan (10YHP), an Urgent and Emergency Care Plan linked to this year’s winter planning process, a new national oversight framework and a redefinition of the role of Integrated Care Boards (ICB’s) as ‘strategic commissioners’. There have been two further important developments this week.
The first of these, received on Wednesday, from NHSEngland (NHSE) is a draft planning framework, that supports the implementation of the 10YHP. This will change the way we organise, deliver and fund clinical services in the future. For the first time it moves from an annual plan to a ‘medium term’ five-year plan with clear requirements of what is expected from provider organisations, ICB’s and the regional tier of NHSE.
It was, therefore, very timely that also on Wednesday senior leaders from across the organisation came together for an important session to begin planning our future strategy. This is actually a requirement of the draft planning framework so, in a sense, ‘we are ahead of the game’.
We’re at a pivotal point. A number of our current strategies are due for a refresh but, as outlined above, with key changes to the healthcare system in Lancashire and South Cumbria, as well as the changes nationally, we’re operating in a very different landscape than when our strategies were first developed. This makes it the perfect time to review everything and set a new course.
Before we looked ahead, we took a moment to reflect on everything we have accomplished since our last strategy was published. The progress is considerable and it’s easy to overlook what’s been delivered when we are so busy. But the truth is we’ve done a phenomenal amount of work over the last five years.
Specific examples are the continued recognition of the quality of our maternity services, which are rated among the best in the country for patient experience; the phenomenal development of our community services which have made us one of the largest community health providers in the North West; our theatre utilisation programmes that were named the best in England earlier this year and our King’s Trust programme which has seen an incredible 150 young people being offered employment through our ‘Get into Hospital’ programme.
There was recognition of the improvement culture and practice, which now underpins everything we do, and of the behaviour framework which is strengthening our people activity. I saw a great example of this when I visited the Emergency Department (ED) ‘improvement wall’ this morning, which detailed progress against a whole range of quality, performance, financial and workforce indicators.
There were so many examples of achievements I couldn’t even try to mention them all, needless to say your efforts have made an enormous difference. Thank you for everything you do.
One thing that really shone through was our unique ‘ELHT people’ and how no matter what we faced as an organisation, we pull together and put a plan in place. We don’t shy away from challenges, we learn, we improve and we deliver. This is certainly the case as we continue to make progress with our financial turnaround plan and are starting to see the impact of your efforts in this area.
We are spending less, particularly in areas like pay - there are some really good things happening here to reduce our use of agency staff, which is 45% lower than this time last year. And we achieved our July savings target of £4.2m. This is testament to everyone’s hard work and I’m incredibly grateful for your commitment, your suggestions and the sheer volume of work taking place to deliver this. In terms of non-pay, there are still improvements we need to make and we will be looking at what else we can do in this area. We are, however, doing the right things and this is being shown in various measures and metrics, but we need to further increase the pace of this delivery.
The second development this week, very much part of the new national oversight framework, is the ‘renewed’ focus on the delivery of key operational performance targets. We are seeing a greater emphasis on data, with league tables of hospital performance currently being created that will be publicly published on a quarterly basis . This will undoubtedly result in considerable amounts of interest from the media, nationally and locally, and from the populations and patients we serve. The likely date for the publication for the first set of league table is September. As a precursor to this , on Monday we received the first of a new weekly overview of operational performance targets linked to specific elective targets and urgent and emergency care, which are also a barometer of the quality of services we provide to our patients. As well as absolute performance we were told where we ‘ranked’ against the other NHS Provider Trusts in England.
In terms of urgent and emergency care, we rated well for the four-hour standard and were listed in the top 20 trusts. It’s a different picture for patients waiting over 12 hours in the department, which is something that we are all conscious of and are working hard to address, again using our improvement methodology. We need to redouble our efforts to improve in this area, particularly in advance of winter as nobody wants to see any patient experiencing a long wait in A&E. Again, I saw good evidence of this in my visit to ED this morning.
On electives, there are two metrics of particular focus and again there was a mixed picture for ourselves. I do recognise, given the sizeable populations we serve, with areas of deprivation, we do have a lot of demand on our elective waiting list. Nevertheless, we are currently ranked ‘mid-table’ for patients on our waiting list for over 52 weeks and of course as we’ve reported previously, we have no patients waiting over 65 weeks.
We are waiting to see how this all translates in the new quarterly league tables. What we do know is that our starting point will be in the bottom quintile, and this is no reflection on the quality of our services or our performances, but purely down to the financial situation we are facing, as any trust in financial turnaround will automatically be placed in segment 5.
Whatever we may think personally about the value of league tables and ratings, and these were very prevalent in the early 2000’s, they are going to be very visible over the next few years.
Returning to the requirements of the draft planning framework and the session held with Senior Leadership Group on Wednesday, it was apparent that one of our greatest strengths as an organisation is that everyone is able to clearly articulate who we are and our vision to deliver safe, personal and effective care. It is something that is embedded in everything we do and we want our strategy to be just as well versed.
Now more than ever we need that same shared understanding of our future direction and what we are trying to achieve.
That’s why we are moving towards bringing all our key strategies together into one concise, unified document that clearly sets out our future priorities. We want to create a single, clear strategy that everyone can get behind.
Our conversation with senior leaders this week was the starting point and we will be engaging with all of you as this is developed. We want this to be something that everyone not only has a part in creating but something that acts as a reminder of our purpose and aims, and most importantly inspires people to want to work here and make a difference.
We’ll share more with you as this develops – in the meantime, thank you for everything you are doing each and every day
Martin