Thanks for all your feedback, messages and questions over the last few weeks about the myriad things that are going on across the Trust at the moment.
It’s always great to hear from colleagues, patients and their families and partners across the health and social care system about their experiences, including what we’re doing well and what could be better.
It’s a busy time operationally as ever but March brings additional pressure at the end of winter, delivering targets, closing down the budget from this year, preparing for the one ahead and, indeed, ensuring this is all based on firm and realistic planning for what we can achieve in the next 12 months too.
We’re always wrestling with keeping people informed without overwhelming them with information, remembering the most important thing in any healthcare organisation is simply caring for patients. It’s a balance though when we are talking about lots of changes and I recognise the thirst for details about what is happening, why and when, with a specific lens on the impact on things including services and jobs.
To this point, I was asked to give clarity on ‘what goes on in the background’ this week as part of a regular briefing to all colleagues called Teams Brief. In a Trust that employs around 10,000 people in core services, as well as around another 4,000 in what are called ‘hosted services’, it’s one of those questions that is very difficult to answer well.
Not least I don’t think anyone – including me – knows the totality of absolutely everything that goes on ‘in the background’ and the truth is that huge amounts of work is delivered across the organisation by all colleagues in all teams in all settings, every day and night, and we probably couldn’t list it all if we tried.
This is a difficult concept isn’t it, when we are trying to reform and reconfigure the way we do things to improve services and reduce costs and, within that, there will be processes and activity happening that we could deliver more efficiently, don’t need to do or can no longer afford.
Some of our endeavours are really easy for all to see, such as the activity in our urgent and emergency care pathways where hundreds of people come in for treatment, are visible in waiting rooms and across the department before leaving, often like the walking wounded with bandages and plaster highlighting the care received.
If you go onto our wards or into our health centres or community hubs for whatever reason, you will similarly see colleagues bustling around, seeing people and delivering treatment and care, often without a minute to pause or take a break. This week colleagues from the regulator the Care Quality Commission (CQC) have been visiting some of our community settings and I would like to thank everyone who has welcomed them and been open to sharing what we do and how we do it too. These visits are rightly unannounced so that the review team get a genuine feel for the quality of our services. We will get the results and share their findings with you in due course.
You can also take a seat outside Burnley General Teaching Hospital and see the results of our fantastic maternity services too, as proud parents take their bundles of joy home.
These are clearly a small number of examples of where the things we do are really clear, but there are undisputable hidden activities too and when I think of them the first thing that comes to mind is the huge amount of work delivered by our community services teams, often behind the closed doors of a patient’s own home or within a residential care setting.
There is a lot more though. When we consider the number of elective procedures carried out across all sites every day, there is a huge team both delivering the clinical activity and managing logistics in the background such as booking people in, making sure the right people and equipment is in the right place for hundreds of thousands of operations and appointments every year.
Here I will quickly pause and recognise the performance of the Trust on elective surgery after we hit our target once again to not have anyone waiting more than 65 weeks for treatment. I know, of course, this is still a long time when you are in pain or discomfort, but it is a really challenging target that demonstrates our commitment to getting waiting lists down and I want to recognise the hard work of everyone involved to achieve it.
I mentioned that we have achieved accreditation for our focus supporting people with endometriosis last week, but to add to that the Trust has also achieved its annual reaccreditation for endoscopy too, which is equally great news. Colleagues who reviewed the service asked me to congratulate the team for their hard work and high standards and I am more than happy to do so.
As always, there are too many teams to mention but I do try and share positive feedback as I receive it – so please let me know where you have updates or feedback you would like me to include, they’re welcome.
Here seems a good place to recognise our Deputy Chief Executive, Executive Medical Director and Consultant Urologist at the Trust, Jawad Husain, who is retiring. Jawad joined us in 2020, just as Covid emerged, and has been with us, providing leadership and expertise through the pandemic and many other challenges, including the implementation of our Electronic Patient Record, since. I joined the Clinical Leaders Forum this week where medical, nursing and Allied Health Professional colleagues thanked Jawad for his support.
I would like to add my own thank you to Jawad for everything he has contributed to ELHT, the NHS as a whole and the support he has given to colleagues and myself personally during his career.
It would be remiss of me not to add that Deputy Medical Director Shahid Islam will step in as Interim Medical Director, whilst we conclude a comprehensive, competitive and robust recruitment process to fill the role on a permanent basis in the next few weeks. Also a Consultant Urologist, Shahid has been with ELHT for many years and I am delighted he will help offer continuity and stability, especially to our medical colleagues.
I know some people have questioned the recruitment of this position and the salary of the post at a time when our financial position could not be more challenging and so it is useful to reiterate that the Trust has to have an Executive Medical Director on the Board and the salary is in line with the level of accountability and responsibility of the role.
Now, coming back to the question of ‘what is happening in the background’, I concluded that the enquirer was probably seeking to shed some light on activity within the corporate side of the Trust, which to many colleagues in patient-facing roles can seem hidden, remote even, at times.
I try and give updates about my own work openly and honestly as things happen week to week but I am sure people walk or drive past my office on their way in or out of site and wonder what really goes on in here.
I am particularly thinking of the financial position and our response to it, which I have spoken about in this blog and in other updates many times over many, many months, but I accept the stark reality of the challenge may still feel like a shock to some. For those who understand and accept it, the worry and concern of what we need to do now will be constant.
On this point, myself, the Chair of the Trust Shazad Sarwar and our Director of Finance Sam Simpson met with national and regional colleagues on Monday to discuss where our budget for 2024-25 will close at the end of March and our plans for the coming financial year which starts in April.
There has been a huge amount of work from everyone across all services and settings to think of ideas about how to reduce costs and where possible deliver them too. I want to thank people for their focus and energy to spend less. It is early days and there is much more to do – but we are seeing some improvements, which is great.
What we are doing in the background is working through every service, every budget line, every idea or suggestion, every bit of learning we have from other Trusts and colleagues who have delivered this before to understand where we could do things differently to reduce costs.
Colleagues and partners across the system know that this will undoubtedly result in some difficult proposals and some difficult decisions being made.
I want to say that whilst we are steadfastly committed to openness and transparency, there are myriad moving parts which can make sharing what is going on ‘in the background’ a challenge at times. Here I am thinking specifically of where team structures are affected and I make no apology for always prioritising individuals with information that impacts on them first.
If this feels, at times, like things have happened under the radar before being announced then I am sorry but would ask everyone – colleagues, patients, visitors and partners – to just bear with us and be patient as we manage some difficult issues as sensitively as we can.
For the NHS, there can be few more sensitive topics than our response to the pandemic and on Sunday the first UK Day of Reflection will take place in response to a recommendation from the UK Commission on Covid Commemoration.
It is difficult to believe that it is five years since the pandemic began and to mark this people will be encouraged to come together to remember and reflect. This is particularly poignant for those who lost loved ones but also for colleagues who worked through such a difficult and distressing time.
I have to say when we talk about ‘what goes on in the background’ there is so much emotion remaining that is connected to the Trust’s response to Covid. People carry it differently and deal with it in lots of ways, but it is there and it may never go away.
I know the anniversary and the inevitable media coverage around it over the coming days and weeks will be difficult for some to watch and, for many, remembering that time it isn’t something they want to do.
Nevertheless, I remain forever proud of how we supported our communities through the pandemic and the way we put ourselves on the line to care for others, but I do not underestimate the lasting effect it has had on colleagues either. If you are struggling, please reach out and access health and well being support or occupational health. We are here for you.
Lastly, to end on a positive, I want to give a shout out ahead of International Women’s Day tomorrow from a husband of a wonderful wife, a stepdad to a young woman who makes me proud every day and the Chief Executive of an amazing organisation which is overwhelmingly and brilliantly female.
Thanks for everything you do – visible, hidden, at home or at work – ELHT wouldn’t be everything it is without you and that’s the truth.
Enjoy the weekend when it comes and let’s hope the sunshine that is promised appears. If you’re working, keep smiling and remember if you’re doing your best, that is more than good enough and appreciated too.
Martin