Chief Executive's Blog

Welcome to the Chief Executive's Blog. I hope it will offer an interesting insight into the running of this Trust and the issues the Board and I face. I look forward to using the blog as a way of keeping staff, patients, visitors and members of the public regularly informed and as a simple method to receive feedback from you all.

If you have any comments about the below blog entries please feel free to get in touch.  

 

Worrying changes nothing. Talking changes everything

20/05/13

I really embrace the idea of Dementia Friends and Dementia Friendly Communities. Like dignity, dementia is not solely a health or social care issue. It's society as a whole that needs to stop walking along staring at their mobiles and look up for a change!

This week is National Dementia Awareness Week. This year the theme is 'Worrying changes nothing. Talking changes everything'.  We're all living longer. That means we're all facing a higher risk of one day developing dementia. It may be you. Or it may be someone in your family.

What can you do about it? How do you recognise the signs? And how will you cope if you or someone you love develops dementia? One thing's certain - the more we know about dementia, the more prepared we'll be to face it.

Dementia Friends is a national initiative that is being run by Alzheimer's Society. It's funded by the government, and aims to improve people's understanding of dementia and its effects. Alzheimer's Society is working with lots of volunteers and other organisations to achieve this goal. Together, we can create dementia friendly communities.

People with dementia sometimes need a helping hand to go about their daily lives and feel included in their local community. Dementia Friends is giving people an understanding of dementia and the small things that they can do that could make a difference to people living with dementia.

Andy Tysoe and Sue Burton are running Dementia Information sessions during National Dementia Awareness Week, for the general public, carers and staff. The sessions are one hour long and are fully endorsed by Alzheimer's Society.  I would urge you to make some time to get to one of the sessions they have planned through the week. Anyone can attend and book onto these sessions using the following link: http://www.dementiafriends.org.uk/session

Since antiquity in various parts of the world, and since the 17th century in England, it had been known that citrus fruit had an antiscorbutic effect; although James Lind was not the first to suggest citrus fruit as a cure for scurvy he was the first to study their effect by a systematic experiment in 1747. It ranks as one of the first clinical experiments in the history of medicine.

Today is International Clinical Trials Day, it is celebrated around the world each year, to commemorate the day that James Lind started his famous trial on the deadly disease scurvy. It provides a focal point to raise awareness of the importance of research to health care, and highlights how partnerships between patients and healthcare practitioners are vital to high-quality, relevant research.

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International Nurses Day

10/05/13

"I attribute my success to this - I never gave or took any excuse."
-       Florence Nightingale

If she had still been living Florence Nightingale would have been 193 years old on Sunday 12^th May 2013. To celebrate her birthday and to celebrate all of the good work nurses do, Sunday 12^th May 2013 has now become International Nurses Day.

Nurses and midwifes make up nearly a third of the staff employed here at the Countess and it is with great pride as a nurse myself, albeit no longer in practice,  to reflect on the massive contribution the profession has had on the lives of the many thousands of patients who pass through our hospital each year.

To be a nurse, a midwife or member of care staff is an extraordinary role. What they do every day has a deep importance. Nurses are crucial in the drive to help people to stay healthy and well for longer and in promoting health and well-being. They help people to recover from illness, sometimes when they are at their most vulnerable. They support people in living with illness. They provide care and comfort when people's lives are coming to an end. They care for everyone, from the joy at the beginning of new life to the sadness at its end.

Despite what you might read, particularly in light of the recent Francis Inquiry Report, we know the vast majority of nurses are doing fabulous and innovative work across the country every day. Such poor care, as described by Francis, is a betrayal of what the nursing profession stands for and has no place in the NHS.  At the recent Royal College of Nursing congress a student nurse, Molly, tried to put the record straight. Click here to hear what she said.

As part of our International Nurses Day celebrations we asked some of our nurses to describe 'why' nursing and to share work experiences they were proud of. Here is a flavour of what our staff said…

"An example is being able to nurse a patient who is at their end of life, maintaining the patient's dignity whilst supporting the family.  To hear a family thank you for being there and making things just that little bit easier at such a difficult time in their life is such a reward as a nurse. The joy of nursing is that every day is a new challenge every day provides new experiences.  Tomorrow may well be my proudest moment!" 
-       Paul Brocklebank, Nurse Endoscopist

"I find nursing to be a very humbling experience because it is a privilege to get things right for a patient."
-       Christina Dominguez, Discharge liaison

"I love caring for people - it makes you feel so good about yourself when they get better."
-       Molly Fairclough, 1^st Year Student Nurse

"I have been a nurse for 6 years and I love to be able to spend time ensuring my patients have everything they need and its lovely to see them go home following good nursing care."
-       Rachel Stelling, Registered Nurse

"I love to interact with the patients and enjoy helping patients feel better when they are not feeling their best."
-       Charlotte Greenbank, 1^st Year Student Nurse

There will be a poster display in the main entrance to the hospital which includes more messages from our staff and importantly information celebrating nursing here at the Countess.  The display will be in place until Monday 13^th May. I would encourage you to find time to take a look. In the words of Jane Lush, manager of the renal dialysis unit our nurses… "Really make a difference to people's lives, this definitely makes me proud."

On behalf of the board and more importantly our patients - Thank you.

Tony

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Are we missing the bus?

03/05/13

In a recent blog I told the story of how the 'Ski-Track' App changed my life - well at least my experience whilst on a recent skiing trip. Since then I found this piece written by a fellow NHS blogger who has been blown away by new technology…

"This is a bit tricky.  I don't want to give the wrong impression.  Don't get hold of the wrong end of the stick.   Here's the truth; I hadn't been on a bus since I was about 5 years old.....

Only recently did I try a London bus.  At the insistence of a friend; 'we'll take the bus'.  I moaned, sulked, pouted and tried a hissy-fit but no; 'we are going on the bus - it'll do you good....'

Buses played no part in my life.  As a kid the bus was something we pedalled-by, overtook and left behind.  In later life the car was the dominant influence. 

Why would I want to spend hours waiting at a bus-stop?  Hanging around in the rain and the freezing cold; yer 'avin a larf.  It didn't work.  I was frogged marched to a bus-stop.  My friend whipped out an iPhone.  It swished its way into life; my life.  It knew where I was.  A finger-tip flicked an App into life.  The Bus-Tracker.  Punch in the destination or the bus number or any clue and the App tells you the bus you want is on the way and will be at the bus-stop in 3 minutes, or 5 or whatever.

Wow!  How does it do that?  Well, it ain't rocket science.  It links together some simple, real-time data and daisy-chains it into something really useful."

Apparently thousands of Londoners have downloaded this App and it's catching on in other towns up and down the country as well. But in this technological age we take things like this for granted with our smartphones and ipads etc...  But apps like this, that are actually useful, reliable and free, show how true innovation can assist us in our daily lives.  This one in particular makes you see bus services as a convenience that you can control at the touch of a button, rather than the old unpredictable service that relied on time-tables on the bus shelter for information.

So if we take these technologies for granted in our daily lives, why don't we see the opportunities in our NHS bubble? Couldn't we use a similar App to tell our patients what the average wait time is in our Emergency Department?

Thinking of going to A&E?  Check the Countess A&E Tracker App. You might find that our waiting time is 3hrs and the wait at another hospital 20 miles away is 1.5 hours.  You might ease the pressure on our Emergency Department and go somewhere else, or you may decide your 'emergency' really wasn't that much of an emergency and you can wait to see your GP on Tuesday. 

Is this a gimmick or has it got real potential?  Who knows?  The real world gives me technology for my banking, entertainment, education, news and pretty much everything else. And with a little bit of thought they could all be applied to the NHS in some way to give us real benefits.

So while many of you will be enjoying the bank holiday weekend, you may be planning a break away, a shopping trip, a trip to a fun park or the countryside. Keep an eye out for anything that makes your experience more pleasurable and maybe ask the question, why couldn't we use that at the Countess? And if you do, let us know.

Have a good weekend

Tony

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Integrated Planning - The West Cheshire Way

29/04/13

"If I'd asked people what they wanted, they would have said a faster horse."

- Henry Ford

Let me paint the picture: It is 1900, it takes all day for 34 year-old Boris to make the twenty mile round trip from Tarporley to Chester by horse to visit his sick mother. What would improve his experience? Obviously, a faster horse! According to Google Maps if you make that journey in a modern version of Mr Ford's car; the round trip is half an hour.

Try the same exercise with the great granddaughter of Boris; now a frail 87 year-old lady who has been in Ellesmere Port Hospital for a month following a nineteen day stay at the Countess due to a fall and a subsequent chest infection. We are struggling to agree a package of care for her to return to her home and her family are considering the options for residential care in Helsby. They are in no rush as she seems comfortable in Ellesmere Port Hospital (EPH). What would improve her experience?

I will not put words in her mouth, but....

Would she talk about falls prevention? A shorter length of stay making it less likely that she gets a chest infection? Better integrated working with social care to ensure that she was able to return home relatively quickly with support and not need to go into residential care? Probably not. I have no doubt that she would be rightly grateful that the Countess of Chester Hospital saved her life and would feel safe and secure at EPH.

Last week a group of over 60 clinicians and leaders from across our patch got together to explore plans for local health services that don't result in the answer: a faster horse.

The NHS version of a faster horse in the twentieth century; bigger better staffed hospitals full of frail older people is both undesirable for patients and unaffordable for our economy. Smaller better staffed hospitals and excellent integrated out of hospital care where patients are supported in, or close to, their homes seems to me to be a more realistic, sustainable and affordable answer.

I would like to take this opportunity to thank everyone who took part in what was a very positive meeting.

Tony

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Forward plans and operational realities

23/04/13

The end of one financial year and the start of the next are always a busy time for NHS planning.

For the Countess of Chester Hospital this comes on the back of weeks of exhausting pressure we are facing in our emergency services. It's true the pressure has been high for years; the peaks of demand we have faced in recent weeks have been pretty unprecedented at the Countess. It gives me no pleasure to state very clearly (something obvious to anybody): our system needs to change.

In a previous blog I described one of the root causes of the pressure in the system is the growing number of patients, mainly elderly, who are frail and with numerous long-term conditions. Our current system seems "designed" to pull these patients into our hospitals and then, eventually, discharge them often in a more dependent state than when they arrived.

This cannot be right.

Next week clinical leads across the West Cheshire Health and Social Care system are coming together to focus our thinking around a clinical strategy we can all commit to. This will allow us to take a long, hard look at what is needed to optimise health and healthcare, in a context of very challenging budgets; and provide an opportunity for us to get to grips with what this means for us, partner organisations and as a whole system. Outputs from the event will directly shape the further development of our vision for the future and our strategic approach to any transformation this may require.

Those of you who read my blogs will know that I like quotes.

"Insanity is doing the same thing over and over and expecting different results." Albert Einstein.

I think this quote covers the challenge well - although I am sure you could provide similar quotes that could do the same. If you share them with me we could perhaps use them next week. 

In the meantime I will finish by thanking all the staff at the countess for continuing to provide high quality and compassionate care during this time of high demand. I thank you on behalf of the board and more importantly our patients. 

Tony

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Off Piste

12/04/13

I favour total transparency, strong managerial skills, and accountability for improvement.

I remember getting a school report card as a 9 year old which said that Antony (that is what I was called at school and still called by my mother) is a very enthusiastic singer. This was interesting as I was not selected for the choir or any school productions.

I love skiing. I can go on and on about it. I am I suppose a very enthusiastic skier! So much so that our Medical Director, Ian Harvey, himself an enthusiastic skier, gave me a link to a skiing 'App', which whilst on the slopes on a recent holiday used GPS to track my top speed, altitude, gradient of slope, mileage and a whole host of real-time data on my performance. I have to say this was transformational for an enthusiastic skier / elite athlete such as me.

'Putting Patients First', The NHS England business plan for 2013/14 - 2015/16 talks about World class customer service: information, transparency and participation as being key to transforming customer service in health and care - patients, professionals and citizens need far better information on local services and need to be able to take control of their health when they want to. Health and care data represents one of our greatest public assets and putting it to work is key to improving health outcomes for everyone. 

This is to be welcomed and can lead to improvement. Anything that creates greater transparency and informs the public about the quality of the services we provide can only serve to drive improvements. Some might see this as a driver for market forces to change supply. I don't see it that way. I believe in expanding choices by access to better information in a collaborative health system. Using data to drive improvement is not new; improving access to that information well that might be new.

I have the 'ski track' run charts to prove it!

Tony

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Principles of Integrating Care

05/04/13

As George Osborne was announcing his budget my team was busy working on the plan for the Countess in 2013/14 which contains a summarised budget for our own organisation.

It will be no great surprise to anyone that we have a significant financial challenge in the coming year. Our financial allocation for this financial year 2013/14 is essentially the same as the financial year which has just ended 2012/13; which means that we can only fund inflation (including pay increments and pay awards) and new service pressures from savings. This is a very harsh reality however; we know we have to do our best for our communities and patients within these resources. We are not allowed to print money (sadly)!

There are very few areas of healthcare that we can stop without either unacceptable consequences for patients or a financial impact on a different part of the health service or an impact in the future. We therefore have to focus mainly on how we spend money. Expenditure is, in reality, only a consequence of what we do and how we do it. Therefore if we are to live within the resources available to us we need to focus not so much on the money itself but on changing what we do and how we do it.

In a previous blog from a couple of weeks ago I made reference to the guiding principles for integrating care systems. These principles are:

-        The patient voice must be at the heart of all provision.

-        Integrated services are based on the practice-based registered list.

-        Consultant opinion is an essential component of effective integrated services.

-        The delivery of integrated services will rest primarily on extended roles for nurses and allied health professionals (AHPs).

-        Integrated services must incorporate social care.

-        Future integrated services should bring together the full range of primary care.

Together with our partners within the Clinical Commissioning Group (CCG) we are using these to help guide and describe the future shape for Integrated Care at its Best in West Cheshire and these will form the basis for our plans going forwards. Once our annual plans are complete and approved by the board they will be posted on line. When they communicated to you, please take the time to read and reflect. Comments on the plans or this blog are always welcome.

To finish I will use a couple of paragraphs from a previous blog.

It is perfectly possible to see the situation we are facing entirely as a threat; after all we have the biggest financial challenge to confront the NHS in its entire history. The experiences we have had in the past or the situations we face on a day to day basis can readily make us cynical. I know this happens to me from time to time; but cynicism cannot protect or improve the NHS.

In my view we have to see this situation as an opportunity. It is an opportunity to "think differently" and to make fundamental changes to the way we organise services.

If we end up in five years' time with more patients cared for at home, or near where they live; if we achieve a service where the NHS, social services, and the voluntary sector are consistently working closely with families and patients to help them remain within their communities; then we will have made lives better for thousands of people. If we provide emergency, urgent and specialist care quickly, efficiently and more safely in a smaller better organised hospital; if patient outcomes are the best possible; then we will have improved on what we are doing now.

Thank you to Alison Kelly for doing the blog whilst I was on leave last week.

Tony

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Future of nursing - a time for all to 'C'

28/03/13

This week's guest blogger…. Alison Kelly, the Trust's new Director of Nursing & Quality

As Tony is on holiday, he has asked me to write the blog this week - writing a blog is a first for me so apologies if this isn't up to Tony's usual standard! However, I am using this as a great opportunity to reflect back to you about my first few weeks at the Countess.

It was a little strange taking a different exit off the motorway to come here on my first day but I have to say that this has come as second nature already. My head has been filled with so much information since starting but the time spent on my motorway journey home helps me to consolidate what I have learnt during the day.

Everyone has made me feel very welcome and as I have walked around the Trust I have met both staff and patients who have been very positive about the Countess and have explained to me how proud they are to work here, which has made a significant impression on me. I have visited a number of clinical areas but as yet have not been able to remember all the ward names and numbers - I'm sure that will come in time.

I have seen lots of really great things which are already embedded in this organisation but have also asked questions about what we could do differently to improve our patients' experience - I am a firm believer that we can definitely go from 'Good' to 'Great' and I see my appointment to the role of Director of Nursing & Quality as a great opportunity to support the Countess in doing this.

I have stepped into this role in probably one of the most challenging times for the NHS - some of my previous colleagues thought I was mad going for a Director role but actually, I am very proud that I have got this opportunity to lead the nursing and midwifery profession and to shape how we can deliver excellent care to our patients. One of my first objectives is to lead the development of our local nursing and midwifery strategy (to reflect the national 6C Nursing Strategy of Care, Compassion, Competency, Courage, Communication and Commitment).

The recently published Francis Report really puts the nursing profession in the spotlight, not to mention every other element of the NHS and having recently been to a conference where Robert Francis presented some of his key recommendations, the message was loud and clear, if you are not shocked at what went on in Mid-Staffordshire Hospital, then you should not be working in the NHS! The conference was certainly hard hitting and we heard some very powerful stories illustrating the immense impact that our actions can have on patients and their families and carers.

This week the Government has formally responded to the 290 recommendations, entitled 'Patients First and Foremost' by setting out its commitment to ensuring that indeed patients are first and foremost, we will of course need time to digest this as we have done with the Francis Report, we need to fully understand what this means for us as a Trust but also as a health system. Essentially the response is a five point plan:

• Preventing problems
• Detecting problems quickly
• Taking action promptly
• Ensuring robust accountability
• Ensuring staff are trained and motivated

You can access the 'Patients First and Foremost' report by clicking here

A very challenging time lies ahead but I am confident that through strong leadership, team work and working closely with our partners externally, we can have a hugely positive impact on the experiences our patients gain through the care we deliver.

Alison

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Pursuing Perfection - redefining what's possible

22/03/13

There can be no doubt that the NHS is in the spotlight for all the wrong reasons at the moment.

The Mid Staffordshire scandal is responsible for most of this and it is clear that the confidence of the public and politicians has suffered a serious knock. We are arranging a series of open discussions with our staff to discuss the Francis Reports. I hope to use these meetings to talk about practical ideas for how we can improve what we do.

Another reason is the continuing, exhausting pressure which we are facing in our emergency services. Whilst it's true that the pressure has been high for years, and very high for months; the peaks of demand we have faced in recent weeks have been pretty unprecedented at the Countess. It gives me no pleasure to state very clearly (something obvious to anybody): our system is not working properly.

The root cause of the pressure in the system is the growing number of patients, mainly elderly, who are frail and with numerous long-term conditions. Our current system seems "designed" to pull these patients into our hospitals and then, eventually, discharge them often, frankly, in a more dependent state than when they arrived.

This cannot be right.

We know that part of the answer is to make sure that key departments and wards are properly staffed and fully functioning seven days a week. But this crisis in demand comes at a time of extreme financial pressure and recruitment difficulties in many crucial medical specialities. If you want a more detailed analysis of these issues across the UK, have a look at the Royal College of Physicians report: Hospitals on the Edge.

To make this happen we need to move our resources: people and money from hospital settings to primary care and community settings.

There is no doubt that some of these proposals are controversial; and they are hard to achieve in the current financial climate. The Nuffield Trust has produced a list of guiding principles for integrating care systems. Together with our partners within the Clinical Commissioning Group we are using these to help guide and describe the future shape for Integrated Care at its Best in West Cheshire. More on this to follow.

Of course to some extent the NHS is a victim of its success over the last twenty years: people are living longer, we can provide much more effective care now: coronary angioplasty, better renal care, people living longer after cancer, day case surgery, more effective anti-psychotic medication, superb diagnostic technology......... and the list goes on.

Tony

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Problems to solve or Polarities to manage?

15/03/13

For every year for as long as I can remember we are told that morale and motivation in the NHS has never been so low. This is often repeated as though it's scientific fact. The NHS is a tough place to work. It's demanding and it can be stressful; it involves shift work and unsocial hours working. It involves caring for people in very distressing situations, it works at the limits of science. The NHS is an enormous system - one of the world's largest and change can take time but there are many positive trends. Our recent staff survey points to some of these. I have seen evidence too on my many walkabouts and meetings with staff.

Very few problems in the complex NHS world in which we all work are stand alone. They generally involve interdependent alternatives that must be managed together. It is rarely an either/or option, but generally both. For example: individual/team, work/home, and cost/quality. Where I think things go wrong, and misconceptions occur, is when polarities which need to be managed are treated as problems that can be solved. These are the problems which don't have a standard solution and require different ways of thinking to resolve them. The solution to a very challenging problem won't be perfect nor should it be, we need to accept this.

There is no shortage of literature on the subject of leadership. 'Followership in the NHS', a paper commissioned by The King's Fund to inform the leadership thinking is worth a look. It considers the vital role followers play in leading organisations and suggests that there is a direct link between styles of leadership and followership and therefore we get the followers (and the leaders) we 'deserve'.

On the whole the relationship between managers and front line staff in the Countess is pretty good. Where I think difficulties occur is when one group feel that they are being ignored or not listened too. Often this is not the case but rather that one individual or group are not always understanding or appreciating the other's point of view.

"The opposite of a deeply held truth is not a lie but another deeply held truth" - Niels Bohr, physicist

Too often when we have a point of view containing a problem and a solution, we think we only need a strategy to bridge the 'gap'. Resistance to our strategy will come from those with another point of view. And unfortunately at times the clearer one communicates a point of view (problem, solution and strategy) the greater the resistance from those holding the alternative point of view. And so it can be between managers and front line staff.

In the long shadow cast over the NHS by the events at Mid Staffs we have talked a lot about the need for compassion in caring for patients. I like to think of it as bringing the belief in our common humanity to work with us. Using the guiding principle of common humanity we would see the people around us (colleagues) and the patients and families we care for as we would our own families and friends.

I know we don't always succeed. The pressures on staff are immense and the quality of care we provide as a result is often not as good as it should be. But this does not mean that we are not striving to do what is right.

I would also like to take this opportunity to welcome Alison Kelly, who from Monday took up the reigns as our new Director of Nursing and Quality. I am sure over the next few weeks and months Alison will be making lots of time available to meet as many staff members as possible, and that you join me in warmly welcoming her to the Countess.

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From Good to Great - Our Destiny

08/03/13

This week, following the March Board of Directors' meeting, we had another of our quarterly joint planning workshops with our Council of Governors. The theme for this was 'going from good to great'.

There was excellent discussion and raised issues about improving communications with patients, the need for greater patient involvement in their care planning, improving our discharge processes and improved whole system planning. To help us move from good to great, and as part of our integrated care journey, we are planning to include 2 new governor quality metrics to our quality delivery and reports. This is new for the Countess and will help focus future governor workshops.

Many of you will be aware that the Care Quality Commission recently undertook an unannounced inspection visit at the Countess. The focus of the visit was on 6 key areas:

• Patient care and welfare
• Respect and patient involvement
• Medicines management
• Record keeping
• Staffing levels
• Safeguarding vulnerable adults and children

This week we received their report and they have given us a clean bill of health and big ticks in all of these key areas with all standards met. I am absolutely delighted with the CQC report.  On reflection it confirms what we already know about the excellent standard of care delivered in this organisation; and more pleasing still are the excellent comments included in the report from the patients interviewed on the day by the inspecting team.

My last blog shared one of Don Berwick's top ten tips on how the NHS can get better and how we need to build a workforce for the future not the past. Here's more of what he said…

'Strengthen your local health care systems - community care systems - as a whole.What you call "healtheconomies" should become the core of design: the core ofleadership, management, inter-professional coordination, andgoals for the NHS. This should be the natural unit of action forthe Service, but it is as yet unrealised. The alternative, like in the US, is to have elements - hospitals, clinics, surgeries, and so on -but not a system of care. Our patients need integrated journeys;and they need us to tend and defend those journeys. I believethat the NHS has gone too far in the past decade towardoptimizing hospital care - a fragment - and has not yet optimisedthe processes of care for communities. You can do that. It is, Ithink, your destiny.'

Enough said… What would you see as our destiny and what would you describe as the key actions to move the Countess from good to great?

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Changing Gear

01/03/13

Delivering a workforce for the future not the past.

Regular blog readers may remember Don Berwick the American Paediatrician who had occupied one of the most senior healthcare roles in the US. In his speech, during the 60th birthday celebrations, Dr Berwick offered top ten tips for the NHS to get better and I agreed to share some of these.

Here's more of what he said…

Train your health care workforce for the future, not the past. Your workforce needs to master a whole new set of skills relevant to the leadership of and citizenship in the improvement of health care as a system.

It is the same here. The Countess continually looks to improve its models of care and the processes and teams that support them. If we are to provide the best possible patient experience, changing and developing the administration which supports our clinical services is of equal importance.  This is about developing the workforce of the future not the past.

This week we have launched a consultation with some administrative staff proposing a move towards a team based approach linked more closely to specialties rather than individual consultants.  Under this arrangement, it is proposed that medical secretaries will be grouped with medical secretaries from other specialities to create "Practices" which will be led by a Practice Manager. This builds upon the on-going modernisation of clinical admin roles that has been undertaken over the past few years in other parts of the Trust including Paediatrics, diagnostic services and theatres. Models similar to those proposed are operational in Diagnostic and Therapy services at the Countess and in many other NHS hospitals.

I have for many weeks now been talking about our need to change gear and adapt. Change is never easy and not always without some risk; however it is my belief that risks can be managed and providing we are flexible and we keep talking and listening to each other, then nobody needs to be disadvantaged by change.

This is the start of a conversation not the end and no firm decisions have been made. Throughout the consultation there will be lots of opportunity to influence and co-create our final proposals. I would encourage all relevant staff to fully engage with the process. Our experience from doing this before at the Countess is that what finally is implemented is always better as a result. As I said in a previous blog - staff always know best.

There is no magic wand to solve all the problems of the NHS or of the Countess. I do believe however that remembering the reason for the existence of our organisation: improving health and providing good healthcare is vital. Caring with compassion is not always easy particularly at times of change however, whatever role we have in the NHS; it is why most of us come to work.

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A Perfect Week... hopefully

22/02/13

I previously promised to give you a flavour of what a typical week as the Chief Executive of the Countess consists of. Here goes…

Monday…
As relatively new members of the Countess team, Monday saw Duncan and I on our staff induction with a further 60 or so other new starters. We both very much enjoyed the session and as always with these things took something new from the presentations. I have to be honest we left the induction before the end to join 5 of our governors in shortlisting for our new non-executive director vacancies. We had a very strong field and the shortlisting process took some time to complete.

Tuesday…
Was an early start and the first of two trips to London during the week! I was on a 7.06 train arriving at Euston a couple or so hours later. Just as the train got in I had a call to say that the Care Quality Commission (CQC) were in my office as part of their unannounced visit programme. The focus of the visit was on 6 key areas:

• Patient care and welfare
• Respect and patient involvement
• Medicines management
• Record keeping
• Staffing levels
• Safeguarding vulnerable adults and children

They spent lots of time talking to staff and patients on wards 41 and 46 as well in the Paediatric Unit. Thank you to everyone who was involved in this. The early verbal feedback was extremely positive.

The meeting that I attended in London was on the future of small hospitals and was positive too; albeit outlining some pretty tough future challenges. I will pick these up in future blogs. I eventually got home at 9pm.

Wednesday…
Was largely a strategy morning and started with an 8.30am meeting to discuss our options regarding the new build and how to maximise these developments for the future. This was followed by a 'Forward Planning' presentation and discussion with the Planned Care team and then my weekly team meeting with exec directors.

Meanwhile…

The assessors from the NHS Litigation Authority were on site undertaking their assessment for NHSLA Level 3 for acute hospital services - essentially a quality and safety kite mark.  We were given a truly amazing score of 49 out of 50. Both external assessors said the score was outstanding and were full of praise for all the hard work required to deliver this standard. A sincere thank you to everyone involved for their hard work and dedication.

The day ended with a joint meeting with our partners at CWP and the local CCG to discuss integrated planning and funding proposals for delivering integrated healthcare across West Cheshire.

Thursday…
Was another early start on the 6am train to meet with our regulators Monitor. The regulation framework changes from April and this was an opportunity to hear how this will impact on the Countess. I arrived in London at 8.30am and this time no phone calls. This session was helpful and presented another set of interesting challenges - more on this to follow. I eventually got home at 9pm.

Friday…
Was all about partnerships and celebration. Celebration first… Duncan and I had the opportunity to thank a cross section of staff that had led our successful NHSLA level 3 work. Inevitably success like this involves a whole team effort; however, I would wish to single out one key individual who without her leadership and hard work success would probably never have been possible. That person is Maryellen Dean.

The rest of the day was spent at a range of meetings discussing plans and opportunities for service developments with local partners.

Last week I asked you what would be your perfect week. Following all of the difficult news relating to the publication of the Francis Report recently, this week feels like a pretty perfect week at the Countess. Better still if the England rugby team can beat the French at Twickenham on Saturday.

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