Making it all add up

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Families from across Wales attended the ceremony.

Last Friday saw the opening of a very special memorial in the grounds of UHW. It is part of a number of activities that marked Transplant Week as we thank those who have selflessly donated organs to help others. Families of donors from our health board area and across Wales were joined by staff from the hospital at the unveiling which commemorates the generosity that over the last six years has enabled us to contribute to 341 life saving transplants across the UK.

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Some of those UHW staff who save lives with their organ donation work.

We have three specialist nurses for organ donation (Susie Cambray, Emma Bennett and Angharad Griffiths) working in the health board. Theirs is a challenging and very sensitive task, working as they do in our critical and intensive care areas, and our emergency department. Their role is to provide support and advice to staff and families to help ensure that every patient at the end of their life is given the opportunity to fulfil their wish to become an organ donor.  The emphasis is to provide families with the current and accurate information they will need to make an informed choice – and the right choice for them. Our team works with the broader clinical team to support families at this difficult time with whichever decision is made.

In Wales, the government has published a Transplant Bill which aims to change our system from opt in to opt out. This is something that has been done in other countries and is driven by a shortage of donor organs across the NHS. Working within this framework we would hope that in the years ahead it might possible to make organ donation a much more normal part of end of life care for the patient’s families.

Standing in the shoes of another can help us to understand things from someone else’s perspective. What would it be like perhaps to be a wife, watching her husband struggle with daily renal dialysis, or a parent of a child with a congenital and potentially fatal heart defect, or a grandmother who is no longer able to see her grandchildren playing in the garden? If we look at things from their perspective it is easy to see what a truly remarkable gift a donor makes.

A reminder about the centrality of family to a sense of who we are and our place in the world, at least for me, was provided a couple of weeks ago when we celebrated together as a family (with one or two important absentees) a 151st birthday. In all around a hundred friends and family came to our home to join in on our special day. My mother-in-law and her husband brought some of their oldest friends, our daughter invited a gang of her friends and my wife asked her best friends to be with her that day. Most of the wider family were there too, as you’d expect.

What was great to see was how well the generations got on together, sharing stories, playing ridiculous games, eating food and the odd (and maybe more) glass of wine or beer. Everyone seemed full of life and it was a really happy day, as judged by the pile of thank you letters, cards and emails we have received subsequently.

Reflecting on that day, I wonder what price I’d pay to ensure that those to whom I’m closest could enjoy another day like that? What would I do if I knew in advance I could help one of them enjoy more such days should some unforeseen circumstance befall me and I could help them? Well I know what I’d want – but I’m not sure everyone around me is as clear about this as I’d like. So in the days ahead I’m just going to gently talk this through so I make my wishes clear. Maybe that’s something we could all do?

Keep well.

PS 151 is a ripe old age but in case you’re wondering no I don’t belong to a family that has someone sitting in the corner with a face like a walnut who can remember Queen Victoria and the advent of electricity. No, the truth is that we were actually celebrating three milestones at once, 80, 50 and 21, which when you add it all up comes to 151.

 

Punk Health Care

After a short break I’m pleased to say I’m now back to these letters. It’s been nice of some of you to say that you’ve noticed I’ve not been writing them over the last few weeks – and that’s helped encourage me to keep finding the time to share my thoughts – thank you.

There’s a lot going on at the moment which is one of the reasons why my letter writing has slipped – but sharing what’s good about what we do still feels just as important as ever.

3654698329_b4e3e862b4_zEvery now and again I catch a song that I haven’t heard for a long time – and just recently I heard Siouxsie and the Banshees’ version of Dear Prudence that took me back to a concert in the eighties in Scarborough of all places. I remember the punk rock revolution arriving and sweeping away all my old listening habits – Deep Purple, Black Sabbath – Uriah Heep anyone? There was something invigorating and fresh about the new wave that assaulted the public, starting for me in the summer of 1977, the Silver Jubilee and all that.

I responded in a teenage way to the Something Better Change atmosphere and it seemed to chime in with an adolescent desire to make the world a different and hopefully better place. There was in retrospect something else too, which over the years since then, I keep returning to. Some people describe me as a very rational person. I certainly believe that to deal with a situation, it is essential to engage with the facts – the world as it really is not the world as we’d like or wish it to be.

So, as I reflect on what it was that resonated so strongly with me when that wave of new, non-pretentious, seemingly spontaneous and explosive music appeared, it was that it somehow swept away all contrivance and pretence – it cut through the thirty minute guitar solos and heaven forbid, drum solos too, and just said it like it was.

Of course as the years pass, this sense of rebelliousness diminishes – but it doesn’t altogether leave, and I must say, to my mind there is something of a parallel to be drawn with another kind of prudence, one that we have all recently heard rather a lot about – prudent health care.

As you probably know, Prudent Healthcare is a new policy idea that has been developed in Wales that might shape how we approach the NHS (and health care across the world) in years to come. At its heart is a simple set of propositions. These are:

 

  • Do no avoidable harm – that is we should aim to make what we do error free, so that it does what it says on the tin. Naturally, we do harm patients, when we operate on them for instance – but if we are to remove the tumour that kind of harm is unavoidable. But if we operate in the wrong area, cause the patient to bleed excessively, over or under medicate, fail to offer thrombo-prophylaxis as we should, or cause the patient to have an infection, then we are creating avoidable harm. A study published in the BMA in 2001 estimated that up to 10% of all health care interventions are associated with avoidable harm.
  • Carry out the minimum appropriate intervention – this is capable of being misunderstood as being to do with depriving the patient of the treatment they need and offering something less as an alternative and I think we need to find a better way to describe what it really means. In fact it is much more to do with working out the most effective treatment that will secure the right outcome, and then making sure it is done properly. There is plenty of evidence that patients are sometimes over treated with no prospect of a good outcome. An example we can all relate to is prescribing antibiotics to a patient who has a heavy cold, where there is no evidence of a bacterial infection.
  • Promote equity between patients and professionals – there is plenty of evidence to suggest that equalising the power relationship between the patient and the professional leads to better outcomes that matter to the patient. It is interesting to observe that some studies suggest that up to 20% of all health care interventions have no impact on outcomes that matter to the patient. For instance, an operation can be judged a success by a professional if it is completed as planned, with no infection, good healing and no complications, but it may not achieve what the patient wanted it to do, perhaps because they misunderstood what was being offered or what the likely functional outcome would be.

Recently health care professionals and scientists (AHPs) in our organisation came together to explore what these propositions meant to them. Seventyfour examples in poster form of best practice were submitted for two awards, Driving Prudent Health Care and Excellence in Practice. That’s an amazing fact – which means that in our health board we have experts in their field who are innovating and leading the development of health care across a very broad spread of patients and conditions.

The Driving Prudent Health Care winners were Samantha Price and Natalie Aitken who are Clinical Lead Specialist Speech and Language Therapists. They demonstrated how they have worked together with local education authorities to develop a joint, integrated pathway for children with speech, language and communication difficulties which effectively organises and filters service users into the right service, which can then provide what they need, but not more than what the need. The outcome they have achieved ensured that accessing the appropriate level of service is easier to achieve, and is delivered with greater consistency and reliability.

Physiotherapists George Oliver and Hilary Hyett  were winners in the Excellence in Practice category, for their work in an evaluation of the musculoskeletal physiotherapy service, which was able to evidence very meaningfully how well this service performs. As their poster says, the feedback was “Very Good. Well Impressed. Well done NHS”.

Congratulations to the winners, but also to all the other staff who contributed to the conference and who are part of our brilliant AHP team who serve so many patients across our community every day. As the man said:

 

Dear Prudence, won’t you come out to play?

Dear Prudence, greet the brand new day

The sun is up, the sky is blue

It’s beautiful and so are you,

Dear Prudence, won’t you come out to play.


Keep Well

Trusted to care

This week saw the publication of a report into care at the Princess of Wales and Neath Port Talbot Hospitals. For all of us who care about the NHS it is terribly sad to hear about situations that have gone wrong, for whatever reason. The Andrews Report, as it is being referred to, is well written, balanced and far-reaching. There are many thought provoking ideas and comments in this report and we all need to have a think about what we can do as a result. Two aspects of the report particularly struck me, although there is much more that is important too. First of all, the report describes situations that staff were witnessing, and understood to be wrong, but were accepting. The report says:

This toleration of lack of care acted for the review team as a diagnostic measure of the culture of care at ABMU.”

I understand that it might seem like a big step to take to speak up or take action. However I want to encourage you to speak up if you are concerned. I promise you that your concerns New Picture (1)will be listened to and where necessary action will be taken in response. I already have a steady stream of people making contact with me and I really find this very helpful and reassuring. The Chair of the Health Board, Maria, also welcomes approaches from staff using our Safety Valve mechanism. The Safety Valve is an idea we had to encourage staff to speak up if they were concerned – as whistle blowing for many people feels like a big step to take. The Safety Valve is a much less formal mechanism and we can agree with you how you’d like your concern to be addressed. Someone said to me once that the standard you are prepared to walk past is the standard you are prepared to accept. I think that’s true, and there is a boundary that we understand is the dividing line between what is acceptable and what isn’t. From my perspective, I can’t put right what I don’t know about – or if you prefer ignorance isn’t bliss. We face many challenges in our Health Board, but we are full of talented, well trained and committed people. I believe we can and are making progress and while there’s a long way to go, with everyone’s help we can continue to build a better service for our patients. For me, the second striking feature of this report is that it opens out another conversation or dialogue that we must also do more to develop – and that is with the public and the people who use our services. The report says:

“The current culture of care of any hospital is defined by what staff and management seem to regard as acceptable along that spectrum. Clearly some of the public, relatives and patients don’t agree with what ABMU hospitals have decided they are able to provide. It would be helpful if the hospitals made their definition more clear and specific and shared that with the public in order to get mutual agreement on what is feasible and can be expected within existing resources.”

This enlightened view is developed in the report and is worth reading for this theme alone. It is a fact that resources are not unlimited and maybe we should now be more explicit about what we think we can deliver at all times, what we aspire to do at all times but may not always achieve and what we cannot promise to do at all. This would then be the starting point for a discussion with the public, and might lead to an agreement being reached about what we should all expect that would help staff and patients alike. I’d be interested to hear what you think about this. As a Board we had already begun to consider what we should do to improve on the conversations we have with the public. We have many ideas in development now and would welcome any suggestions about how we can do more. As I’ve said more than once, I’m worried about the impact that this publicity is having on the confidence of the public. We are thinking through what we are going to do to reassure the public that we have ways and means of identifying problems and responding to them – which I think lies at the heart of developing greater trust. We can’t promise that nothing will ever go wrong – that’s unrealistic. We can promise though to work hard to make things as safe as possible and that when it does go wrong to find out what happened and then work to put it right.

To finish, I’m going to share a letter sent to me this week by a patient called Mr Gareth Jones – who has given me permission to share what he had to say. He writes that he was taken ill in his GP’s surgery and when his GP said ‘Hospital’  “…with all the negative media coverage in Wales I was petrified but too ill to argue.” He continues (the capital letters are his):

 “I SHOULDN’T HAVE HAD A CARE IN THE WORLD, from stepping onto the ambulance to arrival at Llandough, transfer to the wards [I] also spent time in intensive care unit at Llandough and later intensive care and high dependency unit at B7 of the University Hospital of Wales, the care and consideration coupled with the total dedication of the medical and nursing staff was as good, if not better than anywhere in the world. My family and I are totally in your debt forever, From the bottom of my heart THANK YOU”

Thank you Mr Jones for writing to me to let me know about your experience and for allowing me to share it in this letter – I’m really grateful to you and I’m very happy to hear that we were able to help you on this occasion, and I’d like to pass along my thanks and congratulations to everyone involved in you care. Keep well.

Seasons

“For never-resting Time leads Summer on

To hideous Winter and confounds him there;”

William Shakespeare, Sonnet 5

In last week’s letter I shared a story about being a patient myself and talked about how the process of becoming a patient can be so very disempowering even for someone who knows his or her way around. Currently we are sharing our house with my wife’s mum and dad, as my mother in law fell in our garden on Good Friday and fractured her shoulder. We’ve really enjoyed having them around, as they are good company and fortunately they are both in good health, although the fact my mother in law fell and injured herself so badly is obviously a cause for concern. We are very happy that we are able to support them together as she recovers after so many years of supporting us.

It is interesting however to note in the light of her recent fall just how hazardous the world now seems, with potential trip hazards emerging apparently everywhere. Ageing is a complex process and there are many adjustments we all have to make as we get older – while of course remaining the same person we have always been. We have been thinking about the changes we will make as a family to support both sets of parents and indeed our children over the next few years and it is clear that we will have to adapt too.

A book published in 1977 by Daniel Levinson called “The Seasons of a Man’s Life” charts the phases of the lives of American men studied by Levinson. His theory suggests that there are defined stages that (American) men pass through as their life unfolds and there is a distinct pattern to the way this happens. If the title of Levinson’s book seems familiar its probably because it sounds like a quotation that is associated with Thomas More who was the Lord Chancellor of England under Henry VIII, and a film about him called ‘ A Man for All Seasons.’ More was one of the first to use the word ‘integrity’ in the English language, spoke out in defence of free speech, education, and parliamentary government and ultimately was executed for refusing to compromise his conscience. It was a contemporary of More’s called Robert Whittington who said of More that he was a ‘man for all seasons’.

The idea of a life having seasons to it seems particularly apt to me just now.

The slow erosion of a person’s capacity to perform everyday physical tasks and the journey into a season where we are more frail and vulnerable will happen to most of us if we live long enough. I’m really proud of the outstanding work we do in our health board to help people in this period of their lives and I was delighted to hear from Rhian Morse, consultant in geriatric and general medicine recently that some of this great work has been recognised.

The National Continence Awards have selected us for a National (UK) award for the work we do in our Continence Clinic/Service based at the John Pathy Day Hospital at Rookwood Hospital. The service is specifically dedicated to targeting frail older people with incontinence presenting via Intermediate Care Services (Day Hospital/Community Teams/FOPAL) and Chronic Disease Management Clinics (Stroke, Movement Disorders, General Medicine). Improving continence in these groups is challenging but can have a significant impact on health outcomes including hospitalization risks, delaying long term care, falls reduction and general well being. Our service has been set up within current resources with some pump priming and an educational grant from the pharmaceutical industry. The award will be presented at the House Commons.

Well done and congratulations to Rhian and her team – this is just one of the many ways we contribute to improving the lives of old and frail members of our community and I’m very proud to belong to an organization that works so hard to help people as this team so clearly does.

“Then let not Winter’s ragged hand deface
In thee thy summer, ere thou be distill’d:”

William Shakespeare, Sonnet 6

Keep Well

Food for thought

I was queuing up at Boots in UHW the other day, grabbing my usual meal deal as I rushed from one thing to the next, and was doing a little bit of people watching as I waited. The concourse is a real hive of activity, and there are loads of people flowing backwards and forwards or chatting together over a sandwich, a cappuccino or a bottle of water.

ConcourseI really like the hubbub of a busy hospital – I’m probably a bit institutionalised by now – but there is something energising to me about the variety of people all mixed in together – the patients, their relatives along with staff and students.

Being naturally curious I sometimes wonder about who all these people are, what their stories are, what they’re doing and where they’re going next. I like the sense of purpose you feel in health care facilities – the idea that everyone is there for a reason, either to be helped or to help.

There’s also a sense of privilege I feel too, working alongside so many talented, dedicated, passionate and capable people, all of whom are applying themselves to the job of looking after the people who come to see us. It occurred to me as I paid that I very rarely eat my lunch with anyone else, gobbling down my wrap and packet of grapes at my desk or in my car. But then I reminded myself there is one time each month when that’s not what happens.

I look forward to a special meeting each month – one that is quite different to the usual things I go to. This meeting, we refer to as Food for Thought, started happening last year and was prompted by something I’d read – I can’t remember where now. I’d like to share something good that I learnt at this month’s meeting with you in a moment.

Have you ever been a patient? I worked in a hospital in Yorkshire at the start of my career and one of my jobs was to fill the A&E rota with GPs who would work sessions in the department. Each week would start on a Monday with me ringing round to see if I could find doctors to fill the slots. After a while I found a GP who helpfully seemed to have a lot of time on his hands and was able and willing to cover a good proportion of my slots.

Soon I would breeze through this job in no time at all – a quick phone call to him and all would be well. Until one week, when my door was darkened by a towering presence – a Sister, with a ruddy outdoor face at least six foot tall in full sail with a starched hat, cuffs on her sleeves and a belt that hitched in her uniform over her large chest.

In a loud voice she thundered; “Which one of you does the rota for the doctors in A&E?” Timidly I admitted that it was me. “Right lad”, she fixed me with a keen gaze, “I don’t want you sending me Dr. X (my helpful doctor) – he’s too slow, and everything gets backed up round him – we can’t move for patients. Got it?” I submitted that I had caught her drift.

And I did try to avoid using him – but I would weaken and then every few weeks there would be another combustible conversation with the lovely Sister from A&E. Until one week and I fell ill. I was sent up to Occupational Health who took my temperature (104F) and recorded my symptoms (headache, stiff neck) and concluded I should go immediately to A&E. I protested feebly, but they replied that all was well – they had rung down and Sister was waiting for me. On arrival, true enough there she was and I was told to go behind a screen, take all my clothes off and put ‘this’ on – ‘this’ being a gown with no back. “Don’t get off the trolley – I don’t want you wandering round until we know what wrong with you,” she said.

Meekly I complied and then endured several interviews with nurses and various doctors, on each occasion asking if I could have a pee. Each person I spoke to said, if I could just wait a moment until the next job was done, they’d get me a bottle. Finally, I was informed that I was to be admitted – and that they would be taking me up to the ward in a few minutes. By now my need to pass water was (literally) my most pressing problem and on arrival on the ward, and after a short bit of clerking I was finally brought a bottle. I discovered however that the bottles appeared to have been kept in a deep freeze, and despite some increasingly desperate attempts I could not go while lying down.

Eventually, I got out of bed and stood – and finally obtained relief, urinating blissfully into the bottle in a long and loud stream. As I neared completion I glanced round and discovered it was visiting time and that I was standing in an open backed gown, passing water into a bottle in a nightingale ward in full view of visitors and other patients. I tell this story to remind myself that although I don’t regard myself as being particularly non-assertive, becoming a patient can be a very disempowering experience. I  keep this memory alive because it helps me to step into the shoes of those who come to us for care or treatment – and to not lose sight of the fact that it’s often not the technical aspects of care or treatment that trouble our patients most – it’s the small details, the ability to really listen, to show we care, and to offer a simple helping hand.

This leads me back to my special, Food for Thought, meeting and the purpose of my story this week. These are meetings where staff from all levels and areas are randomly selected from the payroll and are then invited to have lunch with me so I can hear about what they do and listen to what its like for them as they work in our organisation. I know people have been nervous about coming to these lunches, but I think we are starting to get the word out that I’m no monster, that they’re not in some kind of trouble and that I’m actually genuinely interested to hear what life is like for them. And I always learn a huge amount.

Last week I met a group of staff, including Joanne Ellis, who is the Operational Team Manager, and who has worked for us for 24 years. Joanne looks after our cleaning staff and the catering team and she reminded me just how important these services are for our patients and how challenging this can be with the tight budgets and staff numbers we have.

She also told me a story, which I shall briefly share. One day she was contacted to say that a patient wanted to complain, and as is her usual practice she found time to pop up to the ward to see the patient. Unfortunately she couldn’t see him there and then so she had to come back later. It turns out that the patient was a Director in a well-known company that has a deserved reputation for the excellence of its customer service. On presenting herself he expressed surprise that she had made the effort to see him, and after listening to his complaint she made arrangements to sort out his issue.

A4 Catering

Joanne Ellis, Operational Team Manager and Lee Taylor, Ward Based Caterer on A4.

They fell into conversation, and he disclosed what he did for a living (Director of Customer Experience) and mentioned that he had a budget of £2.5M for staff to spend to give their customers immediate redress for poor service. He admitted he had expected the worst on being admitted to hospital, and when he was confronted with a member of the catering team who was heavily tattooed, he knew that things were about to take a turn for the worst. However he explained that this young man had confounded his expectations and was in fact the kindest, and most sympathetic individual. Our patient was so impressed he told Joanne that if she didn’t need him, he would be delighted to take him on in his organisation as he’d rarely found someone as clearly committed to customer service as him.

So this week I’d like to congratulate and thank Joanne for keeping the flag flying despite the difficult circumstances she often finds herself in, for acting in the very best way when someone wanted to complain, for remaining positive and for showing her commitment to caring for our patients. And the young man with the tattoos? That’s Lee Taylor, Ward Based Caterer on A4 – well done Lee and thank you, it sounds like you’ve got a bright future ahead of you.

Keep well.

It’s all relative

Have you got your feet on the ground? OK – so you’re presumably sitting down while reading this and you are almost certainly stationary as you do so – I wouldn’t recommend anything else.

unitedstatesonearthHowever, the truth is we are actually flying through space at a mean velocity of 66,000 mph, while at the same time spinning round and round at 1,000 mph – in fact we are spinning so fast that the earth actually bulges at the middle. Meanwhile, the entire solar system is circling around our galaxy at 560,000 mph. It makes those fairground rides seem rather tame. The reason why we don’t experience this as speed that ruffles our hair (or would like it to in my case) is because these velocities are relative – to the sun, the poles and the galaxy respectively.

Relativity is the word of the moment this week, as the Nuffield Trust published its report into the four devolved NHS systems. It is apparently very difficult to draw conclusions say the report’s authors, although there are differences. There are longer waits for some treatments in Wales they say (although the gap is closing) – they also say that England’s nurse staffing ratios are an outlier – that is they are lower than the other devolved systems. Want to bet which of these findings will dominate the news coverage?

We’ve reached the end of another financial year at Cardiff and Vale and it is a moment to step back from the hurly burly and to consider the year that has passed and the year that has just started. I thought it might be useful to put some of our achievements into some kind of context, relative to the rest of Wales – recognising that as the Nuffield Trust found, it is hard to draw conclusions from a relative comparison.

What do we know? Well, we have ended this year with slightly fewer people waiting quite as long for treatment than a year ago. Why is this an achievement? Well in the previous twelve months we had been forced to cancel huge numbers of patients’ operations – more than 3000 – and although in February and March as a result of norovirus closing large amounts of our capacity we had a rougher ride than in previous months, nevertheless the number of cancellations have been significantly fewer – and we have treated all those who weren’t treated last year – all in one year. As of today, the mean waiting time to treatment is 18 weeks for our patients (median 12 weeks) and we expect that to fall in the months ahead.

That’s good, and by this time next year we will be close to eradicating all waits longer than 36 weeks and the year after that we will really eat into this backlog. That’s progress. We also have a plan in the year ahead to dramatically shorten waits for diagnostic tests.

Our performance on most measures has improved – not as much as we’d like – but nevertheless in general there are signs of progress.

We have led the way on making improvements in medicine, particularly inpatient care – and the medicine team has moved their performance from the lowest quartile of UK performance for average length of stay to the top quartile and our mortality indicators have also improved too.

There are many more improvements I could talk about – and many, many challenges ahead – but I wanted to acknowledge and recognise some of what has been done.

These signs of progress are all being delivered against a very interesting backcloth. Here are some facts.

The population in Cardiff and Vale has been growing twice as fast as the rest of Wales, and our child-birth rate is three times higher than the rest of Wales. In a climate where resources are not growing we can expect this to create relatively more demand for services than elsewhere in Wales. We serve 15% of the total Welsh population, but we have 18% of the total population of Wales in the lowest quintile of deprivation – in other words our population has significant levels of deprivation and we know this is associated with higher health care need. Maybe we do have some characteristics that are impacting on us relatively differently.

We have the most intensively used diagnostic plant (MRI, CT scanners and other radiology equipment) in Wales, we have the lowest emergency hospitalisation rate in Wales (we admit the lowest proportion of our population to hospital), the lowest spend on general medical services prescribing and the lowest spend on out of hours services. We have the lowest expenditure on hotel services and maintenance and our historic allocation per head of population is the lowest in Wales (see the table below). I reckon you could argue that much of these data point towards very intensive utilisation and high quality clinical decision making, but also significant pressure.

LHB Non age weighted allocation/head of pop Age weighted allocation/head of pop
Average £1790 £1790
Cardiff and Vale £1611 £1702
Next lowest to C&V £1794 TBC
Highest £1898 £1946

We also deliver 53% of all the research output in Wales, but receive just 47% of the funding.

We have in the last twelve months done the most to save money of all the LHBs and we are the only LHB to have reduced headcount as we do so.

In the year ahead we plan to make some investments into critical care capacity, significantly enlarging our urgent clinical assessment facilities and strengthening our out of hours services. These are all intended to drive up performance, help shorten waiting times and improve the quality of our patient experience.

We are doing this by reinvesting the savings we are making elsewhere – which will be hard won, but it is important to remember that despite all of our challenges no-one is taking money away from us – and if we can make enough savings we will be able to reinvest as these plans demonstrate.

As you can imagine there is a conversation to have about our relative place in the system, and doing so will be much more straightforward if we continue as we are to improve our quality and performance. Despite the challenges we face, we are making progress which is why I’m very proud to say that I work for Cardiff and Vale UHB and it means that I’m looking forward to everything the year ahead holds for us.

Keep well.

A better pill?

This week Chief Executives across the NHS in Wales met at a small informal dinner to say farewell to David Sissling, outgoing Director General for Health and Social Care in Wales. I hesitate to ask what the collective noun for a group of CEOs is – but I’m confident I’ll get lots of suggestions! Over dinner we do as we usually do, swapping stories and sharing our impressions about current issues, and from my point of view attempting to engage everyone in a conversation about the England V Wales rugby match.

Later on as we discussed the NHS, one of my colleagues happened to mention that their car had recently come back from the garage having been repaired after being sprayed with acid. Suddenly everyone was at it – another colleague said that they were receiving threatening calls at home, another colleagues’ children were being bullied in school as a consequence of what they were doing at work, while another was being persecuted by a media organisation about an event which took place long before they were in post. I won’t bore you with what I said, and my purpose here is not to elicit sympathy. We are well paid and experienced people and we fully expect to be held to account for what happens on our watch.

The NHS has come a long way since I first joined it in 1983 – and I for one will never stop speaking up for and defending the ideals of the NHS – and of course there have been disasters along the way – some that are deeply shameful. I worry however about the default switch that now seems to have been thrown – the NHS is in the eyes of much of the media and some commentators an object of scorn, prejudice and anger. And we know that things can and will go wrong – it is in the nature of such a complex undertaking with so many moving parts and people in it that they will.

Recently the English Secretary of State spoke to the NHS in England from Virginia Mason Hospital in the US – a very good hospital run by Gary Kaplan (of Kaplan and Norton fame if you’ve ever read about the ‘Balanced Scorecard’). He talked about wanting to reduce avoidable harm by 50% – and I’m assuming he was doing so from the US as a ‘lesson’ about what could be achieved. In The US, which runs the world’s most expensive health care system and which practices arguably the most defensively because of its extreme litigation culture, a report published in the Journal of Patient Safety states that the numbers of patients in the US who go into hospital and suffer preventable harm that contributes to their death is between 210,000 and 440,000 patients each year, which at the higher end would make this the third leading cause of death in America behind heart disease and cancer.

So what is going on? My personal thinking on to all this was fundamentally changed when I read Fixing Health Care from the Inside, Today, published in 2005 by Stephen J. Spear, who says:

“The problem stems partly from the system’s complexity which creates many opportunities for ambiguity in terms of how an individual’s work should be performed and how the work of many individuals should be successfully co-ordinated into an integrated whole…. [and] from the way health care workers react to ambiguities when they encounter them…they tend to work around problems, meeting patients’ immediate needs but not resolving the ambiguities themselves. As a result people confront “the same problem, every day, for years”…regularly manifested as inefficiencies and irritations – and, occasionally, as catastrophes.”

 

The first LIPS event

The first LIPS event

We are beginning our response to this challenge, (which any interested observer should understand is a world wide, global health care challenge, not something somehow restricted to Wales), this week with the launch of our Leading Improvements in Patient Safety programme (LIPS) which I was privileged to be invited to speak to at the beginning of the week. There are so many possible areas for improvement and I really want to get behind this work and support the people who are hopefully going to start the long road of improvement for our patients and those we serve that lies ahead. I look forward to writing about their achievements in due course.

We are blessed with many who already understand this challenge and have been working to improve our safety for years. One such group is led by Fiona Woods, Director of the Welsh Medicines Information Centre (WMIC). This team, including senior pharmacists Karen Aslan and Gail Woodland have worked really hard to produce the 7th edition of our Good Prescribing Guide, which is an evidence based tool that supports prescribers to make appropriate therapeutic decisions.

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Dave Jones, Fiona Woods and Gail Woodland at the GPG launch.

good prescribing guide cover 2014It’s a an easy to use tool that can be downloaded by using a QR code – and we know that our junior doctors find this particularly helpful and supports them to make timely and safe decisions.

WMIC has a website  which staff and the public can use and is a great example of how we can help to support one another to make the right decisions more consistently and as a result is one of the ways we already have to have to deal with the challenge of complexity and ambiguity.

Keep well.