March monthnotes from Kettering General Hospital

I intended to write weeknotes when I started as Deputy CDIO at Kettering General Hospital — but now I don’t have a train commute I don’t have a quiet time at the end of the week to write as much (as the estimable Andy Callow does ) and hey — the last calendar month has a been a bit unusual…

So here are my ‘monthnotes’…

Week 1–2nd March — a gentle start!

An induction day at training, sat in a room full of newbies from surgeons to physiotherapists to healthcare assistants to heads of nursing. Great diversity. Highlights of the day included fire training (just think about evacuating a ward full of bed patients), the people, and getting a login and pass on day one!

Then it was to Digital Health Rewired for 2 days — thread of the first leadership day at https://twitter.com/ianroddis/status/1234971239803838466.

And lots of good stuff on day two — a nice talk by Matthew, the CEO of NHSX , drawing attention to his focus on 3 things: information governance, productivity enhancing applications, Digital Aspirant fund

And a great talk by Sarah, the CEO of NHS Digital — just as Coronavirus was becoming real

Nice to feel and see the communities I’ll be working with going forward. It also strengthened my desire to fuse together my old world working in NHSD (and with NHSX), and my new world of the local Trust.

Week 2–9th March — ‘mood starts to change’

First real week on site. Starts normally, meeting people, working out what might be early wins — all the normal ‘first 100 days' thing. Then an innocuous ‘would you join the Silver Team meeting for Coronavirus planning?’ towards the end of the afternoon…

This was the equivalent of 'stuff happening’.

You’ll be proud to hear the following morning I rocked up with my Magic Whiteboard, post-its and sharpies and proceeded to get a whole bunch of clinicians (A&E consultants, ICU consultants, Deputy Medical Directors etc) to put post-its on the wall. Still a work in progress as I failed to get ‘one idea per post-it’, or enforce a ‘capital letters rule’ but it felt different for them — “hey we’re brainstorming” said one…

Week 3–16th March — ‘turning the corner’

A bunch of planning, system wide details being shared, a whole bunch of number crunching, people realising the normal way of doing things wasn’t the way we were working now.

Did some virtual interviewing, sorted out some co-working space.

The virtual interviewing might be worth a blogpost in it’s own right — the kit stood up — it was important to keep recruitment going. Interesting to see people’s different takes on ‘interview outfits’ for the webcam.

Week 4 and 5–23rd and 30th March — stuff gets real

How do you support a hospital to make sure staff don’t get ill, and that the hospital is ready to treat Coronavirus patients? Well, this is what we did…

• We supported numerous ward shifts with kit, but also to make sure the emergency bleeper service (for things like cardiac arrests) knew which services were where
• We kitted out an Incident Management room
• We mobilised a whole heap of things to support remote working — securing 300 laptops (and headsets, and MiFi’s, and Jabra’s), an extra 1,000 VPN licenses, brought forward plans to double our inbound network capacity (for all those VPNs), increased the firewall capacity and bought a new VDI capability
• We supported services to work remotely who never had before — finance, procurement, coding, rota-ing services. Essential kit being ordered and delivered
• And of course we introduced Microsoft Teams — including using it for virtual clinics
• We wrote guidance notes — I shared one here https://drive.google.com/file/d/1FKoBLl-IlDvrob3OD2pK981963bqYwg4/view and I keep meaning to share others…
• We amended ‘standard operating procedures’ in finance and IT (and lots of other places) to suit the immediate need
• And we looked to create ‘virtual ward visits’ to the hospital — using some touchscreen devices we had on site for another purpose (and David Walliker @InsideHealthCIO was super helpful in sharing what they’re doing in OUH)
• And we did it all using a Kanban board and having daily stand-ups, breaking down siloes, encouraging openness, assuming ‘remote first’.
• And we didn’t just do the right thing, we did the things right — considering IG and safeguarding issues as we moved at pace
• And we looked out for each other — IT support engineers going on wards in full PPE — which was probably never part of any ITIL training…
• And we implemented a senior leadership rota — split across 2 teams to reduce the chance of infection and working on a ‘3.5 twelve hour days on' and ‘2.5 days off’ rota — also designed to guard against burnout
• And as well as the above there’s some great ‘BAU’ stuff going on (I claim no credit, other than this is what I’ll be building on and the people I’ll be working with in future)

So after 4 (almost 5) weeks some thoughts

• The NHS is a system — each trust is a ‘machine’ . That machine has payroll, procurement, HR, communications, IT, IG , estates, catering, pathology, microbiology, people doing rotas, housekeepers and porters who make the machine work. Hands on clinicians save live, but they can only do that because the machine around them allows them to
• At NHS Digital I mostly worked with Band 8 staff (starting salary £45k, the only 7s were graduate trainees and ‘admin support’). In the Trust I have met people doing critical roles at Bands 2, 3, 4 and 5. That’s a salary range of £18k to £30k. So next time the bleeper system goes off for a cardiac arrest team, it’s a Band 2 staff making sure that works.
• In quiet times some of us have looked to the future — to consider what the new norm might be. I’m pretty certain now there’s no going back. The NHS can use technology in local trusts at many levels, we can change how we work to be more collaborative and remote first — including for patient engagement. And I think the relationship with suppliers will be changing — NHS led — more open and transparent.
• It’s important to carry on the long-term strategic stuff as well as support the immediate — because as one colleague said “winter’s bad enough, but imagine winter + Covid”. So all the things articulated in the digital strategy (electronic patient records, entering observations on tablets and iPods, doing electronic handover notes and remote MDTs and so much more) make things more efficient, resilient, assured and just better. So of course we may tweak what we’re doing in the next few months, but that’s a change of focus and maybe pace, not stopping.
• I’ve been grateful for the work ex-colleagues in NHS Digital have done — not just NHS.UK and 111 online (which is more about advising the general population) but particularly the teams behind NHS Mail and Microsoft Teams — which have been, and will continue to be — essential tools for Trusts going forward. Well done all. Hope we continue to work closely together.
• There’s some great people at Kettering, they really do care, and many have a huge appetite for change. And working with Andy is great, he has such enthusiasm which is infectious, is a great strategic thinker and is very good at decision making (it’s surprising how many people aren’t). It already feels like I’ve been there years, which is testament to the people who’ve welcomed me in.

It’s going to be an interesting few months ahead, glad I appear to be able to make a contribution to one Trust serving local needs — and helping shape the future NHS.