The Workforce - the sixth priority

In reality the Sustainability & Transformation Plans (STP) are all about reducing costs and in the NHS the cost of the wonderful staff is the biggest part of the overall cost to providing care.  So any good planners will be taking a close look at staffing costs and performance.

Prioity 6 for Buckinghamshires STP is:

"Establish a flexible and collaborative approach to workforce."

Their initiative is:

"A shared workforce plan to support rotation of staff across organisations to increase quality of care and staff retention."

Motherhood and apple pie! The NHS locally has been talking about improving retention of staff for years yet it is still a problem. Staff morale is low. Staff select to wok in some areas and avoid others. Much of the care is provided by locum staff rather than permanent staff.

In Buckinghamshire we have been short of A&E consultants for many years. GPs and Practice nurses, District Nurses and other specialities are also Report vacancies.

So there suggestion is to share staff across different trusts. But as the nurse taking my Blood Pressure on her evening ward round said: "Every trust is in the same situation. Every day I get asked by an agency to work for more money"

We need more permanent staff!

We need to have enough staff to cover illness, holidays, training etc.

There have rumours that across the STP, that is in Bucks, Oxfordshire & West Berks, £34m is to cut from staff budgets. This figure is in the published document but they do not explain how this will be achieved. As I type this on Christmas Eve they are trying to move an experienced nurse from my ward to one that does not a enough staff. This is dangerous. I do not know the outcome of the discussion.

This is the reality of 21st century hospitals across the country.

I do not think that this priority has a viable solution yet.

A recap on Buckinghamshire's STP - my thoughts

Ten days ago I wrote a number of blogs before I went for the operation to remove the subcutaneous lump on my shoulder. I am just about over the GA and the couple of big bleeds post-op and somewhere close to normality. Well .... there is a short period each day when I can concentrate for more then 5 mins.  Will that do for normal?

Anyway I am now a cancer survivor.

Hopefully, beds providing, I will heading to another hospital for a skin graft over the Christmas festivities.  Such fun!

Anyway....the blogs were about the Sustainability & Transformation Plan for Buckinghamshire (STP).  I have tried to put in my terms an explanation of a summary document that our CCGs circulated at their recent set of public engagement events.  They have tried to explain why they needed to develop the plan in association with local hospitals and the county council. They were very honest and said that it is because the increasing activity they will have to fund over the next five years will not be covered by the budget given to them by the Government.

Can't be clearer than that.

But sadly people still don't get it. Some people still believe the Government will throw money at the hospitals again. It didn't work in the past and it won't work this time.

Tonight and tomorrow I will try to finish what I started last week. I have their final three priorities to finish.

Specialist services Maximising value - the fourth priority

This one is a horror story!

"Maximising value and patient outcomes from specialised commissioning"

In CCG speak:

"Identify opportunities for modifying pathways, standardising thresholds and increasing prevention to reduce spend and increase value"

Well that is a mouthful! Lots of jargon and management speak in that statement.

What do I think?  I think it is all about reducing the cost of providing specialist care. This is the sort of care that is not done in our local hospitals. The sort of specialist treatment I am getting as I write this.  I have to declare an interest here!

There is always opportunities to improve the path us patients take through the system. We need to reduce the number of times we move between different parts of the system. This is a good thing. But it is not new and has been going on for years. But this must be done in partnership with the patients.

The interesting phrase is 'standardising thresholds'. What do they mean? I think it means they want to make it more difficult for GPs to refer us to the specialist centres. At  the moment many treatments are provided after the patient has ticked the boxes. The condition has to be severe enough for the CCG to fund it. Patients have to apply to the CCG for an 'individual funding review' when the CCG will look at each case before making a decision. This could be extended.

I am not sure what they mean by increasing prevention and I assume this is linked to priority 1.

As I said earlier it seems that the emphasis for this priority is on reducing cost.

A&E issues in Buckinghamshire

There are a lot of unhappy people in the south of Buckinghamshire, especially in the High Wycombe area.  They want their A&E and other hospital services back! The sad truth is that this is unlikely to happen.

As I have written about previously (What is happening to my hospital)  the A&E service closed down in 2005 and first there was the Emergency Medical Centre then in 2012 there was the Minor injuries and Illness Unit (MIIU). This must have felt like a downgrading of services each time there was a change.

The authorities did not do a good job in explaining the reasons for these changes to the residents of High Wycombe and the surrounding area.

As part of their inquiry into the actions being taken as a result of the Keogh inquiry into Buckinghamshire Healthcare NHS Trust the county Council health and social care select committee is going to examine the provision of A & E services.

I am predicting that they will say something along these lines:

• Better facilities for A & E should be provided at Stoke Mandeville Hospital.
• More permanent  Consultants, junior doctors and nurses in A&E are needed at Stoke Mandeville Hospital.
• Better parking is needed  at Stoke Mandeville Hospital.
• Better transport links (roads and public transport) between High Wycombe and Aylesbury are needed.
• An effective and regular publicity campaign about the appropriate service to use (A&E, MIIU, Pharmacies, GP surgeries etc.) is needed.

They may use a few more words though.

See press articles

http://www.bucksfreepress.co.uk/news/healthnews/10718683.Campaigner_calls_hospital_crash_response__a_joke_/

See Steve Baker MP for High Wycombe Blog

http://www.stevebaker.info/2013/10/farce-at-wycombe-hospital/

My questions at the AGM (Buckinghamshire Healthcare NHS Trust)

In the previous blog I gave my own highlights of the Buckinghamshire Healthcare NHS Trust AGM.

After the Chief Executive gave her presentation and the finance director gave his summary of the financial situation we heard from the leaders of the emergency surgery teams. They described how they had changed the service, what is called reconfiguration, and how the new service was producing better outcomes for patients & reducing mortality rates.  Good news.

At the end of the event there was time set aside for the public to ask questions.  I have no idea how many members of the public were present but I was virtually the only person who asked questions. 

Why is it that people don’t ask questions in formal board meetings?  I reckon most people know the answer to that one.

I asked a couple of questions:

The first was about the campaign to restore an A&E department to the High Wycombe Hospital site. A petition with 16,000 signatures has been organised.

There are 16,000 people in the south of the county who believe that there should be an A & E on the Wycombe Hospital site.

Can I ask that the Communications teams from the Clinical Commissioning Groups and the trust remind us, on a regular basis, about the good clinical, organisational and financial reasons why, in the present circumstances, there can only be one A & E in the county?

This is an on-going issue for those who live in High Wycombe.  The A&E department was closed in 2005 after a public consultation and replace with a minor injuries type of service.

As we know from other examples of such closures the local population is incredibly loyal to their local hospital. MPs too! So the story here is how to sell the difficult and complex reasons, hopefully evidence based, for such closures.

In my opinion the only way to tell the story is to keep it simple and be persistent.

However the audience was asked what else could be done to explain the reasons why there are only resources for one A&E department in the hospital.

My suggestion is that the leaders of the campaign should meet with senior clinicians and managers (and the commissioners) to have an informal, facilitated discussion and look at the evidence. 

As for how to improve the conversation between the hospital executives and the patients is something to explore in another blog.

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The second question I asked was about the way they manage complaints.

Can I ask that the board measures its performance on managing complaints by using the following as outcome measures?

a)    Is the complainant satisfied at the end of the process

b)     has the trust learnt from the complaints  

c)    has the trust acted on the learning.

Normally the first thing that the board reports is that they replied to people within the required time. This is important of course, but I reckon that most people would say the best test of a good complaints service is: was I happy with the result?

  I hope that the trust may consider that a different approach will improve the way people think about the way complaints are managed.

They expressed some interest in this approach and said that they are trying to do something like this.  They have been contacting people by telephone after the complaint has been closed, especially complex complaints. But they have not been recording this activity. It sounds as if they are looking to improve the experience of complaining.

They did say that they get many more accolades than complaints. This is good to hear.