Thank you all for the welcome back! The past fortnight has been an eventful one, as always. I hope the following is of interest

 

 

Salmonella outbreak

 

As the Confederation Conference was drawing to a close, I received notice that we had seen several patients with Salmonella infection at Heartlands Hospital. Over the following weekend it became clear that we were dealing with an outbreak, something that is pretty unusual in a hospital, despite the prevalence of this organism in the community

Containment measures were implemented, and the affected patients isolated. All manner of environmental testing was conducted, led by our Director of Infection Prevention and Control (DIPC) and supported by the Health Protection Agency. I cancelled my attendance at the Dalton Review on Tuesday and we put in place our Serious Incident procedure, with the Medical Director chairing an Outbreak Committee

At the time of writing some 30 people have been affected, including community cases, with several developing a bacteraemia. There are 10 patients still in hospital, and 5 staff members have been affected. It looks like the outbreak originated in the community, not the hospital, although we have seen some cross-infection after it was brought into Heartlands. I am told we can expect the outbreak to last around a fortnight, so hopefully we will see it wane during the coming week

 

NHS staff are great in a crisis, and this is no exception. At a time when activity levels are very high, our infection control team, our nursing staff, and many others have responded magnificently to contain something that could have spread much more than it has

 

Reconfiguring our special surgical services

 

Part of our planning for the future involves concentrating the in-patient and specialist aspects of our surgical services on a single hospital site, and the Trust Board gave the go-ahead to this last week. With three hospitals, we cannot meet future standards if we do not concentrate scarce resources, both people and equipment. The number of junior doctors in these specialties is reducing, and we must move to 7 day service provision, so it is imperative we act to ensure we maintain sustainable services that are provided locally

We will consult with the staff and public during the autumn, and this process will allow us to discuss, in more detail than before, the future shape of each of our hospitals. My sense is that members of the public, as well as staff, are more concerned with the future of the whole hospital than with individual services

Inevitably there has been discussion in the press already. We cannot plan without involving our staff, and we cannot (and would not wish to) prevent them talking about the proposals outside of work. I look forward to the consultation when we can correct any misconceptions, and discuss and debate what we feel are a sensible set of proposals that will help us keep as wide a range of services within our part of Birmingham and Solihull as possible

We held a day long session with our clinical teams this week to start the next phase of planning. Change is unsettling for staff, of course, but standing still is not an option. This is a daunting programme of work, and one we must pursue while constantly explaining why change is necessary, and how the new arrangements will work. Both I, and my Medical Director, challenged the assembled to work with us to ensure we get this right for everyone

 

The new CEO of NHS England recently started a debate about how we use our smaller hospitals. Two of ours fall into this category, and we think we have found a formula that keeps them viable and able to cater for the large majority of the needs of the communities they serve

 

NHS Confederation Conference, Liverpool

 

A different tone this year. Well attended and with a tangible sense of hope and even optimism, tempered by recognition of the undoubted challenges facing the service. The new CEO of the Confed, Rob Webster, opened the conference with a very personal speech, talking about the 2015 Challenge and a future based on values, purpose and people. He quoted a poem by Adam Bojelian, which was a truly moving moment. I for one am following Adam on Twitter now!

It was Simon Steven’s first conference as CEO too. He delivered a high velocity, detailed and impressive discourse and gave a clear sense that we now have a very different leadership at NHSE. I was live tweeting, and noted some particular quotes he made. He said ‘I want to see an NHS which is more flexible and more adaptable’ and he promised ‘direction without dictation’. He said that ‘a single national roadmap (for the NHS journey) would not be appropriate’ and he opined that ‘medical training and staffing should not drive service configuration in small hospitals’, comparing this to the ‘tail wagging the dog’. You can read a transcript of this important speech here on the excellent Health Policy Insight website

He was pragmatic, ending by reminding us that ‘our problems are soluble, but they won’t solve themselves’. A thought provoking speech, prompting the following tweet from me at the finish

 

 

Another first for the conference was a talk at the plenary by Dr Patrick Soon-Shiong. A doctor and true polymath, he gave an astonishing account of his work in the field of cancer, information technology and the human genome. The word ‘innovative’ is used a lot, but this is innovation on a scale that is hard to comprehend. There is lots on the web but the website of his Healthcare Transformation Institute is a good place to start if you want to read more – I would  not dare try to precis what he said for fear of demonstrating my lack of understanding!

 

Here is the poem that Rob Webster quoted – written by Adam for the Conference and now on his website. Wise words for one so young, and can you spot what the first letter of each line (after ‘A good leader’) is spelling?

 

Five year plans

 

Just finalising these now for submission later this month. Ours has 4 main elements:

  • safety and quality – a range of new initiatives including a senior team that is much closer to day to day delivery
  • acute medicine  – transformation to a shorter stay / ambulatory model of care
  • surgery and specialist care – concentrate the in-patient aspects on a single site, while keeping frequent visits local (as discussed above)
  • our hospitals – clarify the role and functions of each hospital, so that all three are sustainable and cater for local need

 

Attention is currently focused on the numbers, and on achieving alignment with commissioner and other provider plans. Once submitted I will share more thoughts

 

 

 

 

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