CEO Blog - Working together through the winter pressures

If you follow any kind of traditional news outlets or wider social media channels you’ll recognise that it’s an unusual day if the NHS does not feature for some reason in some way – and this includes everything from high level policy changes from the Government, deals with the President of America on drug tariffs or the performance and challenges of your own health services closer to home.

My personal opinion is that this level of scrutiny is right and proper for a national institution which plays such a critical role not just in public life, but in the quality and enjoyment of it for so many people too.

I am someone who believes the NHS is one of our biggest achievements as a nation but would accept just as readily that it represents a huge challenge for us too, as we seek to do more and more but for less and quicker where we can. The NHS clearly also consumes a huge proportion of tax and other public money and so it must follow that how we perform clinically and operationally, how we spend budgets and on what, why and for who, is something that everyone should be able to understand and influence.

There are some things that bother me though when I weigh the headlines with the reality for colleagues in all settings and services, both within our hospitals and in the community too.

The biggest is the narrative around pressure and demand for services and how we are managing this as a team, particularly in relation to urgent and emergency care which, for us, centres on the A&E department at Royal Blackburn Teaching Hospital. You will recognise without any additional context that this is an area of the Trust which keeps me awake most nights, is always beyond busy and continues to experience high and rising numbers of patients coming in for care and treatment every day.

I have spoken openly about these challenges and indeed apologised to both patients and their families and colleagues across ELHT previously for the impact it has on their experience of care or work. Overcrowded areas with large numbers of people are not ideal scenarios when you’re feeling poorly or trying to provide high quality and safe care – and the long waits to be seen or admitted that can follow are even worse.

The narrative around this can often vary depending on the day, the time of year, the reporter or media outlet itself or, especially, the experience of the patient or the outcome of their care. We see and hear every possible reason for why things are not better, including poor management of the department or Trust as a whole, political decision making from the current or previous Government and even that patients themselves who come in with what others perceive to be silly or low level concerns are at fault.

My view is that the truth probably lies somewhere between them all, but I won’t argue each one now in a blog that has often been described as too long.

However, I will say this.

The team in A&E, the emergency department itself and across urgent and emergency care pathways in Blackburn, Burnley, Accrington and Rossendale are doing everything they can to help as quickly as they can. This is true and the narrative that somehow this is not good enough really needs to stop. This situation is not of the making of colleagues and whilst we continue to question and test ideas to improve every day, the answer lies in a change in society and huge transformation that isn’t within their gift to achieve.

Last weekend was particularly challenging as the meteorological start of winter and beginning of the festive season arrived in one go, resulting in the highest numbers of patients I have ever seen in my 17 years with the Trust.

This led to a very busy department which quickly burst out of its physical clinical area and into the hospital corridor, with patients being cared for in an environment that nobody wants them to be in.

I want to be clear that whilst these arrangements were implemented as an extreme response, we have processes in place to care for patients in these temporary areas effectively. I cannot stress enough either that this is the penultimate action in a long list which ends with us simply closing the doors and turning people away. We couldn’t and wouldn’t ever do this, of course.

What happens instead is that the team works beyond reasonable limits at these times to stretch themselves to care for others. In no way is corridor provision anyone’s fault or in place because someone did anything wrong or should have done something but didn’t. Everyone is working incredibly hard in very difficult circumstances and it’s true that every member of the team wishes it was different each time it occurs.

Beyond A&E, ED or our urgent treatment or walk in centres please know that everyone on every ward and in every community team is also working flat out to support colleagues and patients. This week we have enacted our surge and super-surge protocols, which means extra patients are added into wards to help reduce the need for corridor provision in A&E and get patients where they need to be.

Doctors and nurses from all specialities and departments are constantly doing more – and everyone is moving around all the time to cover and add expertise and energy where they can.

In addition, myriad teams across the community including district nurses, therapists and health care specialists are caring for more people in their own homes or care settings to prevent as many patients as possible from even needing to come into hospital in the first place. They do an amazing, first class job too which rarely makes the news – but I can testify that the impact of their work is huge and could not be more important or critical.

The sum of all of this is a team working under huge pressure, across a massive geographical area, supporting hundreds of thousands of people and doing everything they can, often to their own detriment.

To all colleagues I want to say thank you and share how very proud I am of everything we are achieving despite the odds. Please keep going and know that your best is always good enough, for me and our patients and their families.

As we enter Christmas-time in earnest over the next couple of days remember it is OK to pause and take in some of the things we are doing to recognise people, bring some festive cheer and brighten things up for colleagues and patients as is traditional at this time of year. We’re all human and no one can pour from a completely empty cup.  

I will also be out and about over the coming weeks to see as many people as I can and say hello. It would be remiss of me in closing not to say also that we are welcoming a new Chair to the Trust today in Mike Thomas, who I know will be keen to get out and experience ELHT for himself too.

Of course, he will find challenges, things that might be better and have ideas about how we can improve, but I am confident he will also find positive practice and a great many brilliant people ready and willing to help.

This is the spirit of ELHT that shines so brightly, particularly at this time of year, and I am so grateful to be a part of the team.

Martin