Improving Together: Putting our service users, families and carers at the heart of everything we do
The last couple of weeks have continued to be very busy with lots of joint work with system partners, leading the continued development of our improvement programme and continuing to listen to the voice of service users, carers and families.
As always, I want to share a few updates from my perspective and will align these to our four Trust wide priorities, improving health, improving care, improving culture and improving value.
Improving Health
As part of our programme focussing on learning from deaths, I have chaired a ‘call-to-action’ meeting three times a week. As a Trust, it is vital we make sure our legacy deaths report is given the same focus and attention as our ongoing work to collect, analyse and publish our latest quarterly data on learning from deaths. We have made very good progress; our full legacy learning from deaths report, covering data from 1 April 2019 to 31 October 2023 will be published as part of our papers for Board of Directors meeting in public on 25 July 2024. We will make sure we brief all our colleagues before you hear about it in the local media.
The amazing amount of progress has only been achieved by very many of our staff who have volunteered to help from right across the Trust. Many clinicians, managers and administrative staff have given so very much to the programme and worked over weekends – I am so incredibly grateful to you all. I am also so very grateful for the amazing support from our partners, primary care, both local authorities and both ICBs have been so very supportive and really helped and supported the Trust, again I am truly grateful.
This week is our Board of Directors meeting in public and one of the key items on the agenda is our final Trust wide strategy, 2024-2029. Our five year strategy has been refreshed to incorporate our new strategic framework and I am really pleased we have included, as part of our strategy development, wide-ranging stakeholder engagement with our new strategy. We will be working with you to develop our enabling strategies, and, I want to hear your views to help us shape our future. We will be inviting our partners, our staff and service users, families and carers in different forums to contribute views; please watch out for news on these engagement events soon.
Last week, our Oversight and Assurance Group meeting took place, with our partner organisations present including NHS England, our Integrated Care Boards, the Care Quality Commission and the voluntary sector. We presented our improvement and transformation work across our Trust, providing assurance to partners on our progress in delivering our large-scale strategic improvement and transformation programmes.
Improving Care
On 14 May 2024, I met with Norfolk and Suffolk MPs in London with our Chair Zoë Billingham, our Director of Communications and Engagement, Rebecca Driver and our Governance and Safety Adviser, Gary O’Hare, well as our Integrated Care Board Chairs and Chief Executives. Members of the Campaign to save Mental Health Services in Norfolk and Suffolk, in London were also present.
The meeting provided us with an important opportunity to meet with MPs to share and discuss in detail our recent progress, receive feedback from MPs and share some key highlights which show a number of areas of improvement that impact on all of our Trust wide priorities.
Over the last 12 months, we have seen a net increase of 62 nurses, a net increase in 22 Doctors in last year and our medical vacancy rate has reduced from 26.5% to 10.5%. In addition, our overall Trust wide vacancy levels have fallen to the lowest they have been in the past five years, down from 20% to 17.5% and our staff turnover has reduced from 17% to 12% and remains consistently under target. Whist this is showing a trajectory of improvement, I am also very aware that for our staff working in our clinical services, in teams that have had long standing vacancies, we need to make much more progress.
I am pleased to report that we continue to make good progress with our Care Quality Commission (CQC) must dos and should dos as a Trust. We have completed 23 out of 30, 77% of our must do actions, along with 21 out of 23, 91% of our should do actions. We are moving to a culture of more proactive leadership, improving the quality of care and not relying on the CQC to identify areas for improvement. Our Trust provides 11 core services and I am delighted that as part of our listening into Action programme, each core service will have a triumvirate of leaders who will work with teams to develop improvement plans. Our launch event takes place very soon which I am looking forward to attending
Last week, we were visited by the Health Services Safety Investigation Branch (HSSIB) as part of their national engagement programme. The visit was led by Nichola Crust, Senior Safety Investigator at the HSSIB. She was accompanied by a colleague from the HSSIB and an observer from the Department of Health and Social Care, who attended to observe HSSIB staff. I am pleased HSSIB wanted to come to our Trust and see firsthand, some of the improvements we are making.
The HSSIB wanted to visit for two reasons; following the concerns raised by the Independent Grant Thornton report and the important work our Trust has subsequently undertaken to significantly improve our work on mortality recording and reporting. Nichola and her team saw first hand how we are working with our bereaved families to directly influence and inform our mortality reporting by attending and hearing the discussion at our monthly Learning from Deaths Action Plan Management Group meeting.
Last week, myself and our Chair Zoe met with the Norfolk Community Foundation – delighted that we will be working with them as part of our new NHS Talking Therapy service model in Norfolk and Waveney. They will support us in developing local voluntary sector partnerships to improve access to Talking Therapies from targeted communities. I also met with the Green Light Trust and was blown away with the work they are doing to support service users and carers through a really impactful and innovative model as our voluntary sector colleagues are vitally important to us as an organisation and really enhance the service user and carer perspective.
Improving Culture
You will remember that I mentioned in my blog a couple of weeks ago that we had an important event where our new Listening into Action (LiA) pioneering teams came together to define what they will focus, based on what you told us. I am really pleased and delighted that Priscilla and our teams are doing a great job to really motor this. Our 17 pioneer teams are as follows:
Linked to Improving Health
- Reducing the waiting list in Eating Disorders Services
- Aiming to complete Dementia (Memory) Assessments within 18 weeks
Linked to Improving Care
- Think Family – a whole family approach to meet the needs of our service users
- How to ensure good record keeping
- Care plans and risk assessments – promoting a co-produced care plan and risk assessment with the voice of our service users
- Trust wide improvement of quality of our 11 core services
Linked to Improving Culture
- Creating a development pathway for administrative colleagues
- Improving leaders – developing a strategy and development programme for our leaders
- Listening to our medics – improving their working lives
- Enhancing the quality of Clinical Supervision
- Ensure high quality Appraisals
Linked to Improving Value
- Provide IT/Digital services that can help people to do their job better
- Maximising our estates – improving clinical spaces and parking facilities
- Streamlining procurement processes
- Simplifying recruitment
- Communicating effectively – better staff and clinical directories.
Improving Value
We have many challenges ahead to deliver a significant efficiency programme this year of £17.4 m which equates to 5% of our turnover. There is an expectation across the NHS for this scale of efficiencies to be made. We must work closely with our Integrated Care Boards to ensure we have plans in place to meet this challenge. We have submitted a plan which forecasts a break-even position for 2024-25. Whist this is a big ask, I am really impressed with the level of engagement and leadership that has been demonstrated so far. We have 12 programmes that have been established where we have real opportunities to transform and improve efficiency and value
We have established a Trust wide efficiency board which I chair, which is overseeing this important work on a bi-weekly basis.
It was good to meet up with Chief Executives last week across the Midlands and East of England in Leicester. We spent time focussing on best practice and sharing learning about preparing for inquests and on national long term plan priorities including the new in-patient model set out in the NHS England commissioning framework for mental health inpatient services. The helpful image below sets out what we need to achieve nationally; we are already embedding this into our future ways of working as a Trust.