Message for NHS Orkney Staff sent from the Chair and CEO - A year of significant improvement for NHSO

Message for NHS Orkney Staff

Dear Team Orkney,

Re: A year of significant improvement for NHS Orkney – our future is bright

Thank you once again for all of your hard work and focus on delivering outstanding care for our patients and our community over the last year as we have continued to prioritise recovery from the pandemic (including reducing waiting times for our patients wherever possible) and as we have begun our journey of improvement as an organisation.

Over the last 12-months many important foundations have been laid at NHS Orkney to ensure we can deliver much-needed sustainable change and improvement. At the heart of this has been reconnecting with you – Team Orkney – and our local community to build trusted and strengthened relationships. Wider priorities, as we have described consistently, including via Laura’s 100-day report, have included: achieving leadership stability, operational and financial grip and sustainability, recruitment and retention, investing in Team Orkney and setting a clear vision for our future by developing a new Corporate Strategy which will become our ‘compass’ moving forward (see below for more information on this).

We have listened carefully to your feedback, including your frustrations, about what would make your experience of working here a better one – and have started to make changes that address this, including:

• Listening to and acting on staff feedback (and closing the loop)
• Simplifying our systems and processes – instead of making things impossible for you (and overcomplicating things when we simply don’t need to)
• Better involving you in decision-making
• Improving how we communicate with you and keep you informed about what’s happening and decisions we make
• Being honest with you

As we start turning our attention to year 2 of our improvement journey and setting clear priorities for NHS Orkney to achieve in 2024/25 (which we will communicate in April), it’s important that we take a moment to pause and reflect on some of the significant improvements we’ve seen over the last 12-months which is testament to your hard work and focus.

Here’s a summary of the many achievements you have delivered over the last year:

Strategic objective 1 – WORKFORCE

• We now have a substantive Executive Team in place – bringing much needed stability to the organisation after a period of transition, uncertainty, and change
• Thanks to support from the Endowment Fund, we’ve launched a new Value and Recognition Programme in response to your feedback to us – including our new Team Orkney Awards, Long Service Awards and a way of recognising retirements
• We have a much-improved induction for new starters so that we really focus on first impressions and ensure new members of Team Orkney receive a warm welcome so that people’s time at NHS Orkney gets off to the best possible start
• We’ve commissioned and started an Executive and Board Development Programme (funded by Scottish Government) – and this will be expanded to our Senior Leadership Team (SLT) in the coming year so there is a ‘golden thread’ of development
• We completed an initial establishment review and identified a gap between funded establishment and actual establishment, and we are now ensuring that establishment and budgets are better aligned to support managers across the organisation, recognising this is a source of frustration (there is more work to do here which will continue into 2024/25)
• We’ve implemented E-Roster – and continue to support teams across the organisation as we adjust to new ways of working (though there is more to do to maximise its use across the organisation)
• We were presented with the Gold Award for the Defence Employee Recognition Scheme in recognition of the commitment to the Armed Forces. The last time Orkney was awarded this was in 2018, with NHS Orkney the first Health Board to be awarded this accolade
• Our statutory and mandatory training rates are now at the highest ever, with compliance rates between 70-90% for every subject
• Our appraisal rates are improving month on month and have reached 30% compliance

Strategic objective 2 – CULTURE

• We introduced a new Senior Leadership Team in response to your feedback so that we have clinically-led, transparent and faster decision-making in the organisation and we share a summary of every meeting with all staff. Any member of staff can attend and observe SLT at any time
• We also have a new Extended Senior Leadership Team forum which meets at least once a quarter to discuss a range of strategic issues – Extended SLT is our circa 40 most senior leaders at NHS Orkney coming together to share views, thoughts and to maximise engagement
• A minimum of twice a year we are holding Board-Extended Senior Leadership Team to further strengthen relationships between our Board and senior leadership community
• We have completed over 20 Board walkarounds (visits to services and teams from Board members – an Executive Director and Non-Executive) since launching in May 2023 in response to your feedback about the importance of more visible leadership from senior leaders
• We’ve introduced a strengthened rhythm and frequency of communications with you and ways of listening to and responding to your feedback throughout the year – via monthly all staff briefings, CEO fortnightly blogs, regular drop-in sessions with the CEO and more regular updates being shared with all staff to keep you better informed
• We’ve completed training for our Confidential Contacts (members of Team Orkney who support you by signposting you to the help and support you may need – including the whistleblowing process) and have relaunched the ways in which you can speak up and feel heard
• We’ve introduced a new staff ideas scheme to support our ambition to become a continuously-improving organisation – called our Bright Ideas scheme – so that you feel empowered to share and lead improvements locally recognising you know your service and areas for improvement better than anyone else
• We continue to have an unrelenting focus on visible and compassionate leadership and recognise this starts with our Executive Team and Senior Leadership Team who need to role model this

Strategic objective 3 – QUALITY AND SAFETY

• We’ve recruited a new Head of Patient Safety, Quality and Risk to lead this agenda day-to-day
• We’ve refreshed our corporate risk register as part of our ongoing work to strengthen our approach to risk and risk management and mitigation across the organisation (this remains a priority going into 2024/25 with further work to do to ensure risk management is understood and owned at every level of the organisation)
• Doing more to share feedback and learning from complaints and incidents/Significant Adverse Events with all staff via all staff communications and staff briefings (again – more to do in this space)
• We have improvement projects underway in a number of services, led by patients and staff – including in Pain Services, Endoscopy and Physiotherapy – and our new Team Orkney: Improving Together Programme which puts patient safety, quality and experience at its centre so that we continuously improve care and services for our patients and community
• We have done a ‘stock-take’ of all of our Service Level Agreements (SLAs) with other Boards - both clinical and non-clinical – we now know where we start from and the work that needs to take place to improve our governance arrangements re: SLAs. We have agreed new arrangements to tighten up in this area recognising we are reliant on others to ensure our patients receive timely care when this is needed away from Orkney and so we stay on top of these important contracts
• We’ve contributed to a local fragile services review (looking at the picture in the North of Scotland and nationally)
• We have signed-up to Care Opinion, to expand the ways in which patients can share their feedback about their care and our services – and we will continue to promote its use and our learning from feedback to our patients and community

Strategic objective 4 – SYSTEMS AND GOVERNANCE

• Our Integrated Performance Report (IPR) continues to go from strength to strength, with our full IPR going monthly to Board and SLT and relevant chapters of the IPR going to each Board Committee for oversight, scrutiny and assurance. The IPR includes important benchmarking information
• We’ve completed an operational governance review and the second phase of this work is on track to conclude in April, and includes a new policy framework (i.e. process for approving updated and new policies)
• We’re using a new Chair’s Assurance Report template across the organisation as part of our governance to bring consistency and standardisation
• We’re learning from our shortcomings to ensure we improve – including (1) an external review of Data Quality completed by Public Health Scotland and (2) Annual Accounts learning following late submission of this vital document – both have improvement plans that are being overseen via our Audit and Risk Committee
• We’ve introduced a new integrated Improvement Function, led by our Head of Improvement – Debs Crohn – bringing quality, financial, operational, and digital improvement under one umbrella and a new monthly Improvement Board will be introduced in April, which will report to our Finance and Performance Committee
• We have taken a different approach to the development of our 3-year Financial Plan, with strengthened governance, engagement and more transparency with the process via SLT Extended SLT, Finance and Performance Committee and our Board
• We’ve invested in strengthening relationships with our range of external stakeholders and partners – with new informal Executive-to-Executive Team meetings between Orkney Islands Council and NHS Orkney, as well as Health Board to full Council meetings and meetings with local media and politicians so that we can be open and transparent and build stronger relationships, based on trust

Strategic objective 5 – SUSTAINABILITY

• In response to being formally escalated by the Scottish Government as part of the NHS Scotland Support and Intervention Framework as a result of our deteriorating financial position we have seen this as an opportunity to accelerate improvements already underway and to embrace external support and expertise
• We have a new Recovery Director, a new Improvement Programme (and 12 key workstreams in place) as part of our 2024/25 efficiency programme and a new Quality Impact Assessment process wrapped around this to ensure any decisions we make don’t adversely impact on patient safety, quality or staff
• Our 2023/24 Annual Delivery Plan (ADP) which set out our priorities for 2023/24 – aligned to our Plan on a Page - was approved by the Scottish Government and our Board and our 2024/25 ADP has been submitted to Scottish Government after Board approval
• We have improved operational grip and control, with regular waiting list meetings by specialty and better line of sight of our performance via our Integrated Performance Report

As we start this new year, there are a number of areas we really want us to focus on so that we can make the experience of our patients better still. This includes a continued focus on creating a culture built on honesty, teamwork, and respect.

We will develop a new culture and leadership development programme to support managers to create a learning and continuous improvement culture at NHS Orkney, to invest in upskilling Team Orkney, to reduce sickness absence rates and to further improve mandatory training and appraisal rates in the year to come. We will further strengthen our Corporate Teams (including HR, Finance and Digital Teams) which are key to maximising support for our clinical functions and ensure consistency when it comes to applying fairness to our processes, including recruitment processes.

In the coming month we will launch our new Corporate Strategy, refreshed values, vision, and strategic objectives – so we can ensure we have priorities and ambition that align to what matters most to you, our patients, community, and our partners.

And finally – we will continue to invest in building connections and relationships with you, our patients and community – so that we consistently stay in tune with what’s important to you and our community. In other words, we will put people first in all we do.

We look forward to working with you as one Team Orkney to deliver against our Year 2 priorities and building on the progress we have seen over the last 12-months.

For now though, let’s celebrate our many achievements and recognise how far we’ve come in 2023/24. NHS Orkney is going from strength to strength, and we are really looking forward to the year ahead and seeing us progress again so that we further improve safety, care and services for our patients and community and your experience of working here.

We can’t thank you enough for all of your support, hard work and focus over the last year.

Our future is very bright. Take care and big thanks everyone

Meghan and Laura

Chair and CEO