I am delighted to be here as your Chief Executive, especially at such an exciting chapter in our transformation journey.
Since joining the Trust, I have spent time meeting and listening to colleagues from across the Trust. It has been incredibly positive to hear about the fantastic work teams are doing to improve the care and experience of our patients, and the working environment for each other.
This includes digital upgrades, construction work as part of the Hospitals Transformation Programme to create modern healthcare facilities, improvements to increase flow in urgent and emergency care, as well as a determination to create a great place to work for everyone - all of which are featured in this edition.
We are moving into the next phase of our electronic patient record programme, building on all the brilliant work that has been carried out over the last few years. This upgrade of our systems will enable us to access information in the right place at the right time so we can deliver safe, high-quality care for our patients.
The next stage will involve collaborating with our patients, which is so important in shaping our future healthcare services. We will be listening to and working with our patient representatives to introduce a new patient portal so they can view letters and change appointments online. You can read more about this, and our other digital developments, on page 12
On pages 8 and 10, you can see how we will be expanding and modernising our emergency department at Royal Shrewsbury Hospital and how this will improve care for the communities we serve. Thank you for all your patience and support during the building works that are taking place as part of our Hospitals Transformation Programme. Our construction partners are doing everything they can to minimise any impact on colleagues and patients.
We know we have to get it right for everyone using our urgent and emergency care services. We are putting in place interventions as part of our
transformation work and we are seeing steady improvement. Standardised ward processes have been rolled out to increase flow, which will reduce waiting times in our emergency departments - see page 4. I know you all share our Stronger Together ambitions to support a better experience for our patients, so please can I encourage you to get involved. Urgent and emergency care is everyone’s responsibility.
It was encouraging to hear at a recent Board meeting how our new Frailty Assessment Units are having a positive impact on our more vulnerable patients, and reducing the time they are spending in an emergency department. The feedback so far has been positive from both patients and their loved ones, as well as from colleagues.
Finally, it was so inspiring to hear about the research happening in colorectal cancer services. The team is part of an important study to transform the colorectal cancer pathway for patients to reduce waiting times for a diagnosis. You can read more about this work and the difference it will make for our patients on page 6
I recognise that the scale of transformation happening across the Trust is significant, and I am committed to supporting you as we navigate the next few months. Please do get in touch with me or stop me in the corridor, I really do want to hear from you.
Thank you.
Dear colleague,
MESSAGE
Mary Aubrey Getting to Good Programme Director
Fantastic improvement work continues to happen across the organisation and in every division, and this is down to your drive, determination and commitment.
Each week, I hear from teams about the tremendous amount of work going on behind the scenes to improve patient and colleague experience, and how those improvements are being embedded and sustained and making a difference for our patients.
These improvements are part of our overarching Getting to Good programme so we can achieve our vision to provide excellent care for the communities that we serve.
Some of the highlights over the last few weeks include:
• The pilot launch of patient ‘wait to be seen’ times on new digital information screens in our emergency department waiting rooms. We are testing this new service over the next few weeks so we can gather patient and colleague feedback to make it as effective as possible.
• Sustained improvements to paediatric initial assessment and the 4-hour performance within paediatric ED. This was thanks to our teams jointly working within the children and young people area of the department.
• The continued roll-out of the SHOP model across medicine wards. This was underpinned by a peer support programme during August, which involved senior clinicians observing the process taking place on the wards to promote shared learning and engagement.
• Successful delivery of all current milestones in our Quality Strategy project. The project continues to progress, with improvements made across all nine of the Quality priorities, including falls and patient safety.
• Roll-out of an improvement project on deconditioning on Ward 37 in August, led by Therapies focusing on goals for patients empowering both patients and colleagues.
If you have an improvement idea and need support, please contact colleagues in our Improvement Hub. They will help you to use improvement tools to evidence the impact of the changes you are making. To support you to test changes, there are also improvement courses available on LMS. If you would like any information, you can contact sath. improvementhub@nhs.net.
You can also hear directly from the teams who are making the improvements by joining one of our fantastic monthly sharing huddles. They are 30 mins from 12.30pm-1pm each month. They would really value your support and you might get inspiration for improvements in your own areas.
Thank you for everything you are doing.
STRONGER TOGETHER
Our ambition is to ensure that every patient using our services has the highest quality care and experience from the start of their hospital journey to the end.
Through our transformation work we are focused on reducing long waits in our emergency departments, so our patients are in the right environment for their care and are seen in a timely way. This includes initial assessment on arrival.
We have also made a Trust-wide commitment to improve patient flow through our hospitals and wards to support our urgent and emergency care (UEC) colleagues. This cannot be done in isolation and needs colleagues and teams in every division to play their part. This is the focus of our Stronger Together work.
One way we can increase flow is to have effective ward and board rounds. Over the last few weeks, as part of our transformation work, our ward colleagues have been supporting the roll-out of a new standardised ward processes.
Effective rounds are crucial to decision-making care co-ordination and better patient experience. Daily, early morning board rounds enable teams to rapidly assess the progress of every patient and address any delays and obstacles to treatment or discharge.
A second, afternoon board round/huddle is best practice to review progress and avoid further delays in care. This will support increased flow and ensure that beds are available for patients waiting in our emergency departments to be admitted.
The ward round involves a multidisciplinary team, including therapies and pharmacy, and is conducted using the SHOP (Sick, Home, Others, Plan) model.
During the round, led by a Nurse in Charge, the team identifies patients who are ready to go home and what needs to happen to complete their discharge and ensure there are no delays.
It also enables the team to understand why patients are still in hospital and progress next steps of their care. This includes considering alternative pathways, such as the Virtual Ward or Outpatient Parenteral Antimicrobial Therapy (OPAT) to support their care out of hospital.
Donna Hadley, Divisional Director of Nursing, said: “Having standardised ward processes will enable colleagues to work together cohesively to ensure our patients are assessed each day and to complete their discharge if they are ready to go home.
“Thank you to our colleagues who have embraced this new way of working together. We have also been supported by colleagues at Getting it Right First Time to ensure the processes we have put in place are efficient and effective to support high quality care for our patients.”
“It is early days, but we are already seeing positive benefits of the Frailty Assessment Units on our more vulnerable patients who are being cared for in the right environment with the right specialist teams. The feedback from both patients and colleagues has been extremely positive and we will continue to build on this early work.”
Dr Saskia Jones-Perrott, Divisional Medical Director for Medicine and Emergency Care
OUR GETTING TO GOOD IMPROVEMENT
We are continuing to make improvements through our UEC transformation work. This includes the opening of new Frailty Assessment Units (FAU).
The units, based on Ward 28 at RSH and Ward 9 at PRH opened in July and they are already having a positive impact.
Patients who attend our emergency departments or acute medical units are screened by dedicated Frailty teams before being transferred to the new units for comprehensive assessment and care by a specialist clinical team.
Early data shows patients are spending fewer hours in an emergency department after arrival (more than three hours) and on average, 4 days less time in hospital overall. An average of 75% of patients are also going back to their own homes and are less reliant on social care for discharge.
Patient Lily was screened by FAU team in ED and moved to FAU. Here, she sat in a chair, listening to the radio whilst the team initiated comprehensive geriatric assessment in a less delirium-ogenic environment.
Within an hour of being on the unit, Lily was able to sit and to stand on her frame, have a drink and snack and subsequently able to return to her care home with Virtual Ward support.
A new frailty advice line is also now in place for health partners including GPs and nursing homes. They can speak directly to the Trust’s Frailty Team for guidance and support, to help patients avoid an unnecessary hospital visit. This is also being rolled out to ambulance colleagues.
Laura Graham, Divisional Director of Operations for Medicine and Emergency Care, said: “Through the hard work and drive of our emergency and medicine teams we have seen a number of improvements. Our time to time to initial assessment within ED has significantly reduced.
“Our performance when benchmarked nationally has moved from the lower quartile, now sitting at 11% above the national mean. This is a fantastic achievement for the benefit of our patients. We have also seen a reduction in our length of stay
across Medicine, with patients getting home earlier in the day enabling them to settle back into life at home.”
Other improvements include:
• Ringfencing rooms for immuno-compromised patients to ensure a safe environment
• Bookable return slots for patients using our urgent care services to avoid waits in the emergency department
• The trial of ‘wait to be seen’ times on digital information screens in our emergency department patient waiting rooms
• Piloting a dedicated nurse in the emergency department’s waiting room at PRH, focused on observations, pain relief and communication with patients. As a result of this, feedback has shown that patient satisfaction with their waiting room experience has increased from 57% to 71%
Sara Biffen, Acting Chief Operating Officer, said: “There is a huge amount of work going on across the organisation to support improvements in patient experience and waiting times for patients presenting to our emergency departments. It is only through this collective effort that we can achieve the improvements we need to make for patients accessing the Trust’s services.
“We have also been able to reduce our use of escalation areas to care for our patients which is significant. We recognise that this may change as we approach winter, when we are faced with increased pressures and during really challenging weeks, but we are doing all we can to avoid this and minimise the impact it has on our patients.”
Hayley Flavell, Director of Nursing, said: “We know we have much more to do to get it right for every patient, but we are making steady improvements. A huge thank you to our fantastic teams who have been involved in delivering improvements in their areas and for supporting our efforts to increase flow so our patients are receiving the care they need in a timely way.”
Dr Laurence Ginder, Associate Medical Director, explains more about Stronger Together and how you can get involved here
RESEARCH AT THE FOREFRONT
A £1 million study which could revolutionise the colorectal cancer diagnostic pathway in the county, and potentially worldwide, is to be launched at the Community Diagnostic Centre (CDC) in Telford.
The pathway will reduce the amount of time patients are waiting and worrying about a diagnosis. The test, which is being developed as part of the TRIOMIC study, is quick and pain free and aims to significantly reduce the number of patients who require an invasive colonoscopy. It will vastly improve the experience of our patients.
Medical tech company Origin Sciences is providing funding for staffing and capital costs for the development of the new pathway. This will involve three clinic rooms being created at the CDC at Hollinswood House and staff being recruited on secondments.
Patients will be invited to take part in the TRIOMIC trial, through which the new test is being developed.
About 6,000 symptomatic patients from Shropshire, Telford and Wrekin and mid Wales on the Colorectal Urgent Suspected Cancer pathway will be recruited for the year-long study.
The new test, utilising the Oricol device, will collect samples which will then be delivered to industry leading laboratories to detect abnormal cells from cancer and significant polyps.
The project will include colorectal clinical nurse specialists (CNS) and research nurses – with
consultant oversight.
Jon Lacy-Colson, Consultant Colorectal Surgeon, said: “During the trial every patient will get a faceto-face consultation with a Clinical Nurse Specialist at the CDC within five days of being referred by their GP. Every patient will have a gold star consultation.
“The test results will go back to the CNS who will respond in a timely manner. Instead of people being seen for their first appointment at 27 days, they will be seen and the whole thing turned around in 10-13 days. That is a massive improvement in patient experience.”
Mr Lacy-Colson, who is also Chief Investigator for the study, added: “If the new test works, it will absolutely revolutionise the entire colorectal cancer diagnostic pathway, not just in Shropshire and not just in the UK, but potentially worldwide.”
“The trial offers the Trust the chance to be at the forefront of a new exciting development in colorectal cancer diagnosis, both in terms of the model of care by moving the pathway into a CDC rather than competing with space in acute trust, and of a new diagnostic test.”
Jon Lacy-Colson, Consultant Colorectal Surgeon
Colorectal cancer affects 42,000 people a year (one in 17) in the UK and SaTH sees about 350 colorectal cancer cases a year.
Within the current pathway more than 5,000 patients undergo prep and a ‘regular’ colonoscopy and then are discharged with no further action required.
Benefits of the study:
• All patients will have a face-to-face consultation at the CDC and will be referred for the appropriate investigation in a timely manner
• The sample for the new test that is being developed takes less than a minute to collect. The process is pain free, safe, has no side effects, requires no bowel preparation and can be carried out in any clinic
• If the new technology being developed is successful, eight out of 10 patients will know that they haven’t got cancer within five days following the test rather than having a 45-minute colonoscopy requiring full bowel preparation and a separate visit to hospital
• This study will potentially mean that in the
future only those patients who really need to will be referred for a colonoscopy
• Estimated savings of £100,000 per annum
Mr Lacy-Colson said: “We will be creating a standardised assessment pathway. Patients will not be sent inappropriately for tests they are not fit for. The right patient will be sent for the right test and it will enhance the consent process. They will get diagnosis or reassurance earlier.
“For our staff, we’ll have the opportunity that we all want, to assess our patients optimally. There will be a reduction in consultants’ paperwork and we will be able to meet targets and reduce costs.”
He added: “This is such an exciting opportunity for the Trust to be at the cutting-edge of science and provide a gold standard colorectal cancer pathway for every patient.”
The trial received unanimous support from colorectal cancer patients, their friends and families at a Patient and Public Involvement and Engagement (PPIE) event.
IMPROVING CARE FOR EVERYONE
The first phase of works to expand and modernise our Emergency Department at RSH (ED) is well underway.
The development, which is part of the Hospitals Transformation Programme (HTP) will support our patients to be seen faster with shorter stays through the expansion of healthcare facilities. This will support our communities to receive the right care, at the right time.
Construction and reconfiguration are currently taking place within Ward 29 and Ward 30, which are adjacent to the existing ED at RSH. This space is being transformed into much-needed facilities,
providing four larger, purpose-built resuscitation bays and expanded clinical space. The first phase of development is expected to be completed this winter.
The refurbishment works will then take place throughout the ED, in the Clinical Decisions Unit, current Urgent Treatment Centre and Fit to Sit area. The expected completion date for this work is November 2025.
Throughout the works, the ED will remain fully operational for colleagues and patients and the construction team will be working hard to minimise the impact.
The ED refurbishment works form part of the wider HTP build, where ground works and site preparation are currently taking place at RSH near the old Outpatients entrance.
The new ED has been designed to meet current and future needs of the population, and once construction is completed, there will be a modern, enhanced waiting area and vastly improved clinical space.
Alongside this, the development will provide a greatly improved children’s emergency area, which will consist of a larger, separate paediatric waiting area and five additional paediatric assessment rooms.
The plan is to make this area as welcoming and calming as possible, so a focus group was recently held for children and young people to gather their feedback and ideas.
You can watch a flythrough of the new RSH build here.
MEET THE NEW HTP DIVISIONAL TEAM
As the programme has progressed, HTP has recruited Centre Managers for each of the clinical divisions to act as the link between the programme and clinical teams.
The HTP centre managers are:
Surgery, Anaesthetics and Cancer - Divisional Centre Manager, Andrew Evans and Matron, Clare Marsh
Clinical Support Services - Dianne Lloyd, Divisional Centre Manager
Medicine and Emergency Care – Paul Owens, Divisional Centre Manager
Women and Children’s – TBC
Clare has worked as surgical Matron for the last seven years at SaTH. She said: “I am so lucky to have secured this 18 months seconded post to support the SACC division with implementing this
exciting change alongside the HTP team.”
Clare is working with Andrew to ensure surgical colleagues have the right services in the right place at the right time within the HTP clinical model.
Dianne said, “Our services touch every patient who comes into our hospital in one way or another, be that through diagnostic tests, providing them with medication for their recovery to take home, or therapy to enable them to be discharged safely. It is critical that we are involved in designing the way that we will work in our new clinical model across both sites.”
“We currently have two inadequately-sized Emergency Departments, which creates challenges and constraints when providing patient care. The expansion of the ED at RSH will address those challenges and develop the foundations to improve care for everyone, through clinically sustainable services.
“The development will support patient flow through the emergency department, making sure patients get to the right specialist clinician quicker to continue their care, reducing both patient waiting and ambulance handover times.”
Dr Ed Rysdale, Emergency Medicine Consultant and HTP Clinical Lead
NEXT STEPS ON OUR DIGITAL JOURNEY
The second phase of our exciting electronic patient record programme, which will transform how we deliver patient care, is being rolled out.
It will build on the fantastic work already done, implementing new systems that will provide innovative ways of working and access to information in the right place at the right time. This will help us to deliver safe and high-quality patient care.
The first phase of our digital upgrade started in 2020, focusing the foundations for our electronic patient record. Projects in phase one included:
• CareFlow PAS
• CareFlow ED (including an electronic CAS card)
• Badgernet Maternity
• Bluespier Theatre Management
• Vitals Upgrades
• ICNET
The introduction of these systems has already seen large-scale transformation within the Trust. We now have an integrated theatre management and patient administration system, we have standardised management of patient pathways with the introduction of referral to treatment (RTT) codes and real time coding has reduced delays in discharging patients from the emergency department.
These benefits will support improvements such as increased patient flow and the timely tracking and validation of patient pathways.
The next phase will see the introduction of systems that interlink and build on the foundations of phase one. The aim is to provide aligned and centralised patient information, allowing clinical colleagues to focus on patient care.
DIGITAL TRANSFORMATION AND ELECTRONIC PATIENT RECORD: WHAT’S THE DIFFERENCE?
Electronic patient record programme is part of the Trust’s overarching digital transformation and strategy, which strives to improve the quality, safety and experience of care for our patients.
Electronic Patient Record (EPR) Programme
A group of combined projects that combine to create a platform for patient information, providing the right information to the right people at the right time. This includes the Patient Administration System, Order Comms, Vitals and Bluespier.
Digital Transformation
In additon to EPR programme, digital tranformation encompasses a wide variety of projects. These range from enabling projects such as the network refresh, WiFi upgrades and software roll-out, to departmental systems such as the introduction of systems that have been developed “in-house”, such as the SAU whiteboard. There are currently 160 digital initiatives and projects on the digital transformation worklist. A new process has been developed to facilitate easier requesting of digital support and to provide improved governance and management of projects, you can read more about this on the intranet
OF THE PROGRAMME INCLUDES PROJECTS SUCH AS: PHASE TWO
Upgrades to CareFlow PAS, CareFlow ED and Bluespier
Patient Engagement Portal (DrDoctor)
We will be working with patient representatives to introduce a patient portal in a phased approach. The portal will allow patients to view their letters online, manage and rebook appointments and be sent broadcast messages. The patient portal will enable information to be available for those with language, visual or hearing needs – empowering patients with online access to medical records. It will enable better management of caseload through reduced DNAs (Did Not Attend) and enhances the quality of care we provide to our patients.
CareFlow Connect
Order Comms and Results Reporting
tQuest and Review will be replaced by ICE. This is a major project and will involve a phased introduction of Radiology and Pathology test ordering for all clinical colleagues in the Trust, and primary care. Results will be shared through the patient’s record in CareFlow, creating a more holistic view of the patient record in one place, saving time and resource.
SUPPORTING OUR PATIENTS
Our priority is to deliver high quality, compassionate care to every patient who needs us, and we have been making improvements for those who may need additional support when using our services.
We have services in place to support and help patients with a learning disability or neurodiversity, ensuring they are listened to so their needs can be met better. Acute liaison nurses are available to support the needs of adults with a learning disability, as well as to help colleagues to better understand these needs. They help with appointment scheduling and can also be present during the consultation.
Patients are encouraged to bring their patient passports with them when they attend their appointments. The passport is a tool designed to enable patients to get involved in decisions about their own care, and to improve patient safety.
The patient passport contains information about healthcare, their learning disability and how best to communicate with them in a hospital setting. They can be used for both planned appointments and also in an emergency.
Acute liaison nurses provide training sessions and reinforce the importance of patient passports as a tool to support patients requiring reasonable adjustments.
An example of positive feedback received includes a patient who identifies as neurodiverse, who recently had a surgical procedure: “[the staff] took particular note to understand my difficulties within the hospital environment and ensured that plans were adhered to, keeping my best interests at the centre. This for me is a big thing, it’s difficult to explain my neurodiversity and the importance of calm, quiet spaces when I am heightened. I felt heard.”
We have also rolled out the use of the sunflower lanyard which is a widely recognised tool used to communicate a hidden disability. This will ensure that adequate support is given to our patients who may need it.
The sunflower lanyard encourages our staff to explore if extra assistance is needed.
Describing this initiative, Ruth said “The Hidden Disability Sunflower Lanyard provides a visual prompt, enabling staff to recognise that the wearer may require help finding their way within the hospital or to an appointment, the use of reasonable adjustments, such as additional assistance or a little more time. If you see someone wearing a sunflower lanyard, please offer support when needed.”
The lanyards are available for free to patients and can be collected from the Treatment Centre RSH, and also at the Outpatient Reception or Women and Children’s Reception, PRH.
There are other examples of actions that have been taken to improve the care of patients with additional needs which include establishing a Learning Disability and Autism Patient Experience Group, enabling staff and members of the community to work collaboratively to support improvements. Patients have access to easyread information on the Trust website, making it more accessible. Also, the Trust is recruiting into a Learning Disability and Autism Lead position to drive this forward.
As part of Neurodiversity Awareness Week, colleagues were able to experience an immersive, hands-on training session on an autism reality experience bus. It was designed to give a virtual experience of the sensory processing difficulties experienced by people living with autism. The practical experience gave them greater understanding and insight into an autistic person’s perspective of their environment.
“Identifying and supporting people with hidden disabilities in a healthcare environment is crucial because these individuals may face unique challenges that are not immediately visible but can significantly impact their health and wellbeing. Hidden disabilities, such as a sensory loss, chronic pain, mental health conditions, autism or learning difficulties, can affect communication, understanding, and the ability to access care effectively. Without proper identification and tailored support, these individuals may not receive the necessary adjustments, impacting upon their care, resulting in increased stress and poorer health outcomes.
“Recognising and supporting hidden disabilities fosters an inclusive healthcare environment, ensuring that all patients receive compassionate, personalised care that addresses their specific needs, promotes better overall health, and an improved experience of care.”
Ruth Smith, Patient Experience Lead
CASE STUDY: DIGITAL ACCESSIBILITY
A host of computer applications are now available to support colleagues with neurodiversity.
The digital services team recently rolled out a new suite of products to support the needs of colleagues, ensuring the organisation becomes more digitally inclusive.
John Cunningham, Head of Digital Service Delivery, said: “It became apparent quite quickly, through the People Advisory Team, that there was a gap and we needed a corporately agreed suite of applications to be available as part of the recruitment onboarding process, as well as for existing colleagues.”
A task and finish group involved colleagues from multiple areas contributed in the project, including digital services, recruitment, workforce and information governance. The group reviewed and recommended a number of globally recognised applications that support neurodiversity to be made available to colleagues. These include;
• CaptionED: a live captioning and note-taking software tool
• Dragon Naturally Speaking: speech recognition software to dictate audio into typed text
• Global AutoCorrect: advanced spell-checking tool that will intelligently analyse sound patters to understand what the user is trying to spell
• TextHelp Read and Write: an effective, multisensory speech to text software that works by reading text out loud, as well as tracking whilst reading
Sabeena Khanna, Assistant Director of People Advisory Service, said “It was good to work with various teams to achieve such an important element of support our neurodivergent colleagues require in the workplace. We now have available digital packages which should make access easier and quicker.”
To review the applications, visit the IT self-service portal and select the Neurodiversity Support tile. Please also liaise with your line manager. If there are specific applications you require which are not on the list to select, please log an IT request via the IT self-service portal.
“Digital inclusion is so important. We need to ensure that our colleagues have the appropriate applications to support them in their day-to-day work environment.
“We will continue to work with key committees and neurodiversity focus groups across the organisation. Digital team needs to be involved and listen to staff member experiences to further understand challenges we may not be aware of. This will ensure the digital services team continues to support the diverse needs of neurodivergent colleagues and fosters a digital inclusive environment.”
