Restarting Path to Excellence - February 2021

It provides a reminder about the reasons for change and how clinical teams had progressed working ideas around key areas of hospital care before the pandemic. 

These key areas are:

• Emergency care and acute medicine 
• Emergency surgery and planned operations 
• Planned care and outpatients 
• Clinical support services 

Many of you have been in involved in developing some ‘working ideas’ for how we can improve hospital services and in February 2019 – exactly two years ago – we shared our working ideas for the future.  Many of you will recall the multiple staff engagement events at the Clarion Hotel in Bolden throughout 2019 to discuss these working ideas. 

We paused work on the Path to Excellence programme in March last year to allow our clinical teams to focus on the operational response.

COVID-19 has increased the pressures on staff and services: 

• The impact of COVID-19 has made these reasons for change even more, not less, urgent than ever before
• Staff health and wellbeing is now even more of a concern for us and we know that the pandemic has increased the pressures on staff even more
• Maintaining safe staffing levels has relied on everyone being flexible both with working patterns and their areas of work and we greatly appreciate the heroic efforts of our teams
• We have seen fantastic teamwork. You have had to adapt quickly to a rapidly changing situation to keep everyone safe
• We have also seen some fundamental changes within our hospitals to help stop the virus spreading 

COVID-19 has changed the way patients access services, many stopped attending emergency care and some did not attend their planned hospital appointments. People were worried about catching the virus. 
National campaigns reminded people that the NHS is there for them and the NHS made changes such as virtual appointments and access to services in local communities. There has been positive feedback about some of the changes made with many patients now happy to have a virtual appointment if it is right for them. 

The national decision to postpone all non-urgent operations has left the NHS with a backlog of patients. We must also meet the ongoing need for strict infection prevention and control measures to manage COVID-19 in hospital. This is vital so that we minimise the ongoing impact on planned services.

We cannot lose focus on the vital quality improvements we still need to make. 

We also cannot delay making some progress.  

Given the ongoing challenge of COVID-19, we must also be realistic.  The scale of service change in Phase Two is huge.  Our clinical teams do not have time to consider everything, at once, during a global pandemic.  

Our clinical teams have prioritised to focus on our ‘working ideas’ for Emergency surgery and planned operations.

This will give us the best chance of supporting staff and managing ongoing COVID-19 pressures.  Most importantly, it will mean we can provide the highest quality of care and timely access to all patients who need an operation.

Our ‘working ideas’ would mean the majority of planned operations taking place on one hospital site.

Emergency operations and some complex operations would take place on the other hospital site. Our ‘working ideas’ for General Surgery and Trauma and Orthopaedics would mean: 

• Emergency operations taking place on the Sunderland Royal Hospital site 
• South Tyneside District Hospital focusing solely on elective ‘planned’ care 
• With some planned care continuing on the Sunderland Royal Hospital site 

Outpatient care would continue on both hospital sites. Outpatient care and diagnostic tests and scans would continue on both hospital sites. We will also need to consider how clinical support services such as physiotherapy and occupational therapy may also need to adapt. 

By organising surgery in this way there are many benefits.  It is a tried and tested model.  Many other parts of the NHS have already done this with great success.  

The benefits are: 

• less cancellations or delays to planned operations for patients 
• protected care pathways supporting infection control 
• improved care pathways for common injuries and conditions leading to better individual care 
• better use of our theatre resources 
• staff have a better experience and improved training opportunities.

COVID-19 is another reason why we need to move forward quickly.  Some patients have already had their operation in a different location to help us safely manage during the pandemic.  We need to proactively plan how we do this in future.  

We do not want to delay our plans for surgical services any further.  This will be vital on the road to recovery from COVID-19.

Pressure on our Emergency Departments and medical wards has not gone away.  However, we need more time to debate and discuss the impact of COVID-19.  Frontline staff do not have time to do this right now.  

Further work will need to take place once the COVID-19 pressures ease.  This will be subject to the same rigorous process, including public consultation, in future.

Many of our ambitions for planned care and outpatients are already becoming reality.  COVID-19 has been a welcome catalyst for these positive changes.  We are now providing more services locally than ever before.  We will always do this where this is safe to do so. This work will now continue as part of business as usual and no longer fall under the Path to Excellence programme. 

Our ambitions for a new Integrated Diagnostic and Imaging Centre have also not gone away.  Increasing our capacity to carry out more tests and scans will be vital to help services recover from the pandemic and reduce waiting lists.

This work has also been on hold during the COVID-19 pandemic but we will also now continue this as part of business as usual and the ongoing need to increase diagnostic capacity.

Over the next few months we will do further work on the ‘working ideas’ for surgical services. We will also consider the impact of COVID-19.  

As we do this, we want to hear the views of staff, patients and stakeholders. We want to know what is important to you to make hospital services better. 

We will develop proposals and we hope to launch a public consultation later in the year.

We would like to hear your views about our plans to focus on developing proposals for changes to the way surgery services are arranged. We would like you to look at our updated draft case for change document (February 2021). 

Please tell us what you think are the important issues you think the Path to Excellent programme should consider by answering the three key questions below.

• How do you think the pandemic has impacted surgical services?
• Has the pandemic changed the way you access NHS surgery services?
• Has the pandemic caused or highlighted any issues with travel and transport to NHS surgery services?
• What inequalities and/or disadvantages have you become aware of during the pandemic? How might these be addressed?
• What else do you think is important to take into account about surgery?
• What other ideas should the programme be considering about surgery?

We are holding a further sessions for staff and will also plan in some regular updates using our Facebook channel if people find this a helpful way to find out more information. 

If you want to read more about the restart of Phase Two you can visit our dedicated staff intranet page. 

• Click here to read the updated Draft Case for Change (February 2021) document
• Click here to view the updated Draft Case for Change (February 2021) presentation 

Please stay involved and give your views – we value your input which is going to be vital to make sure we get things right for the future.  

If you have any questions – you can approach Dr Shaz Wahid or Ceri Bentham at any time or email us at STSFTCommunications@stft.nhs.uk 

• Click here to watch the Path to Excellence Phase Two Restart - Staff Facebook Live session from 10th February 2020.