10 minute read
Accelerated digitisation: Sussex Partnership Foundation NHS Trust
by CMI_
Andrew Saunders
The inside story of how Sussex Partnership Foundation NHS Trust met the clinical, digital and leadership challenges of the COVID-19 pandemic
Sam Allen, chief executive of Sussex Partnership Foundation NHS Trust, clearly recalls the moment she realised that a COVID-19 pandemic was about to strike the UK and that it was time to meet the challenge. It was a week or two before lockdown was declared, and she was driving back from a conference in Birmingham, using the time in the car to do some hard thinking.
“I’d stayed overnight with a good friend who works for a global bank. It was obvious that things had really kicked in in terms of business resilience in the banking world. She had been on a call where they’d enacted their business continuity plan. They were splitting their teams in half and they were really very prepared.”
Although the NHS had its own well-established crisis plans, including a detailed response to a flu pandemic, these had not yet been put into action at a national level. “I started thinking, gosh, if this virus really does take hold, how might this affect the patients, families and local communities we serve? And what are the things that could sink us as an organisation? What if we can’t pay our staff? Our payroll team sits in a room together. It was clear that we really needed to get on the front foot.”
Sam Allen
So on her return to HQ in Worthing, Sam brought together her top team and took steps to make sure that the trust would be ahead of the curve. “We took some bold decisions, quickly,” she recalls. “We made an early decision to enable and encourage homeworking and asked teams to develop solutions that would enable them to continue working while minimising their risk of exposure to the virus. We mobilised our Gold Command structure [a key part of the NHS’s strategic response plan for a major incident] and stood up our incident control room. That was a good week before the NHS declared a national Level Four incident. Looking back, I think all those things stood us in good stead.”
Employing around 5,000 people across 120 locations (including hospitals, community centres and clinics), Sussex Partnership Trust is responsible for mental health services for people of all ages across Sussex and some services for children and young people in Hampshire. It works not only within the wider NHS system but also with a range of voluntary and charitable groups to tackle the many issues that contribute to mental health problems. “Good mental health is about having the right care and the right treatment, but it’s also about having somewhere to live and something meaningful to do. It’s much more than hospital and medication,” says Sam.
Although the likely impact of the pandemic wasn’t clear in those early stages, Sam and her team decided on a two-part strategy, enabling them to move quickly and with maximum impact when required. The first step was to establish a small number of very clear goals, and the second was to make sure that every staff member was on board with those goals and kept fully up to date. “We very quickly got into a rhythm around communicating with the organisation to keep everyone up to speed via daily briefings and regular webinars.”
Crisis response
The three strategic goals they set were: to keep patients and their families and carers safe; to keep staff safe; and to make pragmatic and proportionate decisions in a timely way. It was vital to help staff cope with major and unplanned changes in their working patterns while also managing the fear and uncertainty of COVID-19 itself, says Sam. “I don’t have sleepless nights in this job, but I have had a few during the pandemic. This virus has taken a lot of lives and been sad, shocking and scary. We’ve seen its impact on families, and in the health service we’ve seen the impact on staff, especially black, Asian and minority ethnic staff. It’s not just the physical impact – there’s the mental impact to consider too.”
But as every manager knows, the best strategy is worth little without great people and great execution. And Sam is clearly proud of the way that the organisation stepped up to the challenge. Take remote working, a key plank in the goals of keeping staff and patients safe. “When we started, we could support 150 people working from home at once. That was the capacity of our VPN [the virtual private network that provides secure remote connections into the central computer systems]. Within three weeks, we had scaled up that to thousands.”
As the wider NHS went into its COVID-19 incident response, the trust had to reorganise quickly in order to ease pressure on hospital A&E departments, traditionally an important source of crisis mental health support. The trust’s existing mental health helpline was expanded for patients to access services directly, backed up by five 24/7 assessment clinics. “We have managed to keep all our services open, with the exception of our memory clinics for dementia patients. They are paused but we’re working hard on how to get them open again too,” Sam says.
Central to this new way of working was going digital – not only internally but externally too. Patient consultations that would normally be carried out face-to-face were rapidly transferred online wherever possible. “We had a simple vision that was clinically led,” Sam explains. “That any clinician should be able to offer a virtual consultation, and that any patient or their carer should be able to request one.”
The trust’s forward-thinking structure played a big part in making this huge shift possible. “When I was appointed chief executive in 2017, I did a bit of restructuring and created a new role, that of chief digital officer,” Sam says. “So now we have a chief nurse, a chief medical officer, a chief financial officer, a chief operating officer and a chief digital officer.”
Ahead of the curve
Giving digital thinking a place at the boardroom table helped to embed it in the trust’s culture alongside clinical prerogatives. That meant that when called upon to perform such rapid changes, the organisation had both the technical and human capacity to respond. “A lot of my peers would have liked to be able to do this, but they don’t all have the infrastructure and digital leadership,” Sam says. “We’ve got the hardware and we’ve got the data warehouses. We’ve got a clear vision and we’ve got the clinical digital leadership.”
Building bridges between disparate parts of the organisation, especially between management and clinical staff, has been a priority for Sam ever since her first job in the NHS, working with a community mental health team in south-west London. Getting involved with CMI and becoming a Chartered Companion has helped put her on an equal footing with senior clinical colleagues, she says. “I decided to get Chartered Manager status. All of our clinicians are members of professional bodies. We hold them to account and they have codes of conduct. As managers, we don’t have that in the NHS – something which has been the subject of much debate over the years. CMI is my professional body and it’s important to me.”
Sam admits that digital consultations are not suitable in every case and that there is still work to be done around safeguarding. For example, it can be hard to consult virtually with a patient in an abusive relationship if they are doing the call at home, within earshot of their abuser.
But making an online consultation a choice went a long way towards overcoming any misgivings and helped some naturally riskaverse clinical staff realise that sometimes it is worth giving something new a try. “I’ve had clinicians who were really quite anti it saying to me that actually, now they’ve done it, it works really well,” Sam says.
The trust has now undertaken some 16,000 digital consultations on the NHS’s Attend Anywhere online platform since lockdown commenced, the largest number of any trust in the UK. For Sam, it’s a “phenomenal” result.
Although NHS front-line staff have understandably been in the spotlight during the pandemic, Sam says that for many of them suddenly becoming a hero in the eyes of the public was something of a double-edged sword. “The public support and acts of kindness have been amazing and beyond anything we’ve ever experienced before. But heroes are typically superhuman figures who leap in to save the day. Our heroes – the consultants, the porters, the nurses, psychologists and other staff – they are real people with the same vulnerabilities we all have. So it’s one thing putting them on a pedestal, but if they need help they should feel able to ask for it just like anyone else.”
Seizing the opportunity
As the death toll tragically mounted, Sam saw a small bright spot: that the crisis presented a chance for learning. She was determined that the trust wouldn’t miss this one-off opportunity. Traditional organisational boundaries were being overcome by collaboration and teamwork. Changes that would have taken months or years under normal circumstances were happening in days and weeks. And working with other NHS partners and local authorities has been a huge positive.
“The NHS is very hierarchical. This has been a real opportunity, and we’ve seen our clinicians take the floor as organisational leaders. We’ve seen leadership everywhere. I’ve shed tears over the lives that have been saved by the dedication and skill of our teams caring for individuals with mental health issues and learning disabilities. If we can come out of this with flattened hierarchies – clear accountability but more distributed leadership – I think we can achieve a whole lot more.”
To that end, Sam has set up a learning project under the trust’s director of R&D, to capture the key lessons as they come to light, rather than waiting until afterwards, when memories have faded and insights have become blurred. “I want to capture that learning so we can continue to adapt and evolve. We’re going to be living with this virus for some time, so we have to make our response sustainable.”
Long-term issues
Treating the pandemic as a major incident, for example, made a lot of sense but comes freighted with its own issues. “Major incidents are normally over within 24 to 36 hours. Our staff are tired and need the opportunity to reconnect with their families. We can’t just expect them to carry on doing what they’re doing now without that, or without good wraparound support for all the homeworkers. And what does it mean to join an organisation when your team is entirely virtual?”
As well as being a way to get something positive from the pandemic, Sam hopes the project will help the trust prepare for another looming crisis: the anticipated spike in demand for mental health care as the ripples from the initial acute phase spread. “Some of our staff will need support over the coming weeks, as will some of those who have been through ICU and survived. Families and other groups are struggling with the consequences of lockdown. Domestic violence is up 25 per cent, and there’s bereavement and social isolation. There are reports that anxiety and the largest number of depression are on the rise. You can’t just pack away the ventilators and expect everything to return to normal. We’ll be dealing with the psychological impact for years to come.”
