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 Patient First Bulletin
Issue 7: February 2023
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Key moments on Patient First journey
We are about to begin an exciting new phase of Patient First roll-out that looks different from the first. We have listened to feedback from the teams involved in wave one and have made some changes to the way training and coaching will be delivered so that it is easier to access and we can get more teams on board more quickly.
Also we have a new Breakthrough Objective on Sustainability. My Executive colleague, Chief Financial Officer Alan Davies, spoke about this at the staff briefing on Wednesday 25 January.
Although there are teams who will be focusing on specific areas, helping the Trust reduce its deficit and eliminate waste is something we can all do in our every day work to support this Breakthrough Objective. This is a good time to reflect on whether there are changes you can make in the work that you do that could improve efficiency and help us break even.
I'm also delighted that Sheppey Frailty Unit is now operational. This not only enables us to care for frail patients closer to home but also to reduce our Referral To Treatment (RTT) wait times by releasing additional capacity for elective surgery within our main site, in line with our Breakthrough Objective for Systems and Partnerships. I'm loving reading some of the feedback that the public have given us about this - to me, it says in doing this, we really are putting the patient first.
It's very pleasing also to hear about the amazing achievement by the Neurology team who have made a fantastic effort to reduce wait times, in line with our RTT targets, by using Patient First methodology.
You can read more about all these developments further down in this bulletin. I hope you find it useful and informative. Thank you for your support as we take these big steps forwards on our Patient First journey.
Jayne Black
Chief Executive
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The next phase: Breakthrough Objective Deployment
We are starting conversations now with those colleagues who will be central to the next phase of our Patient First roll-out, known as Breakthrough Objective Deployment (BOD).
There will be a fresh approach to training and coaching, in response to feedback from frontline teams in wave one, which will mean we can get more teams on board quicker.
There will be a condensed offering of classroom-based sessions, focusing on A3 thinking and improvement huddles, which are fundamental tools within Patient First. Teams will attend two sessions and complete some further work flexibly in between, and then they will be ready to work on their Breakthrough Objective after four weeks.
The teams in this phase will focus primarily on three Breakthrough Objectives - our new one on Sustainability (see below), pre-noon discharge and RTT wait times. For more information about our Breakthrough Objectives, see the intranet here: Medway Foundation Trust - Our Breakthrough Objectives.
For future phases of roll-out we are building content to enable a package of classroom and fuller digital learning, to increase accessibility and flexibility of training and coaching even further.
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New Sustainability Breakthrough Objective
We are pleased to announce the launch of our new Breakthrough Objective for Sustainability. Through this, the aim is for departments to reduce their overspend in line with their own agreed budgets, to help the Trust bring down its overall deficit, in line with the Financial Recovery Plan.
Financial stability and sustainability are important elements of any successful organisation, and our Trust is no exception. Through working more efficiently we can deliver better care, more affordably – not only making better use of taxpayers’ money but freeing up money to be re-invested in our services for patients and facilities for staff.
The vision of the Breakthrough Objective is: To return and retain the financial sustainability, and deliver a sustainable breakeven position within the Operating Plan.
The Goal of the Breakthrough Objective is: Within this year, we aim to operate within the allocated budget of c£392 million (breakeven position) for 2022/23.
In the next phase of Patient First deployment five teams will focus their efforts on three keys areas – medical staffing pay, drug expenditure (medicines management) and clinical supplies.
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Medical staffing – The Trust currently overspends on medical staffing and through Patient First methodology we will look at ways to address this issue.
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Drug expenditure – We will aim to optimise medicine usage to reduce drugs expenditure.
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Clinical supplies – We are seeing increasing costs for clinical supplies as a result of increased clinical activity and inflationary cost pressures, and we will find ways to mitigate this.
The Financial Recovery Plan is a Strategic Initiative within Patient First. A Strategic Initiative is a 'must do, can't fail' programme of work to drive forward and support delivery of our True North (which is - 'Patient First.')
Further details about the new Breakthrough Objective were shared in our staff briefing on Wednesday (25 January). If you missed it, you can watch it here: https://youtu.be/Tzkdr_sijSc.
Look out for further updates on how our Sustainability Breakthrough Objective is progressing in the coming weeks.
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Referral to Treatment: A success story from Neurology
We know that Patient First gives our staff the skills, tools and confidence to make small changes that matter most. All colleagues play their part, whether they are out on the wards, in other clinical areas or providing essential support services.
A perfect example of this is a success story from our Neurology Department, where the team has managed to reduce 40-week Referral to Treatment (RTT) waits from 374 patients in August 2022, to two patients in the week beginning 16 January 2023. It is anticipated that there will be no patients who have been waiting for Neurology for 40 weeks or longer by the end of January.
As a reminder, we are prioritising work around reducing the number of patients waiting for their first appointment. The expected waiting time for non-urgent, consultant-led treatments is 18 weeks from the day an appointment is booked through the NHS referral service (or when the hospital receives the referral letter), but since the COVID pandemic our work in this area has slipped.
The remarkable turnaround in Neurology was achieved by:
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Carrying out internally-funded weekend waiting list incentives to help reduce the backlog in patients waiting and Did Not Attend (DNA) rates
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Improving earlier access to external diagnostic services
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Reviewing our discharge policy
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Temporarily adjusting the clinic templates to concentrate on new activity.
This has only been achievable due to the commendable effort from the team, and a successful recruitment campaign leading to the appointment of consultant vacancies.
Elsewhere the Cardiology and Gastroenterology teams have also reported significant improvements in their wait times which have contributed to the overall reduction in patients waiting over 40 weeks across the Unplanned Care Division.
Congratulations and well done to all colleagues involved!
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 Sheppey Frailty Unit - helping us reduce RTT waiting times for elective surgery
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As you may already know, our new Sheppey Frailty Unit at Sheppey Community Hospital in Minster officially opened on Friday 20 January 2023.
This means that we are now able to care for frail patients from Sittingbourne and Sheppey closer to home.
However, the move also frees up an additional 18 beds in Medway Maritime Hospital which will be used to treat more elective patients this winter.
Reducing RTT is an important goal for us under the Systems and Partnership True North Domain. We know that patients are waiting longer than we would like as a result of the pandemic which is why we are prioritising reducing waiting lists under Patient First.
Additional capacity also contributes to our Breakthrough Objective to reduce the length of time that patients referred to us for treatment wait for their first appointment.
Well done to all involved in getting Sheppey Frailty Unit open. We look forward to hearing how it is supporting our True North - Patient First.
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We have been engaging with the public about Sheppey Frailty Unit, here's some of the feedback we received:
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‘Excellent idea and good use of beds to free up space in Medway.
'Easy for family and friends to visit, plenty of parking.'
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‘An excellent idea to fully use the wards in our local hospital.
'This will give patients a feeling of coming home, not being in hospital.'
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'I think this ward being opened will be a great asset to the Island.
For people being treated here, relatives can be with them.'
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Did you know, if we discharge 40 per cent of patients before midday on the day that they are ready to go home, we will free up 25 beds for emergency care patients sooner each day?
This improves flow across the hospital and helps us achieve the national target of treating 95 per cent of patients within four hours of arriving in our Emergency Department (ED).
Discharge earlier in the day means a shorter wait in ED, reduced length of stay in hospital away from family and friends and an overall better experience of care.
We know that freeing up space in hospital has never been more important, and it allows patients who really need access to our ED to receive care in the right place at the right time. We also know that as a system, we are challenged when it comes to discharge, particularly early discharge, due to the provision of step down and social care. However, our top contributors for failed discharge are often things within our gift to influence.
As a reminder, our Patient First improvement system means we focus on fewer, more targeted priorities that can have a big impact quickly, like discharging more patients before midday. With this approach, we can deliver real and lasting change over time.
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