Attachment 4

Report to the Board of Directors 2020/21

Date of meeting 26 February 2021

Subject Chief Executive’s Report

Report of Chief Executive

Prepared by Ann Filby, Head of Communications and Corporate Affairs

Purpose of report To update on the COVID-19 pandemic, partnership working, staff engagement and national publications, providing additional clarity on issues that may be dealt with in more detail later on the agenda

Previously considered by N/A (Committee/Date)

Board Action Required Approval Discussion

Decision Information X

Assurance

Executive Summary and recommendation(s) The NHS remains at Coronavirus alert level 5 and at the time of writing the country remains in lockdown with a Government announcement due on 22 February with regard to plans for the future. Further detail on the requirements for Trust governance can be found in a separate agenda item.

A significant number of cases of the COVID-19 virus have been seen in the Trust this year. Whilst this is reducing, the numbers remain similar to the peak in April 2020. The priority continues to be provision of care as safely as possible, supporting our staff who have been working in challenging circumstances for almost 12 months, and managing the flow of patients through the hospital and back into the community. Cancer and urgent procedures including diagnostics are taking place. Highlights this month include:  The COVID-19 vaccination programme and the support being provided to our extremely vulnerable patients  Management of services during the bad weather  The new children’s waiting area in the Emergency Department  An update against the objectives of the Communications Strategy approved in November 2020  The latest national updates including publication of the White Paper and proposal for a Health and Social Care Bill.

The Board is asked to note this update.

Strategic Ambition and Board Assurance Framework (BAF) links 1. Deliver the best possible level of safe and effective care X Strategic Ambitions 2. Provide education, support and development for our staff to deliver X excellence in practice and be the employer of choice 3. Effectively manage our financial resources, our estate and our X infrastructure to ensure we are sustainable 4. Actively participate in innovation, research and partnerships to X transform our services

BAF reference(s) N/A

This paper provides assurance against the Trust objective(s) identified X

This paper is to close a gap in control/assurance in relation to the objective(s)

Legal/regulatory Trust’s Provider Licence (regulatory/legislation requirement with Business continuity plans in relation to Level 4 national specific reference where appropriate) incident (Civil Contingencies Act 2004) Coronavirus Act 2020

Impact Equality Impact/risks (Equality Delivery System 2 – EDS2 Nov 2013) Positive Negative Neutral X

Assurance process and frequency of Monthly update to Board of Directors monitoring

Explanation of Board action required: Information: no discussion required. Update to ensure Board has sufficient knowledge on subject matter and to provide assurance on progress Discussion: when seeking Board members’ views, potentially ahead of final course of action being agreed Decision: when being asked to choose between alternative courses of action Approval: positive resolution required, to confirm paper is sufficient to assure the Board in its ongoing monitoring role or to address a gap in control

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Chief Executive’s Report – February 2021

1. COVID-19 pandemic

The Trust continues to manage the pandemic through its existing business continuity processes, as updated by regional/national requirements. The Coronavirus alert level was increased to level 5 on 4 January 2021, with a national lockdown announced on the same day. Tactical and strategic command meetings continue on a daily basis, with the onsite presence of an Executive Director seven days a week.

Whilst the number of inpatients with the virus has reduced, the numbers remain similar to the peak in April 2020. Our staff continue to do their best to support patients in challenging circumstances after almost 12 months. Patients’ safety and a good experience remains our aim with some improvement in the flow of patients from last month. Reports later on the agenda will present the detail.

o Governance and assurance The Trust’s assurance process continues to be reviewed by the Board on a monthly basis, with a separate report for consideration later on the agenda.

o Our patients Visiting arrangements remain under regular review. In the absence of visiting other than for a small number of exceptions, we are continuing to refine our processes to ensure that an agreed family member can receive regular updates from the team caring for their relative.

We have started to provide Covid tests for asymptomatic pregnant women and their partners in the Maternity Service before each appointment in line with national requirements. This uses the lateral flow test. Those arriving for testing are being advised of the arrangements for parking and their route between the testing area and the hospital.

Information for patients has been updated to ensure clarity on what families and friends can deliver to the hospital to make them more comfortable.

A leaflet has been prepared for our staff to support the care they are providing and enhance the wellbeing of our patients. We have also updated our website with a helpful list so they are clear what to expect during their admission.

o Our staff The weekly Chief Executive’s Surgery using Microsoft Teams continues to see excellent staff participation, with over 200 members of staff attending each session.

Staff messages keep our teams up to date on what is happening, Monday to Friday, with out of hours communications provided as necessary. Each briefing is built around a series of key headings, giving staff the latest information ranging from national updates on the response to the pandemic and the rollout of the COVID-19 vaccination programme to the changes to our services in the hospital and staff health and wellbeing.

The use of self-administered ‘lateral flow’ tests has been in place for patient facing staff. This has now been extended to all staff. The benefit of this testing has been demonstrated through a significant number of staff testing positive since this began in November. Those staff displayed no symptoms.

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This process enabled them to isolate, protecting our patients and others and avoiding further impact on Trust services.

We are starting to plan for the spring and the health and wellbeing support offer that our staff will require. This is in recognition of the length of the pandemic, the long hours and dedication they have provided to the organisation and our patients and the support required as we plan for the future. I want to ensure that our teams are involved in discussions on how we move forward with services, and that they have sufficient time to recover before services are reinstated as the number of cases reduces.

o Vaccination roll-out

At the time of writing, 15 million people have had their first dose of the vaccine in England, confirming the NHS ambition for the top priority groups. Additional vaccination centres have opened across Norfolk and Suffolk in recent weeks and the over 70s or those on the Shielded Patients List who have not yet been vaccinated have been asked to make contact with the NHS to arrange this at a Vaccination Centre or community pharmacy-led service by visiting www.nhs.uk/covid- vaccination For those who can’t, they can call 119 free of charge, any time between 7am and 11pm seven days a week. The NHS is also now inviting 65-69 year olds through the National Booking Service with letters going out to individuals.

The staff messages have been used this month as an opportunity to highlight a series of articles focussed on the excellent work of key staff who have helped make the Trust’s contribution to the vaccination programme such a success.

With over 90% of our staff having had the COVID-19 vaccination, I’m a JPUH Covid Fighter pens have been delivered to all areas. These have also been sent to our volunteers with the latest newsletter to staff and volunteers that are at home.

Staff with serious allergies have access to the Oxford AstraZeneca vaccine from colleagues at Norfolk and Suffolk NHS Foundation Trust.

For those vulnerable patients aged 16-64 who have severe/profound learning difficulties and other conditions, separate clinics have been set up to meet their needs.

o Members of Parliament I continue to ensure that our local MPs are kept up to date on the work that we are doing to support our patients.

2. Trust Developments o New Children’s waiting area in the Emergency Department A new waiting area for children and young people opened on Monday 15 February 2021 as part of our improvements to the hospital’s Emergency Department (ED). This means that our children and young people now have their own modern and spacious designated area to wait for treatment, replacing a small area which was no longer fit-for-purpose. We are about to embark on the second phase of the project in the Emergency Department which includes a full refurbishment of the existing adult waiting room, the reception area and constructing a new main entrance to the department.

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3. Captain Sir Tom Moore We were all saddened to see Captain Tom’s death earlier this month. The Trust has benefitted from over £200,000 of NHS Charities Together money which has enabled us to further support staff health and wellbeing. The remaining monies are earmarked for extending counselling for a further year and will also go towards funding further improvements to enhance wellbeing at work.

4. Integration and innovation: working together to improve health and social care for all On 11 February the Department of Health and Social Care published its White Paper. The Board considered the proposals in December and views were submitted. The way forward will be considered over the coming weeks. The detail can be found at this link https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/9 60548/integration-and-innovation-working-together-to-improve-health-and-social-care-for-all-web- version.pdf NHS Providers has provided a summary of the White Paper which can be accessed at this link https://nhsproviders.org/news-blogs/news/white-paper-welcome-but-big-issues-still-to-discuss

5. Trust-wide communications

o Snow and ice Earlier this month an Amber warning for bad weather led to implementation of our existing plans to ensure that our staff were supported to get to work and our patients continued to get the care that they needed. Everyone played their part in managing our services with many examples of kindness and support. Accommodation was arranged for those who would find it difficult to get to and from work, free hot drinks were provided for all and hot meals for night staff.

Thanks go to a 4x4 service set up by our operations team working with the Norfolk and Suffolk Resilience Forums. More than 120 journeys were made to assist staff in getting to work so we could keep our services running. Norfolk Fire and Rescue Service, the team from Rover Rescue, a local farmer and a team of volunteers also played a significant role.

Our Estates team cleared the site and made it as safe as possible for everyone. Ward 12 staff reached a wide audience on social media with the snowman they built for a patient who wanted to see one.

o Communications Strategy 2020/21 The Board approved the revised strategy at its meeting in November 2020, with quarterly updates to be provided. Due to the second wave of the pandemic, and the focus on communicating effectively with our staff and patients/the public, limited progress has been made. This has been discussed with the new Head of Communications and Engagement. The action plan will be finalised prior to them joining the Trust in April for them to consider as they prioritise team resources. A short update is provided against each objective:

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1. Explain and embed the new ‘business as usual’ processes which will underpin services for our patients, recognising the further waves of COVID-19.

a. Due to the second wave of the pandemic, business as usual is not yet in place.

2. Reassure patients and visitors that our hospital will remain as safe as it can be, at all times – and that we are focussing on delivering their care in the most efficient way possible.

a. Undertaken on a regular basis through social media, web content and interviews with local media as part of the management of communications throughout the pandemic. The Head of Communications is part of the Strategic Management Team which enables strategic oversight of all information available and for this to be refined to provide easy to understand bulletins for staff and consistent messaging for the public in line with NHS national requirements in managing the pandemic.

3. Inform and enthuse staff, patients and the public about the Trust’s plans in both the short and long term, ensuring that there are regular opportunities for them to engage and contribute.

a. Not progressed to date due to the second wave of the pandemic. The new Head of Communications and Engagement will lead on development of an engagement plan for HIP2 (a new hospital). They are being kept up to date on progress prior to joining the Trust.

4. Support the further development of our health and wellbeing offer for staff, reassuring them that their welfare is a priority.

a. The Trust’s Communications Manager works closely with the team on Paget’s People listening exercises and engagement, with further plans being prepared for early in the new financial year. Interim internal communications resource now confirmed as permanent to continue communications support across a range of areas including the staff engagement and wellbeing. This resource has enabled information on the existing intranet to be further developed for ease of access.

5. Working across communications and workforce teams, support the effective engagement of staff through development of a new staff intranet.

a. Business case approved by the Hospital Management Board January 2021 with permanent communications resource to support its development. A landing page for the new intranet has been confirmed, with staff communication due during March and an outline implementation plan to be prepared prior to the new Head of Communications’ arrival in April.

6. Acknowledge the hard work of our staff and celebrate their success.

a. Staff acts of kindness and new Trust developments celebrated through daily staff communications, on social media, the Trust website and through local and national media as appropriate. Details of major announcements and developments in the previous month included within this report.

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7. Promote the Trust as an exemplar of innovation, transformation and good governance, to enhance its reputation both internally and externally, as a great place to work.

a. Not progressed to date, whilst recruitment brochure currently being revised by Workforce colleagues with input from Head of Communications.

8. Ensure the Trust’s plans and developments are positioned in the wider context of the health and social care partnership and emerging Integrated Care System in Norfolk and Waveney.

a. The team continues to participate in system meetings and communication, such as the COVID-19 vaccination programme. Communications across the three acute trusts as part of the Norfolk and Waveney Hospitals Group are led by the Norfolk and Norwich University Hospital’s Director of Communications, working with colleagues at the Trust and The Queen Elizabeth Hospital King’s Lynn.

9. Develop the video and digital capabilities of the communications team to meet the requirements of staff and patients in the ‘new normal’.

a. Funding secured to enhance the team’s capability with the latest equipment which represents a considerable upgrade. This will enable loan of equipment to other Trust staff, with training, to support the effective production of film, which has proved highly effective during the pandemic.

o Monthly communications update The media The communications team continues to deal with numerous media enquiries relating to the pandemic, covering a wide range of areas including infection control, vaccinations and nosocomial infections.

The local media is supportive in sharing the public messages from our social media accounts. Last week two interviews were undertaken:

Director of Nursing appeared live on BBC Radio Norfolk and reflected on the number of patients with the virus, the vaccination programme and the importance of patients still visiting the hospital for cancer and urgent appointments. Paul also talked about his immense pride in all our staff who have been working long hours to support patients and our community.

BBC Look East came on site to film outside the Louise Hamilton Centre to see what is believed to be the first COVID-19 vaccination clinic in the area for patients aged 16-64 who have severe/profound learning difficulties and other conditions, which leave them vulnerable. All the patients were from Cohort 6, as defined by the Joint Committee on Vaccination and Immunisation (JCVI). The clinic was being run by our Learning Disability and Autism Liaison Nurse and was set up in a separate room, with its own entrance/exit through the courtyard of the Louise Hamilton Centre. The room is filled with comfortable chairs and sensory toys to create a calming environment for this particular cohort of patients, away from the noise and bustle of the main vaccination centre next door. Interviews took place with three sets of parents/carers as well as one patient, who was filmed receiving the vaccine. All those interviewed were extremely positive about the service offered, the comfort of the environment and the efficiency and the parents/carers all spoke of their relief that their loved one had received the vaccine.

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Social media During the course of the last month, we continued to get positive engagement from our social media activity, particularly Facebook (see chart below).

Top posts during January included:  NHS Nursing Cadets programme launched at the James Paget (posted 4 January – 76,731 reach)  Job vacancies post including HCA, nursing, pharmacy, clinic receptionist and apprentice roles (posted 22 January – 51,217 reach)  Newberry Child Development Centre video tour (posted 29 January – 19,339 reach).

6. National publications The announcements that could impact on Board decision making, or relate to the Trust’s strategic objectives, are set out below. Information in relation to the pandemic is referenced in the COVID- 19 Governance and Assurance report. Significant information has been published with regard to the vaccination. Direct links to information have been provided to Board members:

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Care Quality Commission  Supporting people's care needs after they leave hospital– 20 January 2021 In this month’s COVID-19 Insight report, we share further data on the designated settings scheme for adult social care, and look more closely at data on deaths. The report considers increases in hospital admissions, comparing this with the overall capacity of beds in designated settings and alternative arrangements in each region of England. Designated settings are intended for people who are discharged from hospital with a COVID-positive test who will be moving or going back into a care home setting. The changes in hospital occupancy rates have varied significantly across regions. As levels of infection continue to increase, hospitals will need to access the capacity created by the designated setting scheme, as part of a wider consideration of the support for people leaving hospital care who need social care.

 CQC launch proposals for more flexible and responsive regulation – we want to hear your views – 26 January 2021 The Trust’s draft response is included later on the agenda.

 Joint statement on the use of COVID-19 positive staff in care settings – 27 January 2021 Jointly issued by the Department of Health and Social Care, Public Health England, Care Quality Commission and the Association of Directors of Public Health, this confirms that under no circumstances should staff who have tested positive for Covid-19, regardless of whether they are displaying symptoms or not, work in a care setting until the legally required period of self-isolation has ended. The national guidance is clear on this and applies equally to other periods of required isolation, for example being a household contact and quarantine periods associated with overseas travel.

Department of Health and Social Care

 Designated settings for people discharged to a care home – 25 January 2021 This document provides guidance on delivery of this scheme, for local authorities, clinical commissioning groups (CCGs), care providers and people who use these services. In line with the hospital discharge service guidance, discharges from hospital should follow the principle of ‘Home First’ and only a small proportion of people who are in hospital will be discharged to care homes. It builds on the letters that were sent to Directors of Adult Social Services on 13 October 2020, and 10 November 2020, which instructed local authorities to begin identifying and notifying CQC of local designated accommodation and to work with CQC to assure their compliance.

 Health and Social Care Secretary Matt Hancock on proposals for a Health and Care Bill – 11 February 2021 White paper referred to at paragraph 4.

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NHS Providers

The Board has been provided with links to the latest information and submissions on behalf of NHS organisations, including responding to the pandemic, concerns about the NHS and staff under severe strain.

NHS Employers

 Mental health of frontline staff ‘a national priority’ – 28/1/21 The leaders of 19 mental health organisations have signed a message of solidarity stating that the mental health of frontline staff during COVID-19 ‘must be a national priority’. In an open letter to people working in health, care and education, the chief executives of mental health organisations, including the Samaritans, Mind, and the Mental Health Network, acknowledged the pressures faced by frontline staff and expressed appreciation for the courage, resilience and humanity shown during the pandemic. The letter states that while some organisations have prioritised the wellbeing of staff, it has not been a ‘universal experience’ and stresses the importance of front line workers having access to mental health support. It encourages staff to support their mental wellbeing by using the resources supplied by Our Frontline - a one-to-one support service offering resources, tips and ideas to look after mental health.

As a Trust we have prioritised the support available for our staff with a Staff Engagement and Wellbeing Lead in place. Updates and access to resources have been provided as part of the regular communications. From January 2021 a weekly wellbeing update is circulated, with access to all resources on the Trust’s intranet.

Further work is underway for 2021/22 as highlighted earlier in this report.

 Updated NHS Staff Council statement on annual leave during COVID-19 – 29/1/21 The NHS Staff Council has re-issued guidance to support the management of annual leave during the COVID-19 pandemic. As we come to the end of the annual leave year, and look to the next, it is important that during the ongoing pandemic, staff are supported to take regular annual leave in order to help maintain their health and wellbeing. Where annual leave has been cancelled due to the needs of the service employers will need to ensure that appropriate plans are in place to enable staff to re-book leave as soon as reasonably possible. A clear process is in place for managers to support staff to take the minimum requirement of leave during 2020/21 and ensure that they have sufficient rest. Due to the pandemic, leave can be carried forward into the next financial year. Further updates will be provided to staff due during March for the process to be followed in 2021/22 and 2022/23.  Travel and quarantine update for new UK arrivals – 12/2/21 From 15 February, anyone arriving into England from a country on the banned travel list (also known as the red list) is required to self-isolate in a quarantine hotel for 10 days and undergo additional mandatory COVID-19 testing. These rules also apply to NHS staff, there are no exemptions. The Trust will provide support on a case by case basis should this affect staff from overseas.

Anna Hills Chief Executive

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