Colleagues on the Trust Board met this week for a timely and useful update and discussion on two things that are inextricably linked within the NHS – money and activity.
Albeit a timely moment to consider both of these enormous challenges, the meeting had been in the diary for a while and this reflects that this time of year is generally busy closely managing the delivery and cost of services to the end of March and ensuring we’re prepped and ready to start the next as effectively as we can.
This year we must acknowledge that those dynamics include a new dimension to consider with the news the Trust, along with neighbouring organisations in Lancashire and South Cumbria, has been moved into segment four of the NHS Oversight Framework (NOF4). If you haven’t heard about this, it’s worth reading the blog from last week here, which I hope offers an explanation as to what NOF4 means and what will happen next.
I briefed colleagues as part of my usual Board update on a number of things which I think useful to share wider with colleagues, partners and local people too.
The first was a new version of the oversight framework which will come into force in April. NHS England colleagues said their aim is to streamline and simplify what is in place now and to recognise that every part of the health and social care system needs to deliver its bit equally for improvements and success to be achieved.
I am mindful of becoming immersed in internal NHS jargon and detailed governance arrangements here, so I will just say this.
In all frameworks current and future, the Trust will remain responsible for providing safe and high-quality services for local people and we are committed as a team across all settings and services to achieving this within our financial means.
It’s tough, no doubt. So let me give a few examples of where we’re pulling this off already and kudos to colleagues who quickly dusted themselves down following the NOF announcement and ran directly at the challenge in hand.
I was particularly inspired by an update from a team of community colleagues who frequently engage with care homes across Blackburn with Darwen and East Lancashire as part of their roles. As the story goes, one of the team is having a coffee and a chat with some care home managers which is more structured than it sounds and designed to exchange best practice, discuss issues and explore learning opportunities or improvements.
Within the session, one home shared that it had accumulated 30 blankets and other linens from ELHT in just a few weeks, when residents were discharged from a hospital stay.
This sparks an immediate thought. If one medium-sized care home has got 30 bits of linen in just a few weeks, how many more are out there in the community that we could get back?
It was so satisfying to hear the energy that followed with the team working with colleagues in laundry and logistics to retrieve nearly 600 items from 18 homes – working out there are probably more than 4,000 items to get in total which would be worth the best part of £25,000.
I have said this before, but this is the spirit of ELHT that I know and love. Thank you to everyone who was involved in this, just brilliant and cheered me up no end. There is no doubt in my kind that the route to improvement and progression out of NOF4 will require all colleagues in all settings and services to be alive to these opportunities and when they spot, act on them in just this way.
In a similar vein, I also heard from nursing colleagues this week who have been developing an Enhanced Care Support Team to help patients who, for a wide range of reasons, can become agitated or aggressive to the point of being restrained for their safety and that of the team or visitors.
Previously, colleagues would have called security to help but the specialist enhanced care team will now aim to provide a therapeutic way of deescalating, ensuring we’re caring for our most vulnerable patients as compassionately as we can, even amidst challenging behaviours.
Whilst this development is firmly rooted in the Trust’s commitment to providing safe, personal and effective care for everyone, it does also help to reduce costs by standing down extra security officers from the team, who will now only be called in once all other ward-based interventions have been exhausted and safety remains a concern.
It is true, of course, that there will always be people who struggle to manage their emotions and behaviours and colleagues may need security and, indeed, the Police – but enhanced care will now be our first point of call.
Please may I extend a huge thank you to all the teams who have been involved in this, which is such a great example of how we achieve higher standards of care and safely reduce costs. Most importantly patients and their loved ones will benefit enormously. Well done.
This topic brings me back to my update to the Board and some reflections I have already touched upon in relation to the impact on colleagues and morale of moving into NOF4. I have spoken about the positive reactions of some, but unfortunately there have also been a small number of negative examples too.
It is understandable and to some extend human nature that news like this will lead to heightened emotions, to upset and personal reflection and to the inevitable questions of why and how. If left unchecked, the narrative can develop unhelpfully into who is to blame and, where the issue is cost related, unhelpful and unfiltered suggestions about who and what could be cut.
I know this has upset a number of colleagues and I want to acknowledge that for the great majority this will not have been the intention. I don’t want to curtail debate, questions, comments or feedback but I ask that people remain respectful, within our values and behaviours as an organisation and consider how they would feel if a similar comment was made about them.
Lastly, I want to mention something that you may have seen in the news this week about our brilliant Alcohol Care Team, which will close in March when funding comes to an end.
Let me be really clear, ceasing the service is no reflection on the team, who have provided a valuable service seeing around 200 people every month who need their support, skill, energy and enthusiasm.
They have helped us to discharge people appropriately, given medication guidance and withdrawal treatment for patients who are dependent on alcohol and, put simply, have made a huge difference to the lives of thousands of vulnerable people. Such is their professionalism and dedication, the team are developing a refreshed e-learning package for colleagues and face-to-face training before they finish.
I want to say a huge thank you to everyone who has been a part of this team over the last three years. My hope is that we are able to find alternative roles with the Trust and keep you in ELHT to continue to make a difference to those in need.
As I said to the Board on Wednesday, we have made some difficult decisions and there are more to come. It is incumbent on us to get on and deliver, of course, but in a way that feels right for ELHT. I am determined we will hold onto our values and do the right thing in the right way, always, even when it is very hard indeed.
Martin