This week colleagues in the Trust have been exploring the notion of a ‘compelling narrative’, which I accept sounds like a whole load of management jargon – but in truth I think just means we’re trying to make sense of everything we are dealing with and how we’re going to work through it and ultimately deliver it as a team.
When I say ‘team’ I want to start with a reminder that ELHT is one of the largest organisations in East Lancashire and we all have a part to play in our success.
This includes, of course, every single person working for the Trust across all services and settings. In hospital, in our community teams and in our support and development functions, including everyone who has recently become part of our Lancashire and South Cumbria-wide corporate engine room, One LSC.
I often hear colleagues talk about ‘the Trust’ as an ethereal being that is disconnected from them somehow and when pressed they feel this term refers only to a small group of senior managers, myself clearly one. But for us to succeed we must recognise we are all part of the Trust – we are the Trust – and we must each play our part in running it with personal responsibility for what we do. Every action, every reaction, every decision by everyone is critical to our future success.
In addition, of course, we include everyone who works directly with us too – partners in the wider health and social care system, including the North West Ambulance Service, the Integrated Care Board, neighbouring NHS providers and primary care colleagues, officers and elected representatives in local and national Government. It is a stark reality that people often don’t differentiate between what is done where or by whom when they access services and so just the simple act of working together is key.
Most importantly our patients, their families and carers and those who represent them in the Trust such as the Patient Participatory Panel (PPP) or Healthwatch are a key part of the team too. The push-me-pull-you nature of health care requires everyone to engage, share information and be accountable for their own actions and behaviours. Positive communication, including feedback and listening, is two-way and we need to understand experiences to learn and improve.
When people are working through challenges or issues they also often suggest that the answer does not lie in the human tendency to look back at what has happened or, indeed, ‘gone wrong’ – instead advocating acceptance and a focus on what needs to be done. I agree with this, but with a caveat that history provides a vital lesson in understanding and ensuring similar mistakes are recognised and avoided. There are important elements of ELHT’s past that contribute not just to who we are but how we got here too.
Firstly, to this point, let me reference our immense response to the Covid pandemic and also the aftermath where huge amounts of energy and expertise were expended trying to catch up, get back on track and progress. As any colleague in the NHS will tell you, it’s often not that easy with emotions and trauma in play and I know lots of people who feel they were personally changed forever from the experience.
Another talismatic episode which remains material to our thinking today was when ELHT was placed in special measures by the Care Quality Commission (CQC) in 2013 after Sir Bruce Keogh, the national medical director at the time, reviewed a group of Trusts for the Government. ELHT was selected because we were seeing more deaths than expected, a clear warning sign for issues with the quality of care. I know colleagues reading this who were here at the time will remember the devastating impact and how it felt to hear we were failing patients. I was here, having joined in 2009, and I speak from my own experience when I say it was a tough and challenging time.
But of all the NHS organisations I have worked for over a very long career, I have never known one so determined to pick itself up, front up and face its issues to improve. What ensured over the days, weeks and months after was a lot of incredible hard work, personal and financial investment and a sheer determination to do and be better than we were. I remain proud to have been part of this response and the rapid improvements which followed. Within a year we were removed from special measures and a year after that in 2015 the Trust was officially rated as ‘good’.
It was really inspiring stuff from many people who remain part of the team today and please know I don’t share this information to rekindle difficult memories for anyone. More a reminder of the spirit of ELHT as we face the very different but equally challenging and inextricably linked issues of today.
The impact of the vast improvements that followed the Keogh Review and the global ask of healthcare during the Covid pandemic is that the Trust has grown hugely in size and cost and we simply cannot afford to continue as we are. It is going to take more energy, lots of expertise and a load of honesty to now tackle the conundrum of providing high quality services within our financial means.
On the back of the Keogh Review, ELHT adopted three words to inspire and guide improvements. Whether you’re a colleague, a patient or a visitor to any of our services you will see safe, personal and effective on everything from your appointment letter, to the walls of the waiting room to the label on your sandwich in the restaurant. It has become who we are and what we do and I believe remains so too, even though the issues are slightly different.
For me safe is a non-negotiable clinical guarantee that underpins our work through all services and settings in every moment of every day. I have said so many times that this is a red line for me and one that I simply will not cross. I am confident that each and every member of the team – both colleagues and patients – would not hesitate to agree.
Personal of course may be different for different people but I think there are two distinct elements of equal importance that apply.
The first is that patients and colleagues are treated with compassion, dignity and respect, always. This was summed up perfectly by the man sharing his patient story in last week’s blog when he said ‘my wife was treated as a person and not a diagnosis and we always knew what was happening and why’.
The second element of personal, however, feels like a gentle reminder to colleagues of their place as the beating heart of the Trust, it’s not something separate or intangible to what we are doing. ELHT is the sum of all our parts equally and all of us have to care for it for it to succeed.
This brings me to effective and it is here where I think our compelling narrative must now evolve the most. Once – and maybe still – this word was considered the second clinical bastion of patient and colleague safety at ELHT, another watchword for the importance of quality care.
But in 2024, moving into 2025 and beyond, effective has to stand for how we operate as an organisation including finance, sustainability and how services are run day to day. The simple fact for everyone is that we do not have unlimited budgets, we are spending significantly more than we have and we have to get this under control, quickly. We have to consider every action, every order and every time an opportunity arises to reduce how much we’re spending, because we cannot afford to continue as we are.
A huge part of this is to review and unpick how services have developed and grown and we must be open to reconfiguration that retains safe and personal but is more effective too. I am pleased that ELHT has a thriving improvement practice culture which has taken us this far and its time we put our faith in ourselves once again, as we did in 2013, to believe we can do this – together and quickly – as we did then.
I never forget or underestimate that eight out of 10 colleagues live in East Lancashire and this Trust is where we work but also where family, friends and neighbours come when they need health care support.
We are all taxpayers too, with a real stake in how ELHT operates, providing high quality safe care in a personal but cost effective way to ensure we protect this brilliant organisation for future generations, who will need our support and may want to work here too.
I think that is a compelling narrative and together I know we can all get behind it. Please do everything you can to help – ideas, feedback and suggestions welcome and, as always, I am hugely grateful for your support.
Martin