It was recognised in our recent CQC report that we put patient experience ‘at the heart of everything’. However, we know that a lot of challenges remain, and we need to continue on our improvement journey.
Impact features the improvements we are making together, as part of Getting to Good, to ensure every patient receives the best care and has the best experience in our hospitals.
You will be aware that we have launched our Urgent and Emergency Care Transformation Programme to improve patient pathways and minimise the time they have to spend in an acute hospital. Urgent and emergency care is everyone’s responsibility, both Trust-wide and system-wide, and we all need to work together to ensure we consistently deliver the best care for our patients and their families.
We will continue to work with all teams, and with our wider health and care partners, over the next 12 months. You can read more on page 4.
After months of planning and construction work, our fantastic new planned care hub at PRH has opened for patients. This is a really exciting new chapter for our organisation and enables us to provide high quality elective care in a dedicated purpose-built facility, all year round.
An incredible amount of work is happening across our organisation to improve patient outcomes and their experience of care in our hospitals.
Importantly, this will support our elective recovery programme. Patients waiting for day case procedures will have much shorter waits and will be treated in a modern and spacious facility. It also means our teams will have a great environment that they helped to design, and are proud to work in.
Since opening, we have welcomed both adult and paediatric patients, and the feedback so far has been extremely positive. A huge thank you to all our teams and colleagues who have been involved developing this facility. You can read more on page 14.
You will also be aware that our new Community Diagnostic Centre at Hollinswood House in Telford is now fully open, supporting our ambition to make healthcare services more accessible for our communities.
Since it opened in October last year, nearly 60,000 patients have used Hollinswood House for blood or diagnostic tests, and for cardiorespiratory or renal services. This is a fantastic milestone and means that fewer patients are having to travel to a busy hospital site for their care.
A number of our colleagues have been working behind the scenes to improve our patient letters and make the information we share more accessible and easier to understand.
In the NHS, the language we use can often be confusing for our patients. This can result in missed appointments, wasted medication or misunderstandings about where to go for care.
The team has worked closely with patient representatives to review and standardise thousands of letters – reducing the number from 7,000 to 150. This is a brilliant achievement and will make such a difference for our patients and colleagues. You can read more on page 12.
Thank you.
Dear colleague,
MESSAGE
Mary Aubrey Getting to Good Programme Director
Through our transformation programmes, we are continuing to make good progress on our Getting to Good journey to improve care and experience for our patients.
A huge thank you to our colleagues and teams who are driving forward improvements in their areas both for their patients and colleagues.
There have been a number of highlights within our Getting to Good programmes this month, including:
• The roll out of up-to-date cloud-based applications, Office 365, across the organisation as part of our digital transformation programme. Being equipped with the latest tools will enable colleagues to do their jobs more efficiently and effectively. This has now been deployed to 5,440 devices and 8,126 users, and will soon become business as usual for new starters.
• The introduction of the cardiorespiratory service at the new Community Diagnostic Centre (CDC) in Hollinswood House, Telford. The new facility is now fully operational, which is fantastic news for our patients. You can read more about the CDC and how it is helping us to make care more accessible for our patients in the next edition of Impact.
• The opening of our planned care hub at PRH which is providing dedicated space for elective day surgery with four operating theatres, along with stage one and stage two bedded recovery
areas. Thank you to our booking and scheduling team which is working differently to ensure that every available theatre slot is utilised.
• Changes in process of following up paediatric patients post emergency attendance as part of our Emergency Care Transformation Programme. This has resulted in strong improvements with 100% of patients now followed up within 48 hours and 85% followed up within 24 hours. A Standard Operating Procedure (SOP) is in place and is being monitored by the Corporate Nursing Team for assurance. You can read more on page 4.
• An improvement project to reduce deconditioning in patients on Ward 26 at RSH. Following a 90-day review, this work is showing sustained reduction in length of stay and supports better recovery for our patients.
Thank you for everything you are doing.
UEC IS EVERYONE’S RESPONSBILITY
Our ambition as part of our Getting to Good journey is to provide high quality urgent and emergency care with the best outcomes and experience for our patients.
To do this we are determined to improve the hospital journey for every patient.
This will reduce waiting times for our patients to receive the care they need and enable them to leave the hospital when they no longer require acute care.
Our Urgent and Emergency Care Transformation Programme is driving forward improvements and will involve every colleague playing their part.
Sara Biffen, Acting Chief Operating Officer, said: “We understand the challenges we have in urgent and emergency care, and we are determined to continue to work together across all teams, and with our health and social care partners, to consistently deliver the care, compassion and dignity we strive to deliver for our patients.
“This is not just about our emergency departments. It is a Trust-wide and system-wide issue that needs a collective commitment and targeted effort across all services, as improving urgent and emergency care is everyone’s responsibility.”
Through future editions of Impact, we will be highlighting some of the fantastic work that our colleagues and teams are doing.
This will include how we are reducing length of stay on our wards, preparing our patients to go home earlier in the day, improving our ward rounds, focusing on the important role of our Portering Team in transferring patients and how our pharmacy colleagues are supporting patients to be discharged.
We have already been making steady improvements in urgent and emergency care over the last 12 months through our Emergency Care Transformation Programme.
This includes improving time to initial assessment for both adults and children arriving in our emergency departments, as well as improving the processes for follow up procedures post emergency attendance.
As part of our transformation work, our teams have been focused on achieving a target of 80% of all paediatric patients to be triaged within 15 minutes of their arrival in our emergency departments.
This included the relocation of some urgent treatment services to the Mallings Building to create a second dedicated children’s triage room at PRH.
A new process is also now in place for following-up children post emergency attendance. Their notes are now being reviewed by the lead paediatric nurse with sign off on any follow up actions by a consultant. This has resulted in 85% of children having been followed up within one day.
“We all have a part to play to improve the urgent and emergency pathway for patients and support our colleagues working in the emergency departments. Over the next 12 months, this will continue to be a Trust priority. We will need all colleagues in all roles to play their part and contribute to an improved UEC experience for our patients.”
Dr John Jones, Medical Director
We have launched our Stronger Together campaign which will be focusing on what our teams are doing in their areas to improve the patient journey and experience through our hospitals. These will be featured in future editions of Impact.
• What are you and your team doing to improve the hospital journey and experience for our patients? Share how you are doing your bit by contacting our colleagues at sath.strongertogether@nhs. net or consider becoming a UEC champion to help spread the Stronger Together message across our organisation.
• If you would like help with an improvement idea, please contact our fantastic colleagues in the Improvement Hub for their support – sath.improvementhub@nhs.net.
Compassionate care for everyone
We have piloted a new transfer team which takes patients to the discharge lounges when they are ready to go home.
Not only will this to support the flow of patients through our hospitals, it also gives back time to nurses for patient care.
Discharge lounges are comfortable spaces for patients to complete the discharge process away from busy ward environments. This in turn helps to free up beds for new admissions, reducing waiting times for patients in the emergency departments who need to be admitted.
The improvement idea from our portering and logistics colleagues was to create a dedicated team that would transfer patients to discharge lounges at RSH and PRH, supported by an agreed process. Previously, nursing colleagues would do the transfer of patients, and this meant they were away from their wards.
The plan was to establish a small pool of porters to undertake patient transfers and carry out a test of change to see the impact it would have. Ward
colleagues who need the team to transfer a patient would log the call via the teletracking system.
The test of change took place over three months during which further adaptations were made, including using healthcare assistants (HCAs) as well as porters. It also meant that when HCAs were not involved in transfers, they were able to support nursing colleagues in the discharge lounge.
During the trial, hundreds of patients were moved during 56 shifts across both hospitals, freeing up more than 180 hours of nursing time.
Due to the success of the trial, a business case is now being prepared to ensure resources are in place so the service can continue.
Ian Morris-Jones, Portering and Logistics Manager, said: “The plan is to continue providing the resource to the discharge lounge as it has demonstrated a significant increase in time back to nursing colleagues to put into patient care, as well as supporting improved patient flow.”
“We know that we cannot work any harder but we can work differently and more efficiently. To do this, we are looking for everyone’s support and ideas, so we can make a difference for our patients waiting for a bed or waiting to go home. We will be stronger if we work together.”
Hayley Flavell, Director of Nursing
GETTING IT RIGHT FIRST TIME
A key priority on our improvement journey is continuous learning so we can provide high quality treatment and care to our patients.
Our organisation is currently working in partnership with colleagues at Getting It Right First Time (GIRFT).
GIRFT is a national programme that undertakes clinically-led reviews of different specialties, examining how things are currently done and how they can be improved based on best practice. The aim is to improve efficiency and capacity, reduce waiting times and improve outcomes.
The Heart Assessment Team has been part of the GIRFT programme over the last 12 months and is seeing some fantastic results.
The team supports the management of heart failure patients, helping them to avoid a hospital admission or reducing their stay in hospital by faciliatating early discharge.
They hold nurse-led clinics to optimise medication and review urgent decompensation of heart failure symptoms. They also provide an extensive cardiac rehabilitation exercise and education programme to help patients recover following a cardiac event.
Heart failure and cardiac rehabilitation services
were being delivered across both sites, but the services offered were limited due to inadequate staffing levels and the misalignment of resources.
The team had also been struggling to recruit into some senior nurse positions, which resulted in clinic cancellations or reduced numbers of patients seen in clinic. This then impacted on inpatient and outpatient reviews which were often delayed.
Following a review, the nurse-led heart failure service was relocated to the dedicated Heart Failure Unit at PRH, and the Cardiac Rehabilitation service was moved to the Cardiac Rehabilitation Centre at RSH.
There has also been an increase in the number of nurse-led clinics that are taking place which is to improve care for patients. This will also support plans to further develop the virtual ward pathway - meaning patients will not need to be in hospital for their ongoing care.
“With these changes in place we will be able to deliver a more structured Heart Failure Service at PRH, facilitating delivery of a comprehensive inpatient, outpatient and urgent day care heart failure service. The increase of routine nurse-led clinics ensures patients medication can be optimised more quickly to promote the best outcome for them and will offer the opportunity to pursue further development around heart failure virtual wards and the introduction of an IV diuretic service.
“Karen’s hard work and determination to not only improve the heart assessment service for the patients, but also to support the wellbeing and progression of her staff, is amazing. It is just the beginning of an exciting journey for cardiology.”
Dr Laurence Ginder, Associate Medical Director
Karen Robinson, Heart Assessment Team Manager, also reviewed the team’s skill mix, and made changes to better suit the needs of the service.
Karen said: “After reviewing our skills mix it was clear that we needed to re-band some positions and use our budget more effectively. The idea was not only to provide a better service and better care for our patients, but also to offer more progression for our existing colleagues.
“It also meant we could look at relocating some of the services we
delivered to either PRH or RSH.”
She added: “I believe that despite having limited resources, it is important to always look at what cost effective changes can be made to the service to make it more efficient for the benefit of our cardiology patients, but also to support the health and wellbeing of my team members.
“There is always the need to seek additional resources, but if you make sure that what you have in place initially is effective and efficient then you have a foundation on which to build for future success.”
Caring
FUTUREPROOFING OUR WORKFORCE
A key priority on our improvement journey is developing and futureproofing our medical workforce so we are consistently providing high quality care to our patients.
One area of focus has been the introduction of the specialist role in 2021.
Our aim was to reduce the number of doctors on extended fixed term contracts and to recognise the important contribution, skills, knowledge and expertise of our doctors by promoting the specialist role as a potential career choice.
SAS doctors (specialist, associate specialist and specialty doctors) are an essential part of the medical workforce and is an alternative to becoming a consultant or GP.
The roles offer an opportunity for doctors to focus predominantly on providing direct patient care without having to rotate, leading to more regular
working hours. SAS doctors can also work in a chosen sub specialty.
Our Medical People Services colleagues found knowledge and understanding of the different SAS grades was limited which meant the benefits and opportunities they represent for the organisation and for medical and dental staff were not being fully realised.
The focus was therefore on raising the profile of the specialist roles and how they integrate into our services, as well as the difference specialist doctors make to the care we provide to our patients.
“The NHS has always relied heavily on SAS doctors. The nature of these posts has changed and in recent years the level of expertise and seniority in these roles has been recognised with the development of the role of the Specialist doctor. The benefits for our patients are evident. Providing the best possible specialist care is a high priority for us. SAS doctors including the specialist posts provide us with the expertise and continuity to enhance our ability to fill senior positions that can be hard to fill through more traditional appointment routes.”
Dr John Jones, Medical Director
This included:
• Enhanced advice and guidance on the benefits and opportunities the reform presented to operational and clinical teams
• Evaluating existing specialty doctors, and assessing eligibility to progress to the specialist grade
• Internal and external recruitment campaigns to increase uptake
• Offering doctors the opportunity to apply for a specialist contract, where appropriate
• Review of NHS locum consultants and offering the opportunity to remain at the Trust by taking up permanent specialist roles, thus reducing the burden of visa applications and providing stability in the workforce.
• Introducing the SAS advocate role as a voice for our SAS doctors to drive improvements. SAS away days are now run on a regular basis to build experience, network and to recognise the alternative career pathway for medical and dental staff
• Introduction of consistent salary recognition for international candidates
• Continuous support for specialists to become future consultants for those working towards a portfolio pathway
As a result, we have increased the number of specialist grade doctors and we have been recognised by NHS Employers for recruitment and promotion of specialist doctors in a national case study.
Where are we now?
There are now 139 SAS doctors in post compared to 101 at the end of 2022/23. We have:
• 101 specialty doctors (compared to 70, 2022/23)
• 25 specialists (compared to 18, 2022/23)
There have also been a number of successful appointments to long-term hard to fill positions including specialists in gastroenterology, stroke and obstetric anaesthesia.
“I came from Saudi Arabia and joined the Trust as a speciality doctor a year ago. I work in SDEC/ AMU and it has been beneficial for me because I am working in the same area and do not move around all the time.
“I think this also helps with the care of patients as I am predominantly here in SDEC/AMU, therefore, I am used to my surroundings and how the department works.”
Dr Muhammad Sadiq, a Speciality Doctor working in Same Day Emergency Care (SDEC) and Acute Medical Unit (AMU) at PRH
Dr Katie Shellis is a Specialist Doctor in Palliative Medicine, and she is also an advocate for the Trust’s SAS doctors.
Katie became an SAS doctor when she found it difficult to be in rotational training whilst having a six-month-old baby.
“I felt that my career was over. I then took a specialty doctor’s post in a hospice 11 years ago and found that palliative medicine was the best career for me. Becoming a specialist doctor at the Trust has given me stability, a team and has let me settle and grow and that really suits me, my personality and family circumstances,” said Katie.
Katie started her advocate role two years ago and is a ‘voice’ for the SAS doctors to support their development and health and wellbeing. She also organises development days which are open to all SAS colleagues.
She said: “I love being able to support others, particularly the new specialty doctors who are just learning about the contracts and the changes from being a doctor in training to an SAS doctor. It is a really nice role.
“The biggest part for me is to get the doctors
away from their wards and enable them to have space as a group to develop networks so we can support each other better. We have an opportunity to nurture our own specialty doctors and ‘grow our own’ specialists or support them through Certificate of Eligibility for Specialist Registration (CESR) or the portfolio pathway.
“Investing this time will allow us to develop our own autonomous workforce which will work similarly to consultants. In an ideal world, we would all go through a training programme and become consultants, but that doesn’t fit everybody.
“To enable everybody to have a meaningful career, we have to think more laterally as we are now in a different era, and we need to have a focus on worklife balance.”
Opportunities for the future:
• NHS Long Term Workforce Plan –offering career development for Locally Employed Doctors (LED)
• SAS doctors in leadership positions –signs of good practice at SaTH
• Further integration of specialists into medical and dental workforce to support alternative roles for our hardto-fill positions
• Promotional opportunity to showcase future career development at SaTH
• Improved retention of SAS doctors
• Developing SaTH as an exemplar internal training organisation
“We wanted to offer a career opportunity for medical and dental staff and to value and recognise the important contribution SAS doctors make to our workforce and to the communities we serve.
“The introduction of the specialist grade in 2021 enabled us to look at the benefits and opportunities at SaTH, so we developed our offer and implemented a number of actions.”
Matt Dimmock, Head of Medical
Services
PATIENT CENTRED CARE
Involving our patients and giving them a voice in shaping our services and how we deliver them is vital to providing patient-centred care.
We have been working with our patients and colleagues to ensure that the health information we are sharing is accessible to everyone.
The successful implementation of CareFlow Patient Administration System (PAS) was a major milestone in our Getting to Good digital transformation programme.
Behind the scenes, multi-disciplinary teams worked together to ensure that the system configuration was aligned with best patient experience. This included a review and standardisation of all inpatient and outpatient letters to be sent from the new system.
With approximately 7,000 different letters active in SemaHelix, a more standardised and consistent approach to the production of patient letters was needed.
To do this, a Letters Task and Finish Group was established to provide assurance that the letters generated in CareFlow and sent to patients were fit for purpose and met the requirements of the accessible information standard (AIS).
The group membership was formed to reflect the diversity of people involved and impacted by the production of patient letters. This
included representatives from teams, patient representatives, divisional colleagues and patient access and digital services.
At the core of the group were members of the Patient and Carer Experience Panel. The patient representatives looked at examples of existing letters and produced guidelines and rules for the new templates to follow.
Thanks to patient input, the letters for inpatient and outpatient activity in CareFlow are now standardised across all services, with specific templates for each process such as booking an appointment and creating a follow-up.
It has also reduced the amount of letter templates in the patient administration system from over 7,000 to under 150.
All letter templates now follow a specific set of design principles such as logo placement, font sizes (which can be altered depending on the presence an AIS patient alert) and contain the essential information required. This aims to increase readability and accessibility of the letters, making them clearer for the person receiving the letter.
“Looking at health literacy statistics nationally, more than four out of 10 adults can routinely struggle to understand health information. This can lead to missed appointments, wasted medication, incorrect preparation for procedures and misunderstanding signposting.
“It is vital that we make our information as accessible as possible to increase the overall patient experience.”
The Letters Task and Finish Group is now embedded within the Trust, providing a futureproof approach to letters standardisation. You can contact our Patient Experience colleagues at sath. patientexperience@nhs.net. They meet every other week to review new letter requests and requested changes to existing letters.
The group must approve any changes before the Digital Team will action requests. This ensures that changes are managed centrally, with patients at the forefront of decisions.
Louise is also increasing awareness of health literacy across the Trust by facilitating colleague
sessions with patient representative Lynn Pickavance. During these sessions, Louise delivers contextual knowledge and examples as to why the language used in clinical settings is so important.
If you would like Louise to attend a session with your team, you can contact her at l.stevens@nhs. net
Louise has also been asked to share the work undertaken by the Letters Task and Finish Group to other Trusts, as well as the National Health Literacy Organisation, as an exemplar approach to patient experience.
PLANNED CARE HUB
Our fantastic new planned care hub at PRH is open and will ensure that our day surgery patients have shorter waiting times for their operations.
This modern facility, with four theatres and dedicated recovery beds, will support the delivery of an additional 3,600 extra day cases per year.
This is fantastic news for our patients who will have shorter waiting times for their procedures.
It will also support our ongoing elective recovery programme, which is a key priority on our Getting to Good journey.
The first patients were seen in the hub in early June – including paediatric patients.
Clare Marsh, Matron for Day Surgery, said: “The hub is a wonderful purpose-built facility that provides a modern healthcare environment for our patients coming in for planned day surgery.
“This will improve the overall utilisation of theatres, which is a key part of Getting to Good, improve patient flow and patient experience.
“As this is a new facility, we are engaging with our patients daily and asking for their valued feedback so that we can continue to improve and shape the services that we provide to our patients.
“We have received excellent feedback from our patients in the first weeks.”
Jayne Hunt was the first patient to undergo treatment in the hub.
She said: “The new hub is amazing. Right from the offset, I was well looked after and kept informed. It is a great facility and I’m sure that every patient after me will have the same opinion.”
The hub is multi-specialty providing gynae, vascular, ophthalmology, breast, upper GI, ENT, maxillofacial and general surgery.
There are:
• A dedicated admissions area, with individual patient pods
• Four modern theatres – two of which are laser proof which will allow for a more varied case mix
• 24 stage one and stage two recovery beds
“The new hub will play an important part in our elective recovery programme. We will be able to substantially increase the number of operations that can take place which means that our patients will benefit from much shorter waiting times for their treatment in an improved healthcare environment. This dedicated facility will be open all year round, despite seasonal pressures, which is great news for our patients. A huge thank you to all our colleagues who have worked so hard over the last 12 months to shape a new healthcare facility that we can all be proud of.”
Sheila Fryer, Deputy Chief Operating Officer
In our next edition we will be focusing on:
• Our priorities for the year ahead
• How our teams are helping to improve urgent and emergency care
• The improvements we are making for children and young people
• The steps we are taking to be a more inclusive organisation
