I have been struck this week by a couple of things in particular that I want to explore here in the blog. I’d be interested in your views and feedback, your own experience and, perhaps most importantly, what you think we can do.
The first question is focused on patient experience and how we strive to not only provide effective and timely health care, especially through the winter months, but continually improve it too.
The second is how we ensure colleagues across all settings and services also feel cared for, valued and supported. That we don’t deliver patient care at the excessive personal cost of colleagues is no less important – and getting that balance right is critical to our success.
Let me share a couple of things connected to this.
On Monday I saw a message from a retired GP who had come into A&E at Royal Blackburn with a 97-year-old man and described a poor and frustrating experience, including patients being cared for on the corridor.
It was clear he had a good understanding of the issues we are trying to manage and we responded to share how we have seen extremely high and consistently escalating numbers of people attending A&E, creating congestion, long waits to be seen and a lack of clinical space which leads to the last resort of corridor care.
Of course, no explanation will detract from this man’s experience, how he felt or what he thought whilst he was here.
I assured him that the team in A&E, colleagues on all wards and in the community were working hard to care for people as a team and within a system which values dignity and respect no matter who, what or where. I explained that we have an Urgent and Emergency Care Improvement Plan and how we are focused on doing our best for every patient, every day, in what are challenging circumstances for everyone.
I wanted him to recognise that this isn’t a local issue or a case of ELHT not being good enough or that colleagues could somehow do more. NHS England recently published details of a ‘record summer’ of demand in urgent and emergency care, with September being the busiest with four per cent more patients compared to last year. In ELHT this is about 72 extra people than usual in the department every day.
NHS England also carried out a mid-year review of the Trust and acknowledged our performance on delivering planned operations and treatment as well as responding to patients who attend A&E. This review also recognised the Trust’s positive performance on seeing people
within four hours of arriving and our commitment to reducing the number who wait 12 hours to be admitted and may be cared for on the corridor when demand is high.
Still, no matter the reasons or rationale, the hard work or focus to improve, we must not shy away from the fact that the experience for patients and colleagues remains unchanged and this is what keeps me and lots of others awake at night.
To this point, I had some feedback from colleagues on Tuesday as part of a regular weekly update, where questions and comments can be posted anonymously in the chat box.
One shared they were worried about maintaining the quality of our services and delivering ‘everything else’ – and that just trying to achieve this was damaging health, well-being and morale. This sparked a wider debate about how everything from financial pressures, data, league tables, grip and control – anything that doesn’t tangibly feel ‘hands on’ with patients – was creating extra pressure and leading some to ‘breaking point’.
I want to acknowledge this here as I did in the session and say thank you for the candid feedback and questions, but it’s important I am equally clear that we will continue to be held to account on the quality of care we deliver to our patients but also our performance and our financial position. There is no alternative and only by working as a team will we reduce the weight of the burden. There is no one person who could solve this on their own and the solution includes both colleagues and patients.
Please, if you are a local resident, help us by acting responsibility and only attending A&E or any of our urgent and emergency centres if you have a genuinely urgent or emergency health issue. You can check the right place for you here. Don’t contribute to the poor experience of others by attending for anything less or something that could be managed elsewhere.
Another comment raised in the same briefing talked about the influence of politics on the NHS and it was interesting on Wednesday to see the Secretary of State for Health and Social Care Wes Streeting and the Chief Executive of NHS England Sir Jim Mackey talking in the media.
Both admitted that, despite preparing more thoroughly for winter than ever before, it was likely the NHS as a whole would struggle and perhaps even become ‘overwhelmed’.
In the same article they described how colleagues, especially those in A&E, were experiencing growing levels of harassment, aggression and violence when care gets delayed. They shared their concerns for the coming weeks when flu, Covid and the planned industrial action by resident doctors would make things very difficult indeed.
I have no doubt we will continue to see tremendous pressure across the Trust met with an equal amount of hard work and determination to manage it, but the impact on patients and colleagues will be a huge worry too. Please do not let emotions overwhelm you and remain calm and respectful to everyone, even when moments of concern or anxiety naturally flare.
Safe to say, we will continue to ask ourselves what more we can do and how we can work differently to improve experience in our settings every day – please provide your feedback to help us understand what it feels like for you.
In the meantime, we are here and doing our best for all patients and their families and we have health and well-being support in place for colleagues too. Please, reach out and ask for care if you need it.
We have so many fantastic people at the Trust who turn in more than just a shift every day and do whatever it takes, often with little thought for themselves or their own families at home.
I think we need to be mindful of our personal resilience and vulnerabilities but also our individual responsibility to think of others, to care for them and do what we can to help. That goes for patients, colleagues, families and partners.
Only by working together will we improve things and ensure everyone feels cared for, supported and valued, whoever they are.
Martin