Today’s all staff Q&A was led by Roland Sinker, chief executive.
The recording of the session is available below.
There’s been some discussion on whether the vaccination should be made compulsory for NHS staff, what’s the CUH view on this?
As an organisation our position has been to do all we can to encourage staff to take up the vaccine and where people have decided not to, we’ve reached out to understand what their position is and why.
We’ve stopped short of mandating the vaccine and will continue to monitor the national guidance on that.
Car parking is pressured and is likely to get worse with more builds on site, and the buses aren’t always reliable or are frequently full. What’s the long-term plan to make access to site as easy as possible for staff?
There are plans going on across Cambridge and the county for how access, the environment, affordable housing etc. can all be knitted together. This includes plans for East/ West rail, additional park and ride facilities and plans you may have heard of for a Cambridge metro.
Within that context we have a well worked up plan for access to the Cambridge Biomedical Campus. That will combine flexible working of the kind we’ve seen over the past year, with sustainable ways to get people on and off the campus. Looking ahead there will be more access to public transport and likely more restrictions to people driving on and off the campus.
That doesn’t mean no more parking at all, but it does mean we won’t be building lots more car parks. It’s being well thought through in the context of the wider Cambridge plan but we don’t want to wait too long for that.
What’s your view on the leak from Dr Fauci’s email and do you find it positive that lack of lockdown measures in some US states hasn’t led to an increase in Covid numbers?
Our position at CUH is that we’ll follow the national guidance and steps out of lockdown as directed. In that context, we’re different from pubs and restaurants and other facilities in that we have vulnerable patients and members of staff. We have a different burden and what is happening elsewhere won’t drive what we do here.
What’s the general sense of how we’re performing against our waiting lists?
We’ve managed to restart our elective activity much more quickly than after the first wave and we’re hitting the targets we’re required to in the national operational planning process. We haven’t solved the problem though, as there are very large numbers of patients still waiting for treatment. We’re able to treat the more urgent cases more rapidly than we were but there are many patients waiting a long time. There’s lots more work that needs to be done to address that, we’re making progress though and it’s a similar picture across the country.
We’re opening extra capacity here, T2 a couple of weeks ago and additional beds over the next 6 months that will make us much more resilient to the pressures of winter and allow us to continue activity during any future waves of Covid and recover the waiting list position. We’re also looking to try and get more theatre capacity for the 40-bed unit currently being built across from the Rosie next to car park 2.
Those things together should make a really big difference, not just to our electives, but the treatment of all our other patients too.
Covid has caused a mix up between NHS and private operations, eg. The Nuffield Hospital hosting some NHS patients. Is there a long-term plan for our relationship with the private sector and how that works around things like waiting time initiatives?
The NHS did use the private sector during the last year, both the Nuffield and Spa, to treat a range of patients. I think it’s inevitable that we’ll continue to use some of that independent capacity, as the alternative would be even longer waits for our patients to get treatment.
How will the axing of the A&E targets impact how we run the hospital and how we report?
The 4-hour standard was a tool that actually created some negative incentives across the country and wasn’t nuanced to allow us to treat more critically ill patients more rapidly, the same standard was applied to all patients.
The new standards provide a suite of measures that will hopefully measure performance across the whole system, so the ambulance service, within the emergency department, the hospital and the system as a whole. They should start to show exactly how systems are performing and where we need to focus our efforts to improve things. Across the country we’ve seen a huge rebound of attendances in ED and it’s not entirely clear why that activity has increased quite so rapidly.
As that activity has increased at CUH we have seen the hospital become fuller, so the ability to admit patients into beds has been significantly affected over the last couple of weeks and it has become a lot more challenging.
What’s the current state of planning and development of the integrated care system (ICS) for Cambridge and Peterborough?
We’ve had an STP for a while that was approved as an ICS in April this year. Over the past few months is a continuation of how we’ve been working across the system. We’ve been doing business planning processes, working across system partners with a single ICS response in terms of our recovery plan and our financial plan – we’re expected to be managing within a set financial envelope across the whole system.
So, we’re continuing as we were before but with more emphasis of working as an ICS, collaboratively with our system partners.
In terms of what’s coming up next, there are three big areas of focus:
1. The government published a white paper earlier this year and we’re expecting legislation to be published soon. That will put ICSs on a statutory footing, so at the moment there are collaborations, partnerships and a series of meetings, but the ICS will become a statutory body in much the same way that CCGs are now. As part of that, the CCG won’t exist anymore and that is quite an important change for us.
2. The system for us is the totality of Cambridgeshire and Peterborough, and we sometimes talk about neighbourhoods, primary care networks etc. One of the big questions we have in our ICS at the moment is what are we doing at place level, so what are our integrated care partnership arrangements going to look like – we’ve been working through the south alliance for the last two years or so, and we’d expect those arrangements to develop and become more formal.
3. There’s been a lot of talk nationally about provider collaboratives, so hoe are we working well with other providers across our system, e.g. working with NWAFT to see if we can manage our regional capacity in a smarter way and building on existing relationships across the region for specialised services
What financial measures are we planning to employ to manage our budget, given the current uncertainty of NHS national funding for the second half of the financial year?
We have a degree of certainty for the first half of this year as a system – we’re getting fixed funding that will get us through the first six months and within that we’re getting quite a lot of extra money to cover the costs associated with Covid. Despite that we do have a financial challenge in the first half of the year and we think that will be covered by the new Elective Recovery Fund, which will give organisations additional funding where activity exceeds historical baseline levels, so above a certain percentage.
We think that might see us through the first half of the year, but the challenge is that in the second half of the year, we’re expecting funding to be reduced as Covid prevalence continues to remain low.
So what are we doing? We’ll have increased scrutiny on Covid-related investments at a divisional level. Some will have to stay in place, such as social distancing, but we could remove others as we move into a different operating environment.
We’ll also have a renewed focus on efficiency. Historically we’ve had difficult efficiency targets to reach and in the second half of the year we’re expecting another national drive for higher levels of efficiency to catch up on some of the missed opportunities over the past 12 months. We don’t know what that will look like yet, but we are planning and being cautious on the basis that we may have to deliver additional efficiency savings.
We’ll start work on that in this half of the year, looking to identify potential opportunities and working with divisions, alongside improvement work supported by the IHI.
Where are we with capital that’s been allocated to CUH for phase 1 and phase 2, and how does that compare with where we’ve been historically?
We’ve just opened an additional ward on site, T2, that was funded largely by the capital funding we got. That was about a £15m program but it’s part of a much bigger piece of work involving the potential opening of an additional 40-bed unit and a 60-bed unit that will become available later this calendar year.
We tend to spend around £30m a year on capital investments. Last year it was around £85m on things like the additional surge facilities we’ve put in place, but also the planning work on some of our major projects, such as our cancer and children’s hospitals. We’re expecting this year to continue at a similar level of spend, so more than double what we would usually spend. It’s really exciting though as it’s about securing the future of the organisation.
What is our strategic response for preparing for subsequent waves of Covid? Will there be anything different in our approach in future?
In terms or preparedness we’re keeping a close eye on cases locally and in January we set out a phased approach to 2021.
We’re increasingly focused on recovery alongside the non-elective work, but we need to monitor what’s happening in the community and try to keep our focus on recovery as much as we can, but we also need to make sure we take the time now to learn from what happened after the second wave and build on last year, so if we do need to respond we’re ready.
Over the past few months we’ve been doing a lot of activity to document what happened since March last year. Common themes of learning through a series of after action reviews and CUH reflects have been coming through and we’re interviewing partners on how the experience has been for them and how we’ve worked together through this period.
A few early conclusions:
1. Empowering front-line teams to get on and make the changes that they needed and make sure all the structures we have corporately are focused on that
2. Working with partners and recognising that we’ve benefitted from partnerships and industry, with the university and other regional hospitals, both to help CUH to respond, and also the NHS as a whole to respond well in difficult circumstances.
3. Learning as we go along – at a time of such disruption, learning throughout is key, rather than waiting until after. We’ve done a lot to embed a culture of learning, stepping back and listening intently to those working in services as things were happening. The first CUH Reflects took place very immediately in May 2020 as the first wave of the pandemic started to subside. The results of that then fed into our response to the second wave.
How is the improvement work going to take those themes forward, in particular the empowerment of staff?
The improvement work launched in April with 42 coaches and 22 teams. That’s not just working within the hospital but with our system partners including Royal Papworth and primary care colleagues to really optimise and improve care for our patients both here and outside the hospital.
There’s been a real opportunity to learn how we’ve approached things differently during Covid e.g. using technology and approaching problems differently, and building those things into some of the teams programmes. Also recognising the really important relationships between us and our system partners, working together in the coach programme on how we build that capacity for improvement and thinking more strategically to bring together all the different agencies invested in improvement to talk about that in the system.
How do we work together rather than in isolation, and use improvement methodology, to make the changes we need to across the system.
Our improvement work links partly with the strategic work and how we drive the improvement whilst thinking about finances.
Some of the cases for improvement are really striking e.g. falls is an ongoing area of challenge and one where many of our teams want to look to do things differently. It’s about the quality of care, but also indirectly affects how we use our bed base, so it has an impact of length of stay and therefore on our finances.
Whilst they aren’t the drivers for this work, it has a huge impact on other areas starting with the quality of care, and then if that’s effective, we think about how can we rapidly upscale that work and roll it out in other areas.
Long Covid is also a key area, as it’s a new challenge that needs a system-based approach – we need to approach it from the point of view of the patient, not CUH, and work with all the different agencies involved in that patient’s care.
What is the pandemic wellbeing offer for staff and how will that remain in place and be augmented?
Positive impact on wellbeing is the aim. There’s a menu of things to support people in that and included investment in this is a given. What it looks like changes as it needs to – we listen and learn. You will continue to see things around staff testing and vaccinations, including boosters if they become available, and there’s a host of psychological wellbeing support.
Centrally, we are listening to feedback from the staff survey and CUH Reflects, we’re talking to teams and those who have been supporting teams, to establish what needs to continue and we can do more of, and where there are gaps how we can address them.
Please continue to access the resources available as listed on the staff portal.
We’re working through all the data available to us to ensure that everyone gets the support they need and leadership is also key to monitoring the wellbeing of the teams we know.
The staff networks have been crucial during this time for regular check ins as well as regular monthly meetings. Information from them has been shared with divisional heads of workforce and occupational health to work out how we can best support everyone – continued feedback is essential to that.
What is your view on the vaccine recently being given emergency authorisation for younger people?
The vaccination roll out has been a global effort on a scale never seen before. While other countries have been carrying out studies of the impact on the younger population, in the UK we’re able to take that evidence and data and scrutinise it independently through the MHRA to make our own conclusions. They have deemed it appropriate to give to that population should we as a country choose to do so. The next step is for the JCVI, another independent group, to decide whether that priority group should be added to the roll out programme, and if so, when. They will advise the NHS on implementing it, should they decide that.
At CUH we hold a very strong view that we should be following the science and the data on this, and the recommendations of the MHRA and the JCVI and staying clear of any of the debates we can sometimes see around the vaccines on social media.
That’s also why we’re listening so closely to the members of our staff and small percentage of the local population who are anxious about the vaccine, trying to understand why there’s a challenge and what we can do to alleviate that concern.
When are pay rises likely to happen and what about back pay?
We are expecting an update on what the pay award will be in July. Depending on when that comes through we will process any back pay after that date as early as we reasonably can.