Today’s 08:27 was led by Roland Sinker, chief executive. The recording of the session is available below.

Secretary of State visit – Ewen Cameron, director of improvement and transformation

  • We hosted the secretary of state for health, Matt Hancock last week.
  • He was making an announcement for government investment in diagnostics particularly for cancer services.
  • We were able to have a good conversation with him on the challenges we have all faced over the last 6 months.
  • He was particularly interested in what we are doing to try and get cancer services up and running.
  • He talked a lot about his view that in the UK we are light on cancer diagnostics and that is something he wants to invest in, accepting that many of the people who go through those services find they do not have cancer.
  • We showcased a couple of developments in the hospital – we showed him the 3D mammography machine, which we recently had funded centrally, and Mr Hancock was interested in how that allows for a much more accurate breast cancer diagnosis.
  • Also, the ability in a single sitting to take people from a scan to a biopsy and diagnosis in a way which previously wouldn’t have been possible, as patients would have had a mammogram, then been put on a waiting list for an MRI, then had a biopsy.
  • He was really impressed with how that removes a difficult and anxiety provoking period for patients.
  • We were also able to show him a project that one of our oncologists have been working on with Microsoft for about a decade. This is a machine learning algorithm that can carry out the first part of radiotherapy planning – traditionally oncologists will sit with planning CT scans and draw around cancers to plan where radiation is targeting.
  • The algorithm allows that to be done in 20-30 seconds, saving substantial amounts of time for the oncologists, and reducing the time from patients being diagnosed to getting to radiotherapy.
  • There was also a session with staff questions where staff told him the challenges faced by social distancing and posed questions about renumeration.
  • He was only here for an hour or so, but we got to show him some of the challenges we are facing and some of the innovative things that are being done at CUH. He spoke to a group of staff who were able to tell him what it is really like on the front line at the moment.

Lorraine Szeremeta, chief nurse

  • I would like to reflect on some of the comments received on the staff Facebook page to say they were unaware the secretary of state was coming.
  • It is always difficult with these visits as we have very short notice ourselves and we are sworn to secrecy for security reasons.
  • What we tried to do when we knew he would give us some time to meet with our staff was to get a group of our staff from across all disciplines and areas of the hospital, across all levels.
  • We wanted to give people the opportunity to ask questions or reflect themselves on how it has felt in the organisation over the past few months.
  • Staff asked some really good questions and Liam Brennan, deputy medical director who also attended the session, was able to raise the challenges we’ve faced with PPE so we were able to raise some of the frustrations we’ve had.
  • It gave us the opportunity to have a conversation.

Liam Brennan, deputy medical director

  • I felt staff raised pertinent but challenging questions.
  • The secretary of state was left with no doubt about the challenges we have had here in Cambridge in managing patients during the pandemic.
  • We raised very directly the issues that we had during the early stages with PPE and maintaining continuity of supply, and he took those on board.

Roland Sinker

  • His visit was focused on cancer and diagnostics but we were able to have a conversation – did you get a sense of what he thinks the next 12-18 months looks like i.e. the balance between providing care for Covid patients vs those without Covid, possible funding settlements etc?

Ewen Cameron

  • I think he recognises that it’s very important we are able to do both of those things – it’s one thing dealing with a surge of Covid but there are substantial knock on effects of not being able to treat other patients, so he recognised this isn’t going to be an easy spell.

Lorraine Szeremeta

  • It was really a reflection on the past few months with an opportunity to show how we are progressing our recovery plans as opposed to what we are looking for in the future.

Roland Sinker

  • We were working extraordinary hard on how we use PPE and making sure we had all the equipment that we needed – did you get the sense that things would be less lumpy in the next few months?

Liam Brennan

  • It is already in the public domain that we have been reliant on PPE from overseas.
  • UK manufacturers and suppliers are going to be coming on stream in the autumn and Matt Hancock said from then onwards we should start to see more of that coming available.

Cohorting and configuration taskforce update – Ewen Cameron

  • We carried out several after action reviews, a benchmarking of our infection control approach, and went through a series of engagement events with specialties and trainees.
  • Over the past few weeks, we’ve been trying to work to describe as a baseline configuration for the bedbase of the organisation to see us through the next 12-18 months but living within the variety of constraints that we have.
  • We are coming to the end of that process and it’s a question of trading off between enough ring-fenced surgical beds to allow us to treat urgent and other patients, whilst also having enough medical beds so that we don’t find ourselves outlying those patients into ring fenced protective areas or have them bedded down in ED overnight.
  • We will then work on how the configuration will change depending on the levels of Covid, flu and norovirus in the hospital.
  • We will also then be able to give staff some more certainty about what the organisation will look like over the next few months.
  • The challenges we will face this winter apart from Covid are that we have now ring-fenced surgical activity within the ATC to protect patients from acquiring Covid in the peri-operative period.

Roland Sinker

  • You have been working on this for a while and it’s been an enormous challenge – you’ve also worked with teams that have come up with innovative ways of doing things or flexibility that’s really impressed you.

Ewen Cameron

  • The biggest change relates to changes within the treatment centre – we focused on protecting patients at all costs from Covid, ring-fencing all elective surgery within a small number of wards.
  • What we learned is that delivering care to groups of patients doesn’t all happen in the operating theatre – it is dependent on multi-disciplinary teams providing that care afterwards, and if you split up the elective and non-elective surgical patients you completely disrupt those multi-disciplinary teams. You are then trading off slightly lower risks of Covid versus significant other quality concerns.
  • A group of doctors, nurses and ops managers quickly came up with a proposal for those patients, to ring-fence both elective and non-elective patients together once they’ve tested negative for Covid – that’s the safest way of managing those groups of patients as we go through this phase.
  • Broadly speaking there are other hospitals much further off their normal levels of activity than we are and there are others ahead of us.
  • We’ve got going reasonably well, but there is definitely more to do and we need to treat as many non-Covid patients as we can over the next phase, as whilst things are quiet at the moment it seems highly likely we will see another increase in Covid activity over the winter.

PPE update – Liam Brennan, deputy medical director

  • Public Health England (PHE) has published updated IPC guidance that includes the use of PPE.
  • This reflects the greater knowledge that we now have about the Covid status of our patients and that is largely due to the enhanced testing capacity we have now, compared to the early stages of the pandemic.
  • The headlines from this new guidance are from known or suspected Covid patients, or those patients for who we do not have their test result confirmed, nothing has significantly changed in the guidance
  • However, for the lower risk patients i.e. those who we have coming in to the organisation who have been tested in advance, who have shielded and are asymptomatic on arrival, and in addition, those patients who are our current inpatients who we are testing on a regular basis, the guidance allows for a de-escalation in some aspects of PPE.
  • This will mostly affect colleagues working in theatres and critical care areas, but other areas too. We have communicated these changes in advance to the leaders in those areas and divisional leadership across the organisation.
  • A link to the guidance is in today’s bulletin and we will be hosting a FB live session on Friday 04 September 13:00-14:00.
  • We are planning to roll it out from today, as colleagues can get used to how it will affect their individual areas of practice.
  • We’re in a very different place now compared to where we were at the height of the pandemic when we had limited testing capacity – now our patients are tested, we know their status, we have a shielding policy in place, our patients are being asked repeatedly about symptoms, and our Epic systems are now able to help us with that, so we are in a much better place to safely manage our patients and safely implement these recommended change.
  • It will be of benefit to our patients, our staff, and the organisation.
  • We have made huge strides in the Covid secure environment measures we have taken – eg. the one-way system in the concourse, and our security teams have done a great job at the entrances to encourage mask wearing.
  • This all adds incrementally to making the organisation safer for everyone.
  • A huge amount of work has been going on over the past few months to get us ready for the next 12-18 months. We are trying to set ourselves up so we can treat as many patients as possible, both Covid and non-Covid, and keep all our staff safe, but we all need to play our part as we go into September and October to make sure we are as well set up as we can be for the winter.

Questions

Is there any work towards improving the Wi-Fi access throughout the Trust, or having Trust computers that you can access microphones and webcams on, so we can all use virtual meetings?

Ewen Cameron – As part of our transition from DXC to Novosco, there will be an upgrade to WiFi on the entire estate – it isn’t a quick job, but it will give us much better capability and all PCs are also being upgraded. It will take some time to get us where we want to be but there is lots being done.