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April 15th 2016

Gavin Boyle
One of the highlights this week has been the time I’ve spent with our Hand team, based down in the KTC. The service has an excellent reputation as a provider of really good quality care. I’d heard a bit about them before I joined the Trust and so was really looking forward to meeting them. I was looking forward to learning more about their innovative work and their multi-disciplinary approach. So first thing on Monday morning Jo Ludlow Lead Practitioner took me down to the unit, got me changed and hustled me into an anaesthetic room. There I met Consultant Anaesthetist Dr Puneesh Tandon, who was carrying out a regional block on a patient in preparation for their procedure. I was interested to see how ultrasound is used to guarantee we ‘hit the spot’, which has led to the vast majority of hand procedures now being carried out without the need for general anaesthetic. This is great news for patients. It meant I was able to enjoy chatting with the patient during his procedure, and learn more about how he found the experience overall. 


Next, I went into theatres with Chris Bainbridge, who was carrying out this patient’s Dupuytren’s procedure to release a finger contracture. Chris told me the operation was named after Napoleon’s surgeon, who apparently pioneered the technique and also earned much esteem by treating the emperor’s haemorrhoids. You learn something new every day!

Later in the week I spent time with Sarah Balmforth in Hand Outpatients, and Sarah Burke, Hand Therapy Team Lead. As they showed me around I saw lots of great examples of innovation, including the integrated working of OTs and physios to provide a seamless therapy service, the provision of in-clinic fluoroscopy for quick diagnosis and treatment and more…  It was a great opportunity to see how a multi-disciplinary team can deliver fantastic results for patients.

Also this week I met a very powerful group! – the senior sisters, matrons and midwives from Integrated Care - who invited me along to one of their team meetings so they could get a good look at me and put a face to the name. We had a good conversation about the challenges facing their services, particularly midwifery, following the National Maternity Review. There were lots of good ideas about how we can respond positively and build on what is already an extremely good service for our mums.

We talked about partnership working and how we could improve our links with other units, but also developing our relationship with other services locally. We also spoke about the importance of supporting and developing our people as a key enabler to delivering better care.

Keeping to the quality theme, we had the Quality Committee meeting this week, which was ably chaired by Pat Coleman, one of our non-executive directors. This is one of the committees of the Board which makes sure we stay focused on providing quality services for our patients.

We began this month with a fascinating patient story, delivered by a lady who received cancer treatment with us. There were lots of positive aspects to her story, particularly in relation to how she was treated by staff and the caring attitude she experienced. However, there were some lessons to be learned. The thing which struck me most was how communication can really contribute to the patient experience or not. I’m sorry to say that in this instance our communication could have been much better, both in terms of explaining and managing the organisation of her treatment but also on a face-to-face basis. I think it’s something we all need to really focus on as part of our jobs to improve.

The other thing I learned was that sometimes disorganisation within our hospitals can lead to issues for patients. In this case, this led to the lady spending a number of unnecessary days in hospital. I think this is particularly important, because staying in hospital is not without risk. If patients are staying unnecessarily it’s not really in their best interests, but also, as we remain extremely busy keeping up with increased admissions we clearly need to make sure patients don’t stay if they don’t need to be here. So acting as an advocate for patients when things are delayed is important – let’s value their time and not be complacent when there’s a hold up.

Another interesting item on the agenda was the impact of human factors, and how we can design our services to help protect patients from risk, taking into account the fact we are all human beings and prone to making mistakes from time to time. We also looked at technology, and made the point that although it can be a real benefit to improving safety, it can sometimes have unintended consequences which we need to understand and guard against. For example, one of the real benefits for patients is the use of infusion pumps for pain management. However, it’s really important that we try to standardise as much as we can and ensure all our staff are properly trained so we minimise risk for patients.

Finally, Friday kicked off with a performance review meeting with Monitor the FT regulator – always a great end to the week! That said, I think we have a very good relationship with our regulators, and we have a ongoing dialogue which means I suspect there will be no surprises for them, and many positive things for us to share. For example, after starting the last financial year with a planned deficit of £33m, we have finished the year having reduced this to £25m, which was part of an agreed plan with Monitor. Next year we’re aiming to reduce the deficit further to £11m, with some transformation funding. Clearly that funding comes with a number of conditions and requirements, but I feel there are signs we’re moving in the right direction to restore our financial health and gain greater independence as a result.

And really finally! I caught up with the For-Ward event this morning a rapid improvement programme aimed at developing better multi-disciplinary working on wards, developing and supporting our people better and releasing more time to spend with patients. It’s a great initiative and I applaud my colleagues for getting involved. Taking some responsibility for the finding solutions to our challenges – now that’s what I call leadership!

All the best 

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