I have spoken recently, a number of times, about the significant financial challenges facing the Trust and, indeed, the wider NHS nationally and at Lancashire and South Cumbria Integrated Care Board (ICB).
I make no apology for continuing to raise this important area, which will be a difficult and complex challenge for everyone at East Lancashire Hospitals to deliver in 2023-24.
Within that context I want to focus on two things though.
The first is that, of course, whilst the cost improvements are huge they can neither be considered or achieved in isolation and reducing our spending in line with the budget we have been given is only one part of the challenge.
The other more important elements are to retain the current quality of services and improve them at the same time.
This balance is the ultimate sum of our goals this year and I want to harness our energy and enthusiasm into the opportunity to do better and to be better across all modalities – just in a way that costs less.
This approach is really no stranger to anyone at ELHT, where we practice and encourage continuous improvement and growth across all our teams, settings and services all the time.
But, nevertheless, the total ask is of the magnitude we have not tackled before and, even with great people, skill and determination, it won’t be easy to do.
This is where the second element comes in and that is to overtly quantify that no matter how hard it gets I am determined we won’t use the lack of money as an excuse not to deliver or do things we need to do.
That’s not to say we’ll get everything right, that we’ll be able to do everything we’ve done in the past with the reduced budgets of the future or that we won’t make changes across the Trust as we aim to transform – but when things fall short, I don’t want to hear it was the money’s fault.
We remain able to consider options and make decisions, after we have weighed the consequences for our colleagues and our community.
I genuinely believe there are always things we can do and that the need to reduce costs is no reason to accept poor quality, a reduction in patient safety, forgetting the basics or, most importantly, how we treat and speak to people. I will simply never accept that a lack of money excuses incivility between colleagues, patients, families or a combination of the three.
ELHT prides itself on having open and honest conversations, a ‘just’ culture and positive relationships that are fundamental to our success, but psychological studies show that when the pressure is on and demand for services piles up, poor behaviour creeps in.
I have said before that I receive a great deal of positive comments and compliments from colleagues and also patients and their families with details about exemplary care and compassion in all teams.
I do also receive feedback and complaints where the experience hasn’t been as good and the real challenge, for me, is to triangulate what is really going on and take action that’s proportionate and fair.
During a meeting of the Trust Board on Wednesday we heard from a man who shared a message about his father and his treatment both in and out of hospital. I want to say first and foremost how brave it was for this man to share details of his dad and how he had clearly been let down a number of times and in different ways. It was remarked upon by a colleague how clear it was just how close the family was and how much the man cared for his dad.
It was heart breaking to hear we didn’t prioritise his procedure or recognise he was non-verbal and in pain or that we discharged him to a nursing home without telling them.
All of these – and the other issues he described – were completely avoidable. There are no excuses and I’m clear this level of care falls well below the standards everyone at the Trust would want for their own loved ones or anyone else.
This is where basics and ‘getting it right first time’ comes in. In simple terms this man should not have been in and out of A&E as many times as he was. He should have been cared for better and sooner. This wasn’t good for him or his family and, in all honesty, it cost money every time he spent time in the hospital that didn’t need to be spent.
This is exactly my point about the relationship between money and quality but, moreover, as a Trust please know we are committed to listening, learning and putting in place improvements that make a difference to patient care and as a consequence of those improvements make an impact on the bottom line.
It would be remiss and misleading of me not to highlight that we hear many contrasting stories where care provided was exemplary and I know patient experience at ELHT on the whole is very positive too.
As our new Chief Nurse Pete Murphy quipped in the Trust Board himself: “We know this as we walk around our sites which are awash with chocolate and gratitude from people who want to say thank you.” It’s not a scientific measure, but it’s a pretty good indication that we are getting it right most of the time.
We must also remember that we are also starting this financial challenge for the year ahead in a good place too. ELHT is the highest performing Trust in Lancashire and South Cumbria, we filed the best financial return for last year and we ended 2022-23 in a really good place, with lots if not all key indicators going in the right direction.
We’re already classified as ‘good’ by regulators the Care Quality Commission (CQC) with some areas of outstanding. Where we’re not already there, we’re making progress towards being outstanding across the board each and every day, thanks to the hard work and dedication of our amazing team. Part of getting there will be the open way we recognise where we could and should have done better.
This was writ large throughout the Trust Board meeting, with Executive Directors providing strong assurance on our plans and activity to Non-Executive Directors.
I won’t pretend it isn’t a very difficult time for everyone in the NHS – indeed across the country and with all communities too as the cost of living crisis continues to bite – but I do know we can and actually will only get through it together.
I’ve said before there is no better team than ELHT to do this and that includes a very strong and mature Trust Board.
On this note, let me end by thanking two of our valued and experienced Non-Executive Directors Dr Fazal Dad and Mrs Feroza Patel for their service as they leave the team this month.
Both have shown incredible commitment to supporting the Trust to improve and make progress over some of the most difficult years I have ever experienced in the NHS.
On behalf of everyone, Feroza and Fazal, please accept our sincere thanks for everything you have contributed to the Board. It has been appreciated and we wish you every future success in whatever comes next.
Take care everyone and be kind to yourselves always.
Martin