Some staff at Calderdale and Huddersfield NHS Foundation Trust have questioned an email from the Chief Executive, Owen Williams, where he appears to justify the Strategic Outline Case for “reconfiguring” the NHS and social care on the grounds that a recent survey has shown things need to improve at the Trust.

4 out of 10 staff who completed the survey towards the end of 2013 reported suffering from work-related stress over the last 12 months, and on a scale of one to five, the average staff score for whether they’d recommend the Trust as a place to work or receive treatment was 3.74.

Owen WIlliams’ email to CHFT staff says these survey results told him that things need to improve at the Trust.

A staff member has commented that the Chief Executive is right to be concerned about work-related stress, but doesn’t see that this justifies the Strategic Outline Case. He also  said the Chief Executive was stretching the facts by saying in his email that staff have shaped the Strategic Outline Case. Another staff member has said that staff are afraid to speak out for fear of losing their jobs.

Trust plans to improve staff feelings about work

The Chief Executive’s email to CHFT staff explains that following the survey, the Board of Directors agreed that the Trust would hold more detailed focus groups  on work-related stress, bullying and harassment, and equality. They  would also work with staff to develop ways of improving people’s feelings.

This would appear to take care of the problem, if the Board of Directors’ plan works.

But Owen Williams appears to think that further changes are needed to improve staff feelings about their work and the care they are able to give patients. His email continues,

“How people feel is an important reason why staying the same isn’t really an option. Whilst I accept statistics can always be turned on their head, it’s our own doctors, nurses and therapists that have shaped our Strategic Outline Case as referenced in my previous messages.”

Baffling

Is Owen Williams saying that the statistics in the staff survey can be turned on their head, once the staff start feeling better as the result of improvements flowing from the Board of Director’s actions?

Or is he saying there are lies, damned lies and statistics? – ie statistics can be interpreted to mean whatever anyone wants them to mean?

Either way, what have either of these statements got to do with his assertion that,

“it’s our own doctors, nurses and therapists that have shaped our Strategic Outline Case”?

Stretching the facts

A Trust staff member said,

“While he and the other Directors are quite right to be concerned about the levels of work-related stress, he then links this as a reason why ‘staying the same isn’t an option’.

Yet again there is a reference that it’s our doctors, nurses and therapists who have shaped the service review. This is at best stretching the facts – a small group of senior staff have been directly involved in this review but most staff I know were never asked directly about this. It is also wrong to consider that work-related stress means that such radical change proposals are necessary.”

Another Trust staff member said,

“People are afraid to speak out for fear of losing their jobs.”

Proposed changes -driven from the top down, very quickly

Shadow Secretary of State for Health Andy Burnham described the proposed changes as,

“driven from the top down, very quickly.”

The shape of the Strategic Outline Case appears to have been determined not so much by Calderdale and Huddersfield NHS Foundation Trust staff views, as by the NHS RightCare programme/NHS Commissioning For Value programme. This is also the case with the other NHS and social care reconfigurations that are being imposed – and fought – across England, in the wake of the Health and Social Care Act 2012.

The NHS Right Care programme announces that it’s been designed to meet

“The challenge for the NHS…to get more for less in an era of ‘no more money’”

A downloadable slideshow about the use of the Right Care programme in systemising reform in Calderdale Clinical Commissioning Group is on an NHS Right Care webpage. (Scroll down the page to the heading ‘Commissioning for Value -National Events’, and the Calderdale presentation is third from the bottom of the list of presentations.)

How did CHFT identify staff views on proposed Right Care changes and use them to shape the SOC?

This is the question UCV Plain Speaker asked Owen Williams, in an email that asked him to describe:

• the process CHFT used to identify doctors’, nurses’ and therapists’ views on the future of health and social care in Calderdale and Huddersfield
• the process CHFT used for shaping the SOC so that it embodies these clinical staff views

Caroline Wright, the CHFT External Communications Manager, emailed back:

“I have attached a copy of the Strategic Outline Document which answers all your questions about staff involvement with pages 4, 12 (para 3) and 57 being particularly relevant. You can also rest assured that we will continue to engage with staff at all levels to ensure they are kept fully up to date and are also given the  continuing opportunity to feed in their views at every stage of the way. For example, our night staff colleagues are having special sessions this week led by Owen.”

Here are those “particularly relevant” extracts from the Strategic Outline Case Document (SOC Doc)

SOC Doc p 12 para 3:

At the start of the Review, four care streams were set up looking at: children’s care, long-term care, planned care,
and unplanned care. The care streams engaged local patients, carers, the third sector, public representatives and staff. The findings from this engagement, informed the
development of a number of plans for improvements to the health and social care system. This work also high-lighted a number of themes that impact on all  areas of health and social care and which, between them, have the potential to really transform the way services are delivered, improving people’s outcomes and reducing costs further. The themes identified were: making the most of existing capacity and capability, digitising the health and social care economy, integrated services delivered in the community, integrated commissioning and personalisation, and taking forward the work of the children’s care stream.

 

P 57

9.4 Engagement with Calderdale and Huddersfield Foundation Trust Doctors and Nurses

Over a two week period in November 2013 the Trust directors and senior managers conducted 1:1 interviews with a wide range of consultant doctors and nurses. Interviews were offered to all nurse consultants and lead clinicians and clinical directors in the Trust plus all
consultants in specialties of A/E, MAU, Cardiology, Respiratory and Geriatrics.
These specialties were identified as the ones most likely to change significantly in response to the NCAT
recommendations and the Future Hospital Commission recommendations on the delivery of acute care in hospitals.

There was overwhelming support for the direction of travel proposed. Respondents identified that this proposal would
improve patient experience, they provided examples of
how this would happen such as reducing length of stay and improving early access to senior decision makers through 7
day working. Respondents also described this proposal as providing higher quality, safer care than the current model through greater standardisation, opportunities to improve
recruitment and opportunities to integrate secondary care
further  into the community.

Whilst in support of the direction of travel there were issues raised by doctors and nurses. This included the level of estate development required on one site to facilitate the
model, they wanted to see an analysis of bed numbers, and flagged the requirement to invest in community services,
including consultant workforce in the community to
facilitate the model. Finally they flagged the potential impact on patients’ travel and transport and the need to
address this in the outline business case.

Examples of the comments some of our senior staff provided are shown below.

‘Right care, first time, every time is what we want but from both a medical and patient point of view.’
Sally Anne Wilson A&E Consultant

‘It will improve flexibility and ability to provide extended hours and 7 day working.’
Andrew Hardy, Acute Care Physician

‘More local home based care for people with a long term condition and some acute conditions requiring antibiotic
therapy at home via Out Patient Antibiotic Therapy
service (OPAT) should be expanded.’
Alan Hart Thomas, Respiratory Physician