This week my thoughts have been consumed with the smooth running of the Trust operationally – and the complexity of balancing a number of things to achieve it.
Of course, this is always through the lens of patients and their families first and foremost – and most specifically their experience of the Trust when they receive care.
But a very close and ever-present second will always be how colleagues are coping, performing and balancing the huge number of ‘asks’ day to day with their health and well being. We simply can’t function without a team that is managing and feeling OK.
On Tuesday morning, I met with senior leaders for our regular weekly catch up which always directly follows a meeting of the Executive Team.
Both meetings were very much focused on reducing the number of people who are waiting for treatment and, in particular, elective procedures and surgery.
It is, of course, no secret that waiting lists nationally have grown following the pandemic and the huge increase in demand for services we have experienced since.
But just because it is a ‘known’ issue doesn’t mean we aren’t absolutely focused on managing it as effectively as possible – and here at ELHT we remain acutely aware that waiting for any treatment is a difficult time and undoubtedly affects the quality of life physically and emotionally.
I am proud that the team at the Trust doesn’t deny issues or shy away from the reality of any situation, but improving our position is complex and I thought it might be useful to share just some of the material factors that are playing into the challenge.
It isn’t exhaustive by any means but as a starter for 10 let’s recognise:
• Demand continues to escalate – even after a protracted period of very high numbers of people attending for treatment in recent years
• May and June have been the busiest ever recorded for urgent and emergency care attendances – with more than 700 people coming into A&E at Blackburn, Urgent Care at Burnley, Minor Injuries at Accrington Victoria or the drop in at Rossendale on some of the busiest days
• High numbers like this puts pressure on every single member of the team – not just in these services but across every hospital and community service in the entire Trust as we work together to discharge those who no longer need to be in, ensure they are cared for effectively when they leave and create space to admit others who need care
• On top of this we have had a number of periods of industrial action involving critical professional groups including junior doctors and consultants but also many other health professionals who are sorely missed when they’re not here. I have said many times I respect the right of people to take ‘strike’ action – but let’s not pretend it doesn’t cause delays to patient care
These are the headline challenges, but I am going to go on.
Regular readers of this blog will know we have just implemented a new Electronic Patient Record (EPR) which will change the face of the Trust forever, but is a significant new way of working for colleagues. It’s stressful and we are still getting to grips with it to ensure it’s working in the best possible way for everyone.
During the EPR ‘go live’ we asked some people not to take leave so we had as many hands on deck as possible – of course now, with the start of the school holidays, colleagues are going off for a well-earned break and, whilst rightly so, it undoubtedly increases the pressure too.
On a related note, most people look forward to Bank Holidays but I have to say we’re already planning for the long August weekend where we lose capacity, planned productivity reduces and that’s before even more people can be expected in urgent and emergency care.
We’re already planning for winter – yes and it’s only July.
Please know I don’t reiterate the issues to moan. The point is that we have to be realistic and face them together if we’re going to overcome them.
And that’s what I did at our meeting on Tuesday.
I have to say I was expecting a ‘push back’ from colleagues who are tired, exhausted even, from very long and a seemingly never-ending shift. Instead, I received acceptance – agreement even – as they recognised that we simply have to keep going and find a way to get more people in to receive the care they need.
I don’t mind admitting it was a humbling experience for me.
This is what sets ELHT apart from every other organisation I have worked in during a very long NHS career. People care more about others than they do themselves and they’ll never ‘push back’ if they know that what we’re trying to achieve – what we’re asking them – is the right thing to do.
I recognise this and moreover I am always blown away and beyond impressed by the mix of resilience and determination from the team. It is hugely appreciated and it makes a massive difference to people’s lives. Thank you.
I then received some feedback from a man who had brought his daughter to A&E in Blackburn with a broken ankle and shared his experience in a measured and helpful way that allowed me to triangle what I think with what is actually happening on the ground.
People who know me well will recognise this is something I am always trying to achieve.
Part of his note said: “I can’t fault the doctors and nurses. She got the best treatment that she needed, but I had to go through A&E and you would have thought World War Three had happened with people queuing outside and every corridor full of people. The doctors and nurses must be at breaking point and something needs to be done.”
As I have said before, I am open to feedback about all our services but particularly from patients sharing their direct experience of the care they have received. I immediately recognised this experience – where both clinical and non-clinical colleagues were doing everything possible to provide safe, personal and effective care – but the sheer volume of people attending was creating a pressured and challenging environment for everyone.
We are constantly assessing this and making improvements all the time. Again, not an exhaustive list, but a few of the changes we have made include:
• Colleagues across all services and settings – both in hospital and in the community – are doing everything possible to reach into urgent and emergency care and help patients who can be treated or supported elsewhere
• This includes a team of people positioned at our front door and an electronic triage system which aims to ‘stream’ people more effectively according to clinical need – this has been particularly helpful in Burnley Urgent Care Centre where patients can be provided with an appointment and encourage to come back rather than wait
• We are also pioneering new ways of working through our community teams to try and get people home or to a place of care other than hospital as soon as possible – as well as offering support in the community to keep them from need to become inpatients in the first place
It is great to hear people praise the hard work, determination and compassion demonstrated by colleagues working, day in and day out, in these extreme conditions. We recognise this too and in response have developed a comprehensive health and well being offer, including occupational health provision, which flexes to support individuals as well as teams as a whole.
It is a complex situation and I want to offer the following further context around some of the other issues raised:
• The Trust does utilise corridor care where every other avenue has been explored – this is partly to care for people when we have literally run out of space
• This also helps colleagues from North West Ambulance Service to hand patients over for care and get back out to see other people who need their help – we met with crew only this week to also ensure community teams support a reduction in calls to the ambulance in the first place
• Financially, the Trust is facing a difficult budget for 2023-24 which has already resulted in 53 beds being removed from our base position
• We do have people in hospital who do not clinically need to be here but cannot be discharged because of a lack of ongoing appropriate care – this impacts on our ability to manage optimal flow around the hospital and bring people in who need inpatient treatment
Whilst not exhaustive, these are the main challenges for the Trust at the moment and so you can understand why it is occupying most of my waking moments and, indeed, keeping my awake at night at times.
Please know and be assured that as a team we are working together to care for the great number of people who need it, whilst also supporting colleagues across the wider health and social care system – including ambulance crew – who are also working incredibly hard with the same aims in mind.
ELHT is well positioned to manage this and continues to explore and develop new and innovative ways of providing healthcare for our communities.
To this point, let me quickly mention everyone I met at the Trust’s new leadership development programme this week, who asked me to pop in and talk about my own career pathway so far. We also considered all of the issues I’ve already described and how we’re going to tackling them together, using skill and expertise, but also our commitment to values and behaviours, which are so important to us.
I want to thank you for your support and reflect my gratitude to each and every colleague, actually, who is ensuring patients and their families are well cared for and able to recover where possible.
Do let me have your feedback, I really appreciate it.
Martin