In my role as Assistant Chief Executive Officer at Nottingham University Hospitals (NUH), I primarily work to support the key priorities of the Trust alongside our Executive team. My background as Director of Improvement and Integration supports this and provides a broader context to change and transformation at an organisational level.

I have the privilege of sitting on the East Midlands AHSN board on behalf of my CEO, Tracy Taylor. This is important to us as it allows us to support the incredible work of the AHSN. It’s also a great opportunity to identify opportunities to innovate via the work of the AHSNs as well as provide the perspective of an acute trust, so the AHSN can learn from our views in order to form their direction, delivery and strategy.

Working as a collective

A strong focus of my role is working with external partners across health and social care and with wider agencies and organisations, together contributing to the health outcomes of our communities. For example this includes (but is not limited to) working with our Integrated Care System (ICS), Clinical Commissioning Group (CCG), Integrated Care Partnership (ICP), our local universities, local authorities and other partners such as charities.

By bringing the right partners together for the right topic, we are able to get better results for overall health outcomes – contributing in the most holistic way to the population we serve.

Examples of effective partnership working during COVID-19

Across Nottinghamshire, we had already built a strong foundation of working as a collective across all agencies that support health outcomes. During COVID-19, there were some great examples where this really came in to play and where health and care outcomes were the driving force for collaboration. Some examples include:

• Patient safety support – Ensuring the best possible levels of patient safety has been critical. Rather than concentrate on that internally as a Trust, we have drawn on external partners (such as the AHSN and Patient Safety Collaborative) to undertake COVID-19-specific patient safety initiatives – broadening the potential impacts.
• Safely discharging patients to non-hospital settings – An initial challenge that we had at NUH was the amount of people that had required hospital care but were still residing in hospital when no longer needed a hospital level of care. Being a patient in hospital during the pandemic has inherent risks and we also needed those beds to care for more poorly patients. A huge amount of work was undertaken by partners across local authorities, community care and the Trust in order to safely discharge these patients and continue their care in an alternative setting.
• Supporting the homeless community – During the first wave of the pandemic, there was an initiative to support all homeless individuals to be helped off the street. In Nottingham City ICP, the effort went above and beyond this and looked to provide wrap around care for these individuals, not just solving the immediate problem but working to improve their long-term health and situation. This was a striking example of bringing partners across the system together to reach a common goal and the life-changing impact this can have for individuals.
• Working with academic partners – At the start of the pandemic, the University of Nottingham reached out to offer support to the Trust, offering to help in any way they could. NUH and UoN each nominated a lead, and set up an arrangement where we could readily and quickly draw on the University for almost every type of support imaginable!

A foundation for change

We were in a position where we had strong foundations for these collaborations, which made operationalising projects easier during the pandemic.

More generally, transformation and change has been made possible during COVID-19 because people have shifted their perspective of risk.

Normally in health and care, we see the risks of change as well as the benefits. There is a status quo which is hard to move away from. However, during the pandemic, the status quo became a much riskier place to remain. This change in risk balance markedly altered people’s actions and freed people up to make decisions. There were also other enabling factors such as funding which was made available and relaxed regulations for some areas. There was a real collective focus and we were not inhibited to make changes to respond to the situation.

The journey forward

I have been involved in many conversations about locking in these changes and how we hold on to this new way of working. It’s important for us to think about how we create these shared priorities and maintain this sense of freedom. We need to broaden the parameters and give people the permission to innovate – health and care staff and the public are innovative and resilient and come up with brilliant ideas when they feel empowered to do so.

Whilst the pandemic has had horrendous and tragic impacts on individuals, families and communities it has also resulted in people and organisations undertaking more radical and transformation change than previously. When you’ve done it once, it is easier next time. However, there are tens of thousands of people across our county (and across the country) who won’t have been involved or felt that they are in a position to make change happen. We need to genuinely empower people to challenge the status quo, make hard decisions and take risks. This will allow us to move forward with the current consciousness that we need to innovate and take risks in order to make holistic, sustainable improvements.

Author 

Tim Guyler, Assistant Chief Executive Officer Nottingham University Hospitals NHS Trust