Sara's blog - November 2018
This month Sara talks about Leeds’ collective response to delayed transfers of care, how we can all be winter heroes and say thank you and getting advice from a change management guru as well as a round up from senior level meetings across the patch and her usual reasons to be proud (including the glittering Trust Awards).
Welcome to my monthly blog for November 2018. With our last Board meeting of the year taking place on Thursday 29 November I’m sure a lot of the members will be thinking about how well prepared we are for winter with all the pressures and challenges we’re currently facing in the health and care system.
Local pressures around delayed discharge from acute care were highlighted recently by the Yorkshire Post, which summarised the work of consultants Newton Europe. They’ve reviewed 1,368 acute care beds across Leeds and found 27 per cent were occupied by people fit to leave. They also found nearly 40 per cent of patients with mental health problems and complex illnesses including dementia treated in 186 beds at units including ours were also well enough for discharge.
However, what we do have in Leeds is a strong and mature partnership across NHS, local authority and third sector organisations. Through this partnership we have agreed a transfer of care policy with a joint commitment to support as many people as possible to get back home swiftly, where it is safe and appropriate. It’s important that we continue to work closely with such partners as winter starts to bite.
Leeds Winter Heroes and saying a Big Thank You
As well as professionals working well together, we’re also supporting public awareness campaigns this winter – namely The Big Thank You and Winter Hero campaigns.
Firstly there’s an internal facing element which is all about recognising the extraordinary efforts people make to help people stay well over winter and beyond. This campaign recognises not just those we automatically think of when talking about health and social care – such as doctors, nurses, care staff – but also those who can go unrecognised. So this means saying thanks to the city’s unpaid carers, community groups as well as people in a range of occupations from hospital porters through to bin men and women or gritter truck drivers who are out in all weathers.
The external facing element of the campaign is designed to encourage a social movement where people recognise and say thanks to those who helped them out. A thank you can be for anyone in any capacity so someone may choose to thank a neighbour, a teacher or even a bus driver – anyone who they feel deserves that recognition. The campaigns are being led by Leeds CCG but working across with all public sector and third sector organisations in the city.
In addition to this we want people to be a winter hero this time around by pledging to take at least one simple action. This could be anything that means they look after themselves (like getting a flu jab), look after a neighbour (like picking up a prescription) or being prepared (like keeping an eye on the weather). This closely links with Leeds City Council’s professional-facing Winter Friends initiative, by providing simple options for people to keep healthy and look out for vulnerable neighbours.
This will be followed up in the New Year with a regional campaign to encourage neighbourliness and a return to a sense of community spirit. The campaigns will officially launch with coverage in the Yorkshire Evening Post on Thursday 6 December. Please get involved where you can – anybody can be a winter hero and anybody can say a big thank you.
Change guru works on our Senior Leadership Forum
In November senior leadership colleagues came together for the last time this year. Firstly, we had a quick look back at our achievements during 2018, for example implementing the changes in our community mental health services, supporting our acute inpatient services and expanding home treatment, setting up the new gambling addiction service, continuing the inpatient refurbishment work and starting the implementation of our new electronic patient record system.
This was followed with a session led by internationally-acclaimed strategic change guru Myron Rogers. He took us through a practical application of his key principles of systems theory, or Myron’s Maxims as he calls them, which are:
- People own what they help create
- Real change happens in real work
- Those who do the work do the change
- Connect the system to more of itself
- Start anywhere, follow everywhere
- The process you use to get to the future is the future you get
Hopefully people may recognise some if not all of the truisms that lie behind the ‘maxims’ – indeed I think we’ve followed some if not all of them as part of our community redesign project.
Health and Safety Executive (HSE) inspection outcomes
Following our HSE inspection, we received verbal feedback from the inspection team on 15 November. We expect our written report in the next two weeks, from which we’ll produce a response and action plan early in 2019 which will be reported through our audit committee.
The inspectors have no major concerns about how we manage risk within the organisation, but there are a number of areas which we need to improve. These include clearer procedures, improved use of audit and monitoring especially of policy compliance, sharing good practice on security and how we minimise risk to staff from moving and handling injuries and violence and aggression.
The inspectors again stressed how impressed they were at the passion and motivation of all our staff.
Fire Safety Update
Still on the subject of safety, I’m now chairing a fire safety group following our audit by the West Yorkshire Fire Authority and progress is already being made sharing and embedding learning across our inpatient services. For example:
- There is now a new ward-based training offer from our Fire Officer
- We’ve revised guidance on what is and is not allowed on our inpatient wards for patients, staff and visitors.
- We’ve rolled out lockers across all inpatient wards for patients to store smoking equipment so it is not on their personal possession in the ward environment.
- There’s clearer guidance and support for ward staff on how to manage smoking on inpatient sites.
- Posters and patient information leaflets being devised on mutual expectations regarding personal possessions and ward safety.
We’re also planning to go back to being fully smoke free as a Trust from April 2019 – meaning there will be no smoking allowed by anyone on any of our sites. We had to relax this a bit in 2017 following feedback from staff that the previous policy wasn’t working properly.
Leeds Providers Committee in Common
The second meeting of the committee of Leeds’ health provider organisations took place in November.
The city’s three NHS trusts have signed up to a Memorandum of Understanding (MoU) – a formal agreement of how we’ll work together and make decisions, whilst retaining our organisational accountabilities. The GP confederation intends to sign up but need to understand the work plan in more detail first.
We have agreed to develop a 3-5 year blueprint of what service provision should look like in Leeds. This will help us pursue any funding opportunities related to the soon-to-be-published NHS long term plan as well as influence commissioning intentions.
There was an update report on the work of frailty and feedback on our development of an older adults specialist mental health offer was very much welcomed as a significant component of this work. We agreed to the need to develop the service delivery model with an update to the next meeting.
At our last meeting we agreed there needed to be stronger leadership and governance of local care partnerships. We received a comprehensive update and were assured there is now more robust leadership and planning in place covering development of the model, support for culture and practice change, practical support and resources to support wider engagement of the third sector. Going forward the development of LCPs will be accountable to the Leeds Providers’ Integrated Care Collaborative (LPICC).
West Yorkshire and Harrogate health and care partnership – moving towards an Integrated Care System (ICS)
I recently attended a meeting with regional directors from NHS England and NHS Improvement which focused on how we’re developing as a system, our progress against the national memorandum of understanding (MoU) and how our relationship will evolve as a result of the changes in NHSE/I.
NHSE/I were very positive about the progress we’ve made to date, the strength of leadership across the system and closer partnership working. All of which is recognised as helping the system progress on some issues more quickly than would have previously been possible; for example the stroke pathway work.
NHSE/I were supportive of the work we have started on mutual accountability – and are keen to work with us as it evolves. We discussed performance across the system and the expectation that the ICS would begin to take an increasing role in addressing these issues.
We raised an issue about the non-recurrent funding streams that are used to fund most of the partnership’s activities. We often get late notice of these and in most cases have relatively little discretion over how they are used. We’re looking at a more sustainable way of funding our regional health care partnership activity and NHSE/I are supportive.
You can keep up to date with the partnership via their website and weekly blogs.
Mental Health Collaborative
Our collaborative of four mental health and community trusts across West Yorkshire met on 12 November. Here are a few key updates.
- Out of area placements – the bad news is that we and South West Yorkshire Partnership Trust (SWYPFT) on course to exceed our agreed targets. A detailed analysis on bed modelling is being commissioned including psychiatric intensive care units across West Yorkshire, building on the work we did with consultants from NICHE.
- The urgent and emergency care work programme is refreshing its work plan. It’s worth noting that is since changes in the legislation all other areas have seen in increase in detentions under section 136 apart from Leeds.
- A workforce work stream is now established chaired by Alan Davies, Director of Workforce from SWYPFT to support the collaborative.
- Capacity to support communication has now been increased and a plan is being developed for more regular sharing of the work we are doing across the system.
- £280,000 of non-recurrent money has been allocated across the different work streams.
- There are plans to establish a learning disability forensic outreach liaison service (FoLS) led by SWYFT for West Yorkshire and Barnsley.
- Assessment and treatment units and a new service model continue to be developed with strong multi agency engagement. We anticipate this progressing to business case for the next Committee in Common.
- A new care model business case for forensic services is in development.
Reasons to be Proud
I’d like to start by recognising the work of Dr Claire Eccles, a junior doctor who started with us in August. She was highlighted as a rising star by our Director of Medical Education, Dr Sharon Nightingale, following wide ranging praise for her “outstanding diligence to patient safety, team working and communication skills.” This is fantastic recognition. I feel it’s important that we encourage our staff from the outset of their journey with us.
And finally, what a night we had at the annual Trust Awards on 9 November where we celebrated the amazing contribution of staff and volunteers.
This has been the biggest year yet in terms of number of nominations and numbers of staff attending the award ceremony. It made me feel both proud and privileged to work in the organisation and the feedback so far has been incredibly positive. Staff really do appreciate the Trust valuing the work they do and celebrating the difference they make day in and day out, 365 days a year.
Whilst all our winners were highly deserved, I wanted to especially recognise the awards we gave to the Forensic and Specialist Supported Living leadership teams – both of whom have shown committed and sustained leadership and engagement that have benefited both staff and service users. You can see them celebrating in style here!
