Getting shielded staff back before winter key priority, says hospital CEO

Norfolk and Norwich University Hospitals Foundation Trust boss Sam Higginson said trusts faced a tricky balancing act of needing to beef up their on-site numbers again to help restore services, but also ensuring staff took a break before winter.

Mr Higginson said: “At the peak we had 1,200 [of the trust’s 9,000 staff] having to work from home or shielding. We are down to about half of that now and anticipate more will come back because of the [recent] relaxation of shielding.

“We have to get a lot of our shielded staff back as quickly as possible. That’s challenging because we need to create covid-secure environments so people feel safe. [But] if you normally work on a ward or in an operating theatre, we really need to try to help these people get back into the building in a safe way.”

He added: “My biggest concern at the moment [however] is how we get people to take a break, take a holiday and take a little bit of time to re-charge [before the winter]. That’s challenging, but it has to be a priority.”

Getting staff back on site represents a challenge across the whole NHS, but because the trust’s workforce is representative of Norfolk’s older than average population, it is “a particular challenge” for NNUH.

The elective challenge – show us the money

The need to get staff back on site has been made even more pressing by NHS England’s “very stretching” phase 3 guidance which included a demand for trusts to deliver 90 per cent of their elective activity for the same period last year by October.

NNUH already had 50,000 patients on its waiting list before the coronavirus outbreak and it predicts this could hit around 80,000 by the end of March 2021 without intervention. Mr Higginson, who took on the role in October 2019, said he supported the targets set out in the phase 3 guidance, but warned the appropriate funding would need to be in place to deliver them.

He said: “The really difficult balancing act is ‘how do we get all of that [elective activity] restarted and prepare for a second wave’? We absolutely have an ambition to deliver [NHSE’s phase 3 targets]… I think it’s right we aim high, but we’ll need the financial envelope to deliver it. That will be a key bit of the conversation.”

That funding envelope will not be known until adeal is finalised between NHS England and the Treasury on the finance arrangements for the rest of the year, which is expected in the coming weeks.

The former NHSE director of strategic finance said his other major priorities to address before winter was rolling out point of care testing so the trust can test for covid at the front door, which needed to be addressed as soon as possible, and the trust’s flu vaccination programme.

From Epic to the digital desert

Mr Higginson joined NNUH from Cambridge University Hospitals FT, where he had been chief operating officer since March 2017. His move meant he transferred from one of the most digitally mature trusts in the NHS, having implemented the Epic electronic patient record, to “the digital desert”.

He said: “Norfolk and Waveney is otherwise known as the digital desert, and the whole covid experience has brought home what a big issue this is. Coming here felt like going back to the 1990s in terms of digital sophistication. We still have a lot of paper records, which are an infection control risk. We can’t easily exchange information regarding to patients…

“We have signed off and agreed an outline business case for an electronic patient record. The clinicians here tell me that this was promised when the NNUH was built in about 2000. The next phase is agreeing a full busines case some time next year for a system which is interoperable across the three trusts [NNUH, Queen Elizabeth Hospital King’s Lynn Trust and James Paget University Hospitals FT] and primary and community care.”

He explained that while the “national attend anywhere has allowed us to get some outpatients up and running remotely, but what we don’t have is the underpinning EPR to bolt it altogether”.

With an EPR a long way off, he said interim solutions were being deployed to support the trust’s digital capabilities and better integrate service. The trust is rolling out a new e-observations system, provided by Web-V, a piece of software developed by Northern Lincolnshire and Goole FT, a project it hopes to have in place before winter.

It is also deploying a electronic document management system, IMMJ Systems, to scan and digitise its existing paper records. The project will be overseen by EDM Group.

Trust targets “good by 2021”

Mr Higginson said he believed the trust, currently rated requires improvement, was on track to deliver on a pledge to get a good rating from the Care Quality Commission, depending on how inspections are restarted.

While much work still needed on the “pockets of cultural issues”, and “all the literature suggests culture change takes three to four years but it does feel like we’ve got some of the building blocks in place and we’re beginning to see those green shoots”.